Is sexual orientation related to mental health problems and suicidality in young people?

BACKGROUND: This study examines the extent to which gay, lesbian, and bisexual young people are at increased risk of psychiatric disorder and suicidal behaviors using data gathered on a New Zealand birth cohort studied to age 21 years. METHODS: Data were gathered during the course of the Christchurch Health and Development Study, a 21-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. At 21 years of age, 1007 sample members were questioned about their sexual orientation and relationships with same-sex partners since the age of 16 years. Twenty-eight subjects (2.8%) were classified as being of gay, lesbian, or bisexual sexual orientation. Over the period from age 14 to 21 years, data were gathered on a range of psychiatric disorders that included major depression, generalized anxiety disorder, conduct disorder, and substance use disorders. Data were also gathered on suicidal ideation and suicide attempts. RESULTS: Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95%, CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3). CONCLUSIONS: Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder.     

Behavioral and psychiatric disorders in Prader-Willi syndrome: a population study in Japan

Prader-Willi syndrome (PWS) is a genetically determined neurodevelopmental disorder characterized by mental retardation and distinct physical, behavioral, and psychiatric features. Based on parents' questionnaires, we examined the prevalence of behavioral and psychiatric disorders of 165 persons with PWS aged 2-31 years in Japan. The data were analyzed comparing four different age groups with PWS: group 1, 2-5 years (n=34); group 2, 6-11 years (n=57); group 3, 12-17 years (n=45); and group 4, 18-31 years (n=29). Further, we compared the results of our PWS group 4 with those of 42 age-, gender-, and intelligence level-matched intellectual disability (ID) individuals without PWS. Our results showed that repetitive speech and stubbornness were prominent from early childhood and other behavioral problems such as hyperphagia, stealing food, temper tantrums, lying, and emotional lability tended to be more frequent with age among persons with PWS. Moreover, young adults with PWS have significantly higher rates of behavioral and psychiatric disorders than IDs without PWS, such as stubbornness, hyperphagia, temper tantrums, self-injurious behavior (skin picking), hypersomnia, inactivity, and delusion. Degree of obesity was not necessarily related to behavioral and psychiatric features associated with PWS. Our findings revealed that persons with PWS are more vulnerable to behavioral and psychiatric disorders particularly in young adulthood compared to those with ID from other etiologies in Japan.     

Prevalence of attention deficit–/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates*

OBJECTIVE: This study was performed to evaluate the prevalence of ADHD as well as comorbid conditions among young male prison inmates. METHOD: We investigated 129 prison inmates (mean age+/-SE: 19.2+/-2.0 years) and 54 healthy male control subjects (mean age+/-SE: 22.2+/-3.12 years) for the presence of adult ADHD using the Wender Utah Rating Scale (WURS), the Eysenck Impulsivity Questionnaire (EIQ), the diagnostic criteria for ADHD according to DSM-IV and ICD-10-research criteria and the Utah criteria for adult ADHD. In order to determine comorbid personality disorders we applied the International Personality Disorder Examination (IPDE). Externalization (ED) and Internalization Disorders (ID) were evaluated by means of the Achenbach Scales. Alcoholism (ALC) was examined via the Alcohol Use Disorder Test (AUDIT) and substance use disorder (SUD) has been investigated with the Structured Clinical Interview for DSM-IV (SCID). RESULTS: The overall prevalence of ADHD according to DSM-IV was 45%. The prevalence of disturbance of activity and attention (DAA) and hyperkinetic conduct disorder (HCD) via the ICD-10 research criteria was 21.7%. Sole DAA without any comorbid condition could be detected in one case. The most common diagnostic combinations were DAA/HCD and SUD/ALC (89% of all DAA/HCD cases). CONCLUSION: The prevalence of DAA/HCD or ADHD in young adult prison inmates is significantly elevated when compared to nondelinquent controls. Generally the population of young adult male prison inmates exhibits a considerable psychiatric morbidity. Of the total sample, 64% suffered from at least 2 disorders. Only 8.5% had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities.     

