> Surgeon Generals Mental Health Report Chapter Two: Epidemiology of Mental Illness: Children and Adolescents

Mental Health: A Report by the Surgeon General


Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America

Chapter 2

Epidemiology of Mental Illness


Children and Adolescents

The annual prevalence of mental disorders in children and adolescents is not as well documented as that for adults. About 20 percent of children are estimated to have mental disorders with at least mild functional impairment (see Table 2-7). Federal regulations also define a sub-population of children and adolescents with more severe functional limitations, known as “serious emotional disturbance” (SED).4 Children and adolescents with SED number approximately 5 to 9 percent of children ages 9 to 17 (Friedman et al., 1996b).

Table 2-6. Best estimate 1-year prevalence rates based on ECA and NCS, ages 18—54

 

 

ECA Prevalence (%)

NCS Prevalence (%)

Best Estimate ** (%)

Any Anxiety Disorder

13.1

18.7

16.4

Simple Phobia

8.3

8.6

8.3

Social Phobia

2.0

7.4

2.0

Agoraphobia

4.9

3.7

4.9

GAD

(1.5)*

3.4

3.4

Panic Disorder

1.6

2.2

1.6

OCD

2.4

(0.9)*

2.4

PTSD

(1.9)*

3.6

3.6
       
Any Mood Disorder

7.1

11.1

7.1

MD Episode

6.5

10.1

6.5

Unipolar MD

5.3

8.9

5.3

Dysthymia

1.6

2.5

1.6

Bipolar I

1.1

1.3

1.1

Bipolar II

0.6

0.2

0.6
       

Schizophrenia

1.3 — 1.3

Nonaffective Psychosis

— 0.2 0.2

Somatization

0.2 — 0.2

ASP

2.1 — 2.1

Anorexia Nervosa

0.1 — 0.1

Severe Cognitive Impairment

1.2 — 1.2
       
Any Disorder 19.5 23.4 21.0
*Numbers in parentheses indicate the prevalence of the disorder without any comorbidity. These rates were calculated using the NCS data for GAD and PTSD, and the ECA data for OCD. The rates were not used in calculating the any anxiety disorder and any disorder totals for the ECA and NCS columns. The unduplicated GAD and PTSD rates were added to the best estimate total for any anxiety disorder (3.3%) and any disorder (1.5%).

**In developing best-estimate 1-year prevalence rates from the two studies, a conservative procedure was followed that had previously been used in an independent scientific analysis comparing these two data sets (Andrews, 1995). For any mood disorder and any anxiety disorder, the lower estimate of the two surveys was selected, which for these data was the ECA. The best estimate rates for the individual mood and anxiety disorders were then chosen from the ECA only, in order to maintain the relationships between the individual disorders. For other disorders that were not covered in both surveys, the available estimate was used.

Key to abbreviations: ECA, Epidemiologic Catchment Area; NCS, National Comorbidity Study; GAD, generalized anxiety disorder; OCD, obsessive-compulsive disorder; PTSD, post-traumatic stress disorder; MD, major depression; ASP, antisocial personality disorder.

Source: D. Regier, W. Narrow, & D. Rae, personal communication, 1999
Table 2-7. Children and adolescents ages 9 to 17 with mental or addictive disorders,* combined MECA sample

 

Prevalence (%)

Anxiety disorders

13.0
Mood disorders

6.2
Disruptive disorders

10.3
Substance use disorders

2.0
Any disorder

20.9

 

* Disorders include diagnosis-specific impairment and Child Global Assessment Scale <or=70 (mild global impairment).

Source: Shaffer et al., 1996

Not all mental disorders identified in childhood and adolescence persist into adulthood, even though the prevalence of mental disorders in children and adolescents is about the same as that for adults (i.e., about 20 percent of each age population). While some disorders do continue into adulthood, a substantial fraction of children and adolescents recover or “grow out of” a disorder, whereas, a substantial fraction of adults develops mental disorders in adulthood. In short, the nature and distribution of mental disorders in young people are somewhat different from those of adults.


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