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Estimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

We examine the impact of including subthreshold disorders on estimating psychiatric morbidity burden in adolescents. To more fully understand this burden it is important to focus on both full syndrome and subthreshold disorders and the impairment associated with each, since evidence suggests prevalence of subthreshold disorders is substantial as is impairment.

Methods

Data were analyzed from a probability sample of 4,175 youths 11–17 years of age. We examine the prevalence of DSM-IV disorders (FS) and subthreshold (SUB) disorders, with and without impairment. Diagnostic categories examined were anxiety, mood, attention deficit hyperactivity disorder, disruptive, and substance use disorders in the past year.

Results

The prevalence of any FS disorders was 16.1 and 42.3 % for SUB. The combined prevalence was 58.4 %. By requiring impairment, the prevalence of any FS in the past year dropped to 8 % and for SUB to 15.7 %, with a combined overall rate of 23.7 %. For FS disorders, 49.6 % met criteria for moderate to severe impairment, compared to 37.8 % for SUB. One in four adolescents had either an FS or SUB disorder with impairment.

Conclusion

The results indicate that SUB disorders constitute a major public health burden in terms of psychiatric morbidity among adolescents. Given their substantial impairment and their high prevalence, consideration should be given to including SUB disorders in estimates of the public health burden psychiatric morbidity. Doing so would provide a more accurate estimate of psychiatric morbidity.

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Acknowledgments

This research was supported, in part, by Grant Nos. MH 49764 and MH 65606 from the National Institutes of Health awarded to the first author, by the Michael and Susan Dell Center for Healthy Living, and by the University of Texas. Work on this paper was supported by Grant No. MHI85150 awarded to the second and third authors and by Columbia University and New York State Psychiatric Institute.

Conflict of interest

There are no potential conflicts of interest for any author. Catherine R. Roberts, Ph.D., the University of Texas School of Medicine (retired) assisted in the design and conduct of the study and collection and management of the data.

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Authors and Affiliations

  1. UTHealth School of Public Health, University of Texas Health Science Center, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA

    Robert E. Roberts

  2. Department of Psychiatry (Child Psychiatry), Columbia University College of Physicians and Surgeons, New York, USA

    Prudence W. Fisher & J. Blake Turner

  3. Department of Child Psychiatry, New York State Psychiatric Institute, New York, USA

    Prudence W. Fisher, J. Blake Turner & Min Tang

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  1. Robert E. Roberts
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  2. Prudence W. Fisher
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  4. Min Tang
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Correspondence to Robert E. Roberts.

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Roberts, R.E., Fisher, P.W., Blake Turner, J. et al. Estimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders. Soc Psychiatry Psychiatr Epidemiol 50, 397–406 (2015). https://doi.org/10.1007/s00127-014-0972-3

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  • DOI: https://doi.org/10.1007/s00127-014-0972-3

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