Suicide in older people without psychiatric disorder

OBJECTIVE: To determine the psychological characteristics and nature of life problems, including physical illness, in people 60 years and over dying through suicide in the absence of psychiatric disorder. METHODS: Psychological autopsy interviews with relatives and friends for 23 people aged 60 years or over who had died through suicide and did not have a psychiatric disorder at the time of death. RESULTS: Three (13%) of the sample had significant psychiatric symptoms, one had a diagnosis of personality disorder, and ten (43.5%) had significantly abnormal personality traits. Physical illness and recent bereavement were the commonest life problems associated with suicide. Five (21.7%) of the sample were suffering from severe physical illness at the time of death. CONCLUSION: Sub-syndromal psychiatric disorder may be less important than personality factors, physical illness, and recent bereavement as important contributory factors to suicide in older people not suffering from psychiatric illness at the time of death.     

Psychiatric disorders in young adult intercountry adoptees: an epidemiological study

OBJECTIVE: The prevalences of psychiatric disorders in young adult intercountry adoptees and nonadopted young adults from the general population were compared. METHOD: In the Netherlands, a total of 1,484 young adult intercountry adoptees (72.5% of the original sample at age 10-15 years) and 695 nonadopted subjects (78.1% of the original sample) of comparable age from the general population were interviewed by using a standardized psychiatric interview generating DSM-IV diagnoses. RESULTS: The adopted young adults were 1.52 times as likely to meet the criteria for an anxiety disorder as the nonadopted young adults; the 95% confidence interval (CI) was 1.15-2.00. The adoptees were 2.05 (95% CI=1.32-3.17) times as likely to meet the criteria for substance abuse or dependence. The adopted men were 3.76 (95% CI=1.69-8.37) times as likely to have a mood disorder as nonadopted men, while for women there was no significant difference between adoptees and nonadoptees. No significant difference for the diagnosis of disruptive disorder was found. For all diagnoses together, adoptees with low and middle parental socioeconomic status in childhood did not differ from the comparison subjects, while adoptees with high parental socioeconomic status were 2.17 times (95% CI=1.50-3.13) as likely to meet the criteria for a disorder as nonadoptees with high parental socioeconomic status. CONCLUSIONS: Intercountry adoptees run a higher risk of having severe mental health problems in adulthood than nonadoptees of the same age. The risk of later malfunctioning differs for different disorders and different groups of adoptees.     

Objective sleep in pediatric anxiety disorders and major depressive disorder

OBJECTIVE: To examine objective and subjective sleep problems in early-onset anxiety and depression. METHOD: Children and adolescents (46% female, ages 7 to 17 years) with anxiety disorders (n = 24), major depressive disorder (MDD) without comorbid anxiety disorders (n = 128), or no history of psychiatric disorder (n = 101) spent two consecutive nights in a sleep laboratory and completed self-reports of sleep quality. RESULTS: On objective measures, the anxiety group exhibited more awakenings than the MDD group, less slow-wave sleep than the control or MDD group, and greater night 2 sleep latency than the MDD or control group. The anxiety group exhibited no decrease in rapid eye movement latency from the first night to the second. The MDD group exhibited less time awake than the control group and less stage 1 sleep than the anxiety or control group. On subjective measures, young people with anxiety reported greater sleep latency on the second night and no decrease in sleep latency. Age was covaried in analyses. CONCLUSIONS: Findings provide objective and subjective evidence of sleep disturbance in children and adolescents with anxiety disorders and replicate findings of limited objective sleep disturbance in those with MDD. Sleep problems are an important consideration when treating young people with anxiety.     

Mental health services and young people with intellectual disability: is it time to do better?

Background There is evidence that the mental health needs of children with disabilities are inadequate. The aim of the present study was to determine the extent of specialist health service use during adolescence by a group of individuals with intellectual disability (ID) and mental health problems. Method The study population consisted of 80 young people with ID, who were examined in childhood and adolescence for psychiatric and behaviour disorder. These young people were interviewed again in early adult life for the presence of psychiatric and behaviour disorder. Evaluation questionnaires were used during the follow‐up study to assess service use from adolescence. Results The key finding was that the great majority (64%) of subjects with persistent challenging behaviour from childhood into adult life and those with an established childhood psychiatric disorder received no specialist mental health care. Conclusions The development of mental health services for this vulnerable group with complex psychiatric and behaviour disorders has been poor for a number of reasons, including lack of recognition at the primary care level and insufficient numbers of trained professionals within specialist services.     

