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The Prevalence of Mental Health and Addictive Disorders

Few families in the United States are untouched by mental illness. According to current estimates, at least one in five people has a diagnosable mental disorder during the course of a year. This includes adults as well as children. The prevalence of mental health disorders is defined as the number of people with a disorder that are present in the general population. This is usually expressed as a certain number per thousand people or a percentage.

Based on the 2000 US Census Report, InCrisis estimates there are 39.4 million children 12 to 17 year old in the US today. The MECA Study (Methodology for Epidemiology of Mental Disorders in Children and Adolescents) estimated that almost 8.4 million of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder associated with at least minimum impairment (Table 1). This translates to a prevalence of almost 21% or 1 out of five children. When the diagnostic criteria used to estimate the prevalence required the presence of significant functional impairment, estimates dropped to 11 percent. This estimate translates into a total of 4.3 million youth who suffer from a mental illness that results in significant impairments at home, at school and with peers. Finally, when extreme functional impairment is the criterion, the estimates dropped to 5 percent. This means there are 2 million children in the U.S. with extremely severe functional impairments.

Table 1. Children and adolescents ages 9 to 17 with mental or addictive disorders,* combined MECA sample.

Disorders

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

The Surgeon General estimates that 6.5 million emotionally disturbed and 3.5 million severely disturbed children are not getting the help they need (U.S. Public Health Service, 2000).

Federal regulations also define a sub-population of children and adolescents with more severe functional limitations, known as “serious emotional disturbance” (SED). The term “serious emotional disturbance” is used in a variety of Federal statutes in reference to children under the age of 18 with a diagnosable mental health problem that severely disrupts their ability to function socially, academically, and emotionally. The term does not signify any particular diagnosis; rather, it is a legal term that triggers a host of mandated services to meet the needs of these children. Children and adolescents with SED number approximately 5 to 9 percent of children ages 9 to 17 (Friedman et al., 1996).

Elster and Marcell (2003) reviewed mental health related problems seen in adolescent medicine. The current prevalence of significant mental health related problems facing physicians are presented in Table 2.

Table 2.  Critical Adolescent Mental Health Related Problems

Problem

Males

Females

Disabling sadness, unhappiness or depression

33%

34%

Suicide attempts requiring medical attention

2.1%

3.1%

Drinking and driving

17.0%

9.5%

Alcohol consumption (prior to age 13 years)

24.0%

34.0%

Physical fights

43.0%

33%

Carry a weapon at school

10.0%

3.0%

Chlamydia trachomatis

15.7%

12.2%

Elster and Marcell found that children with these problems are at a much greater risk for dropping out of school and of not being fully functional members of society in adulthood. The burden of disease includes the prevalence of mental illness, morbidity, and cost. All sectors of society are involved. Prevalence estimates range from 17.6 to 22 % (Costello, et al., 1996) in one study, and 16 % in another (Roberts, et. al., 1998). Furthermore, child mental disorders persist into adulthood; 74% of 21 year olds with mental disorders had prior problems. The cost to society is high in both human and fiscal terms.

According to the Surgeon General Report (1999), approximately four out of five children with mental or addictive disorders will not receive services. Others estimate that 2 out of 3 are not receiving services. The reason for this is unclear but it has been suggested that the cause may be an absence of appropriate screening, a scarcity of qualified professionals to conduct screenings, high cost and a lack of services.

References

Costello, E.J.; Angold, A.; Burns, B.J.; Erkanli, A.; Stangl, D.K; and Tweed, D.L. (1996). The Great Smokey Mountains Study of youth: Functional impairment and serious emotional disturbance. Archives of General Psychiatry, 53(12): 1137-1143

Elster, A. B., & Marcell, A. V. (2003). Health Care of Adolescent Males: Overview, Rationale, and Recommendations. Adolescent Medicine: State of The Art Professional Reviews, 14 (3), 525-540.

Friedman, R. M., Katz-Levey, J. W., Manderschied, R. W., & Sondheimer, D. L. (1996b). Prevalence of serious emotional disturbance in children and adolescents. In R. W. Manderscheid & M. A. Sonnenschein (Eds.), Mental health, United States, 1996 (pp. 71–88). Rockville, MD: Center for Mental Health Services.

Paperny, D. M., & Hedburg, V. (1999). Computer-assisted health counselor visits: A low cost model for comprehensive adolescent preventive services. Archives of Pediatric Adolescent Medicine, 153, 63-66. 

Roberts, R.E.; Attkisson, C.C.; and Rosenblatt, A. (1998). Prevalence of psychopathology among children and adolescents. American Journal of Psychiatry, 155(6): 715-25.

Shaffer, D., Fisher, P., Dulcan, M. K., Davies, M., Piacentini, J., Schwab-Stone, M. E., Lahey, B. B., Bourdon, K., Jensen, P. S., Bird, H. R., Canino, G., & Regier, D. A. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC- 2.3): Description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865–877.

U.S. Public Health Service, Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, DC: Department of Health and Human Services, 2000.

Dated: February 28, 2012

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