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      Epidemiology of mental disorders in children and adolescents Translated title: Epidemiología de los trastornos mentales en niños y adolescentes Translated title: Épidémiologie des troubles mentaux chez l'enfant et l'adolescent

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          Abstract

          This article provides a review of the magnitude of mental disorders in children and adolescents from recent community surveys across the world. Although there is substantial variation in the results depending upon the methodological characteristics of the studies, the findings converge in demonstrating that approximately one fourth of youth experience a mental disorder during the past year, and about one third across their lifetimes. Anxiety disorders are the most frequent conditions in children, followed by behavior disorders, mood disorders, and substance use disorders. Fewer than half of youth with current mental disorders receive mental health specialty treatment. However, those with the most severe disorders tend to receive mental health services. Current issues that are now being identified in the field of child psychiatric epidemiology include: refinement of classification and assessment, inclusion of young children in epidemiologic surveys, integration of child and adult psychiatric epidemiology, and evaluation of both mental and physical disorders in children.

          Translated abstract

          Este artículo entrega una externa revisión acerca de la magnitud de los trastornos mentales en niños y adolescentes a partir de investigaciones en la comunidad realizadas en diversas partes del mundo. Aunque existen diferencias considerables en los resultados de acuerdo con las características metodológicas de los estudios, los hallazgos demuestran que aproximadamente la cuarta parte de los jóvenes sufre algún trastorno mental en el último año y cerca de la mitad lo presenta a lo largo de la vida. Los trastornos de ansiedad son las condiciones más frecuentes en los niños, seguidos por los trastornos de conducta, los trastornos del ánimo y los trastornos por el uso de sustancias. Las variaciones en la frecuencia de la magnitud de los trastornos de la niñez a través del mundo se pueden atribuir a factores metodológicos y también a válidas diferencias culturales. Menos de la mitad de los jóvenes con trastornos mentales actuates reciben tratamientos especializados de salud mental. Sin embargo, son aquéllos con los trastornos más graves los que tienden a recibir los servicios de salud mental. Los últimos temas que en la actualidad están siendo ideniificados en el campo de la epidemiología psiquiátrica infantil incluyen: precisión en la clasificación y evaluación, inclusión de niños de menor edad en las investigaciones epidemiológicas, integración de la epidemiología psiquiátrica de niños y adultos, y la evaluación tanto de los trastornos fisicos como mentales en los niños.

          Translated abstract

          Cet article propose une revue détaillée de l'ampleur des troubles mentaux chez l'enfant et l'adolescent à partir d'études réalisées en communauté à travers le monde. En dépit de variations substantielles des résultats dépendant de la méthodologie employée dans les études, les données obtenues montrent qu'environ un quart des jeunes ont souffert d'un trouble mental au cours de l'année précédente et environ la moitié au cours de leur vie. Les troubles anxieux sont les affections les plus fréquentes chez l'enfant, suivis des troubles du comportement, des troubles de l'humeur et des addictions. Les variations observées à travers le monde seraient dues à des facteurs méthodologiques et à de réelles différences culturelles concernant l'ampleur des troubles chez l'enfant. Moins de la moitié des jeunes souffrant actuellement de troubles mentaux font l'objet d'un traitement psychiatrique spécifique. Cependant, les jeunes les plus sévèrement atteints semblent bénéficier d'une aide des services de santé mentale. Au sein de l'epidemiologie psychiatrique infantile, plusieurs objectifs actuels ont été identifiés; perfectionnement de la classification et de l'évaluation, inclusion de jeunes enfants dans les études épidémioloqiques, intéqration de l'épidémiologie psychiatrique infantile et adulte, et évaluation des troubles à la fois physiques et mentaux chez l'enfant.

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          Most cited references148

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          Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.

          Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
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            Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.

            Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons. DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed. Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene. The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.
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              Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.

              This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.
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                Author and article information

                Contributors
                Genetic Epidemiology Research Branch, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA
                Genetic Epidemiology Research Branch, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA
                Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
                Journal
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues in Clinical Neuroscience
                Les Laboratoires Servier (France )
                1294-8322
                1958-5969
                March 2009
                : 11
                : 1
                : 7-20
                Affiliations
                Genetic Epidemiology Research Branch, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA
                Genetic Epidemiology Research Branch, National Institute of Mental Health Intramural Research Program, Bethesda, Maryland, USA
                Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
                Author notes
                Article
                10.31887/DCNS.2009.11.1/krmerikangas
                2807642
                19432384
                c9e8050e-f681-4a3c-ad09-2df50084c28d
                Copyright: © 2009 LLS

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                State of the Art

                Neurosciences
                service,adolescent,children,risk factor,mental health,psychiatric disorder,epidemiology
                Neurosciences
                service, adolescent, children, risk factor, mental health, psychiatric disorder, epidemiology

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