Two-year outcome of children treated for depression

Abract Fifty-four children and adolescents (age 8–17) were assessed two years after a clinical intervention trial of cognitive-behavioural vs. non-focused treatment for depression. Eleven (20.4%) subjects fulfilled criteria for depression, while 21 (38.9%) reported significant depressive symptoms during the previous year. Seventeen young people (31.5%) had a psychiatric disorder (including depression). Overall, the sample maintained the improvement since the termination of treatment, without detecting specific treatment effects. Presence of depression at two-year follow-up was best predicted by self-esteem ratings before and after treatment, and co-morbidity at post-treatment. Depression in young life carries a high risk of recurrence, despite initial remission. Continuation or preventative treatment for young people at risk of relapse needs development and evaluation. Received: 4 March 1997 Accepted: 15 May 1997     

Prevalence of Psychiatric Diagnoses and Challenging Behaviors in a Community-Based Population of Adults With Intellectual Disability

Previous research has suggested substantial variation in prevalence rates of psychiatric disorders in individuals with intellectual disability (ID) and also differential patterns of associations between psychiatric disorders and challenging behaviors in people with ID. The aim of this study was to determine the prevalence rate of specific psychiatric disorders and challenging behaviors and the relationship between them in a community-based sample of individuals with ID. A community-based sample of 159 adults primarily with mild and moderate ID was surveyed for the presence of psychiatric disorders and challenging behaviors using the Behavior Problem Inventory and the Psychiatric Assessment Schedule (PAS-ADD). Individuals who met threshold on the PAS-ADD were subsequently evaluated using the Mini PAS-ADD Interview. Screening for psychiatric disorders using the PAS-ADD indicated a prevalence rate of 10%. There was a large discrepancy between the overall rate of challenging behaviors (45%) and the rate of psychiatric disorders identified by the Mini PAS-ADD Interview (6%). However, the rate of more severe behavior problems (8%) was closer to the rate of psychiatric disorders (6%). Thirty-one percent of people with severe challenging behaviors also were rated as having psychiatric disorders and odd ratio analysis indicates that individuals with severe challenging behaviors are substantially more likely to present with a psychiatric disorder. However, the relationship between different topographies of challenging behaviors and discrete diagnostic categories of psychiatric disorders appears to be unclear. This study reports a low prevalence of psychiatric disorders in a community-based population. The presence of severe challenging behaviors appears to have some association with psychiatric disorders but does not appear specific to discrete diagnostic categories. Clinicians and researchers need to debate the validity of considering challenging behaviors atypical manifestations of psychiatric disorders.     

Psychopathology and young people with Down's syndrome: childhood predictors and adult outcome of disorder

There is a scarcity of follow‐up studies into adult life of psychiatric disorder in young people with intellectual disability. The key aims of the present study were: (1) to determine the outcome of psychopathology present in childhood in individuals with Down's syndrome (DS); and (2) to look at childhood predictors of adult psychiatric disorder. Fifty‐two young people with DS were identified from a sample of 193 subjects examined in childhood and adolescence for psychiatric and behaviour disorder. These young adults were interviewed for the presence of psychiatric disorder. No significant relationship was found between childhood mental disorder and psychiatric disorder in adult life for those individuals with DS. Early childhood factors of psychiatric disorder, challenging behaviour and family environment, except social background, did not predict adult psychopathology in young people with DS. Childhood disorder in individuals with DS has a good early prognosis with little evidence of continuity of the disorder into adult life.     

Injury risk in young people with intellectual disability

Epidemiological studies have established injury as a major public health problem for young people in the general population, but minimal population‐based injury information exists on those with intellectual disability (ID). The present study investigated risk factors for injury to subjects in the Australian Child and Adolescent Development (ACAD) programme, which is examining emotional and behavioural problems in young people with ID. Extensive biopsychosocial data for the ACAD programme were collected at two time intervals (i.e. 1990–1991 and 1995–1996). Carer report of medically attended injury over one year was collected for the first time period (1995–1996) on a sample of 465 ACAD subjects (aged 5–29 years) representative of young people with ID (IQ < 70) to determine risk factors for injury using the ACAD biopsychosocial data. Psychopathology [odds ratio (OR) = 3.4] epilepsy (OR = 2.4) and an overly sociable temperament (OR = 2.2) are associated with injury in young people with ID. Social and family factors had minimal influence on injury risk in this population. Those who are highly disruptive, self‐absorbed, anxious, have problems relating socially, have communication disturbance or have attention deficit hyperactivity symptoms are particularly at increased risk for injury. The present study demonstrates a largely under‐recognized public health problem of a high unintentional injury risk for young people with ID, and identifies substantial and important risk factors for injury. Injury prevention programmes, with a particular focus on those with highly disturbed behaviours or epilepsy, are warranted in this population.     

