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Cumulative Prevalence of Psychiatric Disorders by Young Adulthood: A Prospective Cohort Analysis From the Great Smoky Mountains Study

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Objective

No longitudinal studies beginning in childhood have estimated the cumulative prevalence of psychiatric illness from childhood into young adulthood. The objective of this study was to estimate the cumulative prevalence of psychiatric disorders by young adulthood and to assess how inclusion of not otherwise specified diagnoses affects cumulative prevalence estimates.

Method

The prospective, population-based Great Smoky Mountains Study assessed 1,420 participants up to nine times from 9 through 21 years of age from 11 counties in the southeastern United States. Common psychiatric disorders were assessed in childhood and adolescence (ages 9 to 16 years) with the Child and Adolescent Psychiatric Assessment and in young adulthood (ages 19 and 21 years) with the Young Adult Psychiatric Assessment. Cumulative prevalence estimates were derived from multiple imputed datasets.

Results

By 21 years of age, 61.1% of participants had met criteria for a well-specified psychiatric disorder. An additional 21.4% had met criteria for a not otherwise specified disorder only, increasing the total cumulative prevalence for any disorder to 82.5%. Male subjects had higher rates of substance and disruptive behavior disorders compared with female subjects; therefore, they were more likely to meet criteria for a well-specified disorder (67.8% vs 56.7%) or any disorder (89.1% vs 77.8%). Children with a not otherwise specified disorder only were at increased risk for a well-specified young adult disorder compared with children with no disorder in childhood.

Conclusions

Only a small percentage of young people meet criteria for a DSM disorder at any given time, but most do by young adulthood. As with other medical illness, psychiatric illness is a nearly universal experience.

Section snippets

Participants

The Great Smoky Mountains Study (GSMS) is a longitudinal study of the development of psychiatric disorders and need for mental health services in rural and urban youth.7, 20 A flowchart detailing sample recruitment is provided in Figure 1. A representative sample of three cohorts of children, ages 9, 11, and 13 years at intake, was recruited from 11 counties in western North Carolina. Potential participants were selected from the population of some 12,000 children using a household equal

Cumulative Prevalence of DSM-IV Disorders by Young Adulthood

Unimputed and imputed cumulative prevalence estimates are presented in Table 2. Unimputed data approximates the unlikely assumption that there would be no cases of psychiatric disorder in missing observations. Even with this conservative bias, close to half of individuals across the three cohorts met criteria for a well-specified psychiatric disorder and another 22.5% displayed an NOS disorder only. Together, more than seven of 10 subjects met criteria for a psychiatric disorder using unimputed

Discussion

Estimates of cumulative prevalence of psychiatric disorders from childhood to adulthood have hitherto relied on retrospective recall, despite evidence that forgetting is common for recall beyond 3 to 6 months.30, 31, 32 Even with these concerns, lifetime prevalence estimates from such studies have suggested that about half of adults will meet criteria for a DSM-IV disorder by age 75 years.6 We assessed psychiatric functioning over a limited period at each assessment to minimize forgetting and

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    This article is discussed in an editorial by Dr. Kathleen Ries Merikangas on page 213.

    This work was supported by the National Institute of Mental Health (MH63970, MH63671, MH48085), the National Institute of Drug Abuse (DA/MH11301), and the William T. Grant Foundation.

    Disclosure: Dr. Copeland receives research support from the National Institute of Mental Health and the National Alliance for Research on Schizophrenia and Depression. Dr. Shanahan receives research support from the National Institute of Mental Health. Drs. Costello and Angold receives research support from the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute of Child Health and Human Development. Drs. Costello and Angold are corecipients of the 2009 National Alliance for Research on Schizophrenia and Depression Ruane Prize for Outstanding Child and Adolescent Psychiatric Research.

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