Psychopathology in Children and Adolescents with Autism Compared to Young People with Intellectual Disability

Autism is a neurodevelopmental disorder with a specific pattern of behavioural, communication and social problems. Additional mental health problems are often poorly understood and undetected. This study investigates the level and pattern of emotional and behavioural problems in young people with autism compared with children with intellectual disability (ID). Subjects were 381 young people with autism and a representative group of 581 Australian young people with ID aged 4–18 years. Parents/carers provided details of the emotional and behavioural problems of their child using the Developmental Behaviour Checklist (DBC-P). Young people with autism were found to suffer from significantly higher levels of psychopathology than young people with ID. The implications of this finding are discussed.     

The use of melatonin to treat sleep disorder in adults with intellectual disabilities in community settings – the evaluation of three cases using actigraphy

Background   Sleep disorders are known to be very prevalent in adults with intellectual disabilities (ID) but to date there has been limited objective assessment of either sleep disorders or of interventions such as the use of melatonin.
Methodology   A protocol-driven assessment and intervention procedure was followed with three people with moderate to severe ID identified as having a possible sleep disorder. Actigraphic assessment was used to determine the nature of the sleep disorder, after which sleep hygiene advice and then individual treatment with melatonin were provided, following which further actigraphic assessment was carried out. Behavioural disturbance was formally assessed before and after the intervention phase.
Results   Following treatment with melatonin, changes in circadian rhythm were noted, together with improvements in challenging behaviour, but no significant effects were noted with regard to either quantity or quality of sleep.
Conclusions   A standardised procedure for assessment and treatment of sleep disorders in people with ID was established. Although no apparent effects on sleep quantity or quality were noted, this may reflect factors inherent in the sample, rather than the relative efficacy of melatonin treatment per se .     

Alcohol and its relationship to offence variables in a cohort of offenders with intellectual disability

Abstract

Background Alcohol use and misuse may be lower in people with intellectual disability (ID) than in the general population but may be related to offending.

Method Alcohol-related crime and history of alcohol use was recorded in 477 participants with ID referred to forensic ID services and related to offending.

Results Level of alcohol-related crime and history of alcohol misuse was lower than in some previous studies at 5.9% and 20.8%, respectively. History of alcohol abuse was associated with alcohol-related offences and theft. Higher rates of alcohol problem history were associated with histories of a number of offences, psychiatric disturbance in adulthood, psychiatric disturbance in childhood, and experiences of childhood adversity. Most effect sizes were weak or moderate.

Conclusions The convergence of childhood adversity, psychiatric problems in childhood and adulthood, and alcohol abuse is consistent with studies that have found these as risk markers for offending.     

What’s in a name? Is accurate recognition and labelling of mental disorders by young people associated with better help-seeking and treatment preferences?

BACKGROUND: The possible benefits or harms of using psychiatric labels in the community have been a focus of debate for many decades. The aim of this study was to examine associations between the accuracy of labelling of depression or psychosis by young people aged 12-25 and their help-seeking, treatment and self-help preferences, whilst controlling for a range of potential confounding factors. METHODS: A randomly selected population sample of 1,207 young people aged 12-25 years from several regions of Victoria, Australia, was interviewed via a telephone survey. The structured interviews used vignettes of a young person with either depression or psychosis followed by a series of questions related to recognition of disorder and recommended forms of help and treatment. Multiple logistic regression analyses were used to measure the association between a range of help-seeking, treatment and self-help preferences and the predictor variables of accuracy of recognition, socio-demographic background and exposure to mental health problems. RESULTS: Correct labelling of the disorder was the predictor variable most frequently associated with choice of appropriate help and treatment for both the depression and psychosis vignettes. In regard to self-help preferences, correct labelling of the depression vignette was only associated with being less likely to recommend smoking marijuana to relax. Correct labelling of the psychosis vignette, or labelling it as depression, was associated with being less likely to recommend dealing with the problem alone. CONCLUSION: These findings support the view that improving the use of psychiatric labels by young people is beneficial, because it facilitates appropriate help-seeking and treatment choice. The label may be the cue to activating a schema about appropriate action to take.     

Prevalence of visual and hearing impairment in a Dutch institutionalized population with intellectual disability

A screening of hearing and visual function was performed using clinical assessment methods in a Dutch institutionalized population of 672 people with mild to profound intellectual disability (ID). Because the studied population was not comparable to the total Dutch population with ID, subgroups were distinguished according to level of ID, age younger and older than 50 years, and the presence or absence of Down's syndrome (DS). The prevalences of both hearing and visual impairment were considerably increased in all subgroups, as compared with the general population. In the least affected group, i.e. those < 50 years with a mild or moderate ID by other causes than DS, the prevalences of hearing and visual impairment were 21% and 4%, respectively (as opposed to 2–7% and 0.2–1.9% in the general Dutch population <50 years, respectively). The prevalence of hearing impairment showed a sharp and highly significant increase in individuals with DS and subjects ≥ 50 years. To a lesser extent, young adults with severe or profound ID had an increased risk of hearing impairment. Visual impairment and blindness were specifically highly prevalent in people with severe or profound ID (51% < 50 years of age). Down's syndrome and an age ≥ 50 years were also significant risk factors for visual impairment. There was an alarmingly high prevalence of combined sensory impairment, especially in those with severe or profound ID (20%). Although hearing impairment had been diagnosed prior to this screen in 138 people and visual impairment in 65 individuals, a first diagnosis of hearing impairment was made in 128 subjects and of visual impairment in 90 cases. This highlights the tendency for sensory impairments to go unnoticed in people with ID, which is not restricted to those with severe or profound ID. Therefore, the present authors stress the importance of regular screening as outlined in the existing IASSID international consensus statement.     

Involvement of Youths with Autism Spectrum Disorders or Intellectual Disabilities in Multiple Public Service Systems

The objectives of this study were to estimate the prevalence of autism spectrum disorders (ASD) and intellectual disability (ID) among youths active in at least one of five public service systems: mental health (MH), educational services for youth with serious emotional disturbance (SED), child welfare (CW), juvenile justice (JJ), and alcohol and drug services (AD). This study also reports the characteristics and patterns of system involvement among these youths. Results indicate that approximately 12% of a random sample of youths involved in these public service systems had ID or ASD. These disabilities were particularly prevalent in youths in the SED (25%), MH (13%), and CW (13%) systems and were less prevalent in the JJ and AD systems (4% each). Youths with ID or ASD were more likely than other youths to be White, have a higher socioeconomic status, and be more likely to have externalizing psychiatric and other problems. Of those with ASD or ID, approximately one-third were served in more than one service system, with the MH and SED systems most likely to be serving youths with externalizing psychiatric disorders. These findings have important implications for service provision, treatment planning, and workforce development.     

Psychiatric disturbances among prepubertal children in Southern Finland

The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studied in a two-stage epidemiological survey. In the first stage of the study 3397 children aged 8 or 9 were screened with the Rutter A2 scale for parents, Rutter B2 scale for teachers and Children's Depression Inventory (CDI). In the second stage a random sample of the children screened was drawn for more detailed assessment. Altogether 279 children were interviewed with the Finnish version of the Diagnostic Interview Schedule for Children (DISC), and their parents with the Isle of Wight Interview Schedule. In the parental interview the prevalence of psychiatric disturbance among children was 15.1%. The rate was higher for boys (23.7%) than for girls (5.3%). The prevalence of psychiatric disturbance verified with the child interview was 14.9%. The prevalence of psychiatric disturbance in boys based on the child interview was 20.5%. For girls the prevalence of psychiatric disturbance based on the child interview was 8.7%. The spectrum of psychiatric disturbance differed in the two interviews. Attention deficit disorder, depression and conduct disorder were the most common diagnoses in the parent interview, while anxiety disorder and depression were most common according to the child interview. In only 24% of the cases both the parent and child interview gave the same diagnosis. Accepted: 3 December 1997