Anxiety disorders in children and adolescents with intellectual disability: Prevalence and assessment

Children and adolescents with intellectual disability are known to experience mental health disorders, but anxiety disorders in this population have received relatively little attention. Firstly, this paper provides a review of published studies reporting prevalence rates of anxiety disorders in children and adolescents with intellectual disability. Secondly, the paper reviews measures of anxiety that have been evaluated in children/adolescents with intellectual disability, and details the associated psychometric properties. Seven studies reporting prevalence rates of anxiety disorders in this population were identified, with reported rates varying from 3% to 22%. Two-one studies evaluating a measure of anxiety in a sample of children/adolescents with intellectual disability were identified. While these studies indicate that several measures show promise, further evaluation studies are needed; particularly those that evaluate the capacity of measures to screen for anxiety disorders, not only measure symptoms.     

大连市精神疾病患者就医意向与卫生服务利用调查

目的探讨大连市精神疾病患者就医意向及对精神卫生服务资源的利用情况。方法采取多阶段分层随机抽样方法抽取大连市年龄≥18岁的居民5062人,采用复合性国际诊断交谈检查表CIDI3.0进行入户调查,对患有各类精神疾病的410位居民的就医意向及卫生服务资源利用状况进行研究分析。结果在各类精神疾病患者中,仅4.6%患者病后会采取不同的方式求助,其中女性求助比例(8.7%)高于男性(2.6%);求助对象中精神科医师所占比例(68%)最高;推迟求助的原因涉及到个人对症状认识、病耻感、经济负担、医疗保险、医疗资源的获得以及对卫生服务机构的满意度等。结论大连市民患精神疾病后求助意向低,对精神卫生服务资源的利用明显不足。     

Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders

Objective

This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization.

Method

This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization.

Results

Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29).

Conclusion

Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings.     

Late-life anxiety disorders among Puerto Rican primary care patients: impact on well-being, functioning, and service utilization

With the growing population of older Hispanic adults there is a need for additional research on the mental health care of this patient group. This study explored the impact of anxiety disorders on the health status of 291 older (>/=50 years) Puerto Rican primary care patients (n = 65 with anxiety disorders, n = 226 without anxiety disorders). All analyses controlled for potential confounding variables, including depression diagnosis and physical health burden. Logistic regression indicated that anxiety disorders were associated with higher psychological distress, suicidality, and emergency room service utilization, as well as lower instrumental functioning and perceived health quality. Analysis of covariance indicated that both anxiety disorder status and history of ataque de nervios were related to higher percentages of lifetime somatic symptoms. These data highlight the need for improved recognition and treatment of anxiety disorders in older Puerto Rican adults.     

Prevalence and correlates of mental disorders among adolescents in Italy: the PrISMA study

Background  While in the last 5 years several studies have been conducted in Italy on the prevalence of mental disorders in adults, to date no epidemiological study has been targeted on mental disorders in adolescents. Method  A two-phase study was conducted on 3,418 participants using the child behavior checklist/6–18 (CBCL) and the development and well-being assessment (DAWBA), a structured interview with verbatim reports reviewed by clinicians. Results  The prevalence of CBCL caseness and DSM-IV disorders was 9.8% (CI 8.8–10.8%) and 8.2% (CI 4.2–12.3%), respectively. DSM-IV Emotional disorders were more frequently observed (6.5% CI 2.2–10.8%) than externalizing disorders (1.2% CI 0.2–2.3%). In girls, prevalence estimates increased significantly with age; furthermore, living with a single parent, low level of maternal education, and low family income were associated with a higher likelihood of suffering from emotional or behavioral problems. Conclusions  Approximately one in ten adolescents has psychological problems. Teachers and clinicians should focus on boys and girls living with a single parent and/or in disadvantaged socioeconomic conditions.     

Brief report: Identity processes in Filipino late adolescents and young adults: Parental influences and mental health outcomes

This study focused on a process-oriented approach to identity formation using a sample of Filipino late adolescents and young adults (17–30 years; N = 779). Indirect relations between parenting and mental health via identity formation processes were examined. Two parenting dimensions (psychological control and support), two types of mental health outcomes (depression and psychological well-being), and five identity dimensions (commitment making (CM), identification with commitment (IC), exploration in breadth (EB), exploration in depth (ED), and ruminative exploration (RE)) were assessed. Recursive path analysis showed indirect relations between parenting and mental health via EB, ED, RE, and IC. Model differences between late adolescents (17–21 year olds) and young adults (22–30 year olds) were examined using multigroup path analysis. Results showed that the direct effect of psychological control on RE, and its indirect effect on depression through RE differed between the age groups. Implications and suggestions for future research are provided.     

Prevalence of suicide ideation among adolescents and young adults in rural Bangladesh

Suicide is a leading cause of death world-wide. However, adolescent suicidal behavior is a neglected public health issue, especially in low-income countries such as Bangladesh. The study was conducted to estimate the prevalence of suicidal ideation among adolescents in a rural community and to examine factors associated with suicidal ideation. A cross-sectional survey was carried out in 2013 among 2,476 adolescents aged 14–19 years, selected randomly from a rural community of Bangladesh. An adapted version of the WHO/SUPRE-MISS questionnaire was used to collect data in the Raiganj sub-district. A two stage screening was performed to identify the suicidal ideation cases. It was found that the life-time prevalence for suicidal ideation was 5 percent among adolescents. The majority of the adolescents with suicidal ideation were females 66 (52.8%), unmarried 103 (82.4%), and students 92 (73%). Suicidal ideation was statistically significantly associated with age, education, occupation, living with parents or others, and house ownership. Respondents who were aged 18–19 years, had secondary school certificate (SSC) and secondary school certificate (HSC) or higher education, were day laborers, had own house, and do not lived with parents had odds ratios of 2.31 (CI 1.46–3.65), 2.38 (CI 1.51–3.77), 4.15 (CI 2.41–7.14), 0.28 (CI 0.13–0.60), 0.14(CI 0.05–0.35), and 1.80 (CI 1.07–3.03), respectively. Among adolescents, the prevalence of life-time suicidal ideation was moderately high. Age, education, occupation, house ownership, and living with parents were statistically significantly associated with suicidal ideation. It is important to design and implement effective community based suicide prevention programs for adolescents in Bangladesh.     

Health care utilization in children and adolescents with psychiatric disorders

Objective

Mental illness is increasing among young people and likewise the request for health care services. At the same time, somatic comorbidity is common in children and adolescents with psychiatric disorders. There is a lack of studies on health care use in children and adolescents, and the hypothesis was that children and adolescents with psychiatric disorders use more primary-, and specialized somatic health care compared to children without psychiatric disorders.

Methods

In this retrospective population-based register study, all individuals aged 3–17 years living in Västra Götaland region in Sweden in 2017 were included (n = 298,877). Linear and Poisson regression were used to compare health care use during 2016–2018 between children with and without psychiatric diagnoses, controlling for age and gender. The results were reported as unstandardised beta coefficient (ß) and adjusted prevalence ratio (aPR) respectively.

Results

Having a psychiatric diagnosis was associated with more primary care visits (ß 2.35, 95% CI 2.30–2.40). This applied to most diagnoses investigated. Girls had more primary care visits than boys. Likewise, individuals with psychiatric diagnoses had more specialized somatic outpatient care (ß 1.70, 95% CI 1.67–1.73), both planned and unplanned (ß 1.23, 95% CI 1.21–1.25; ß 0.18, 95% CI 0.17–0.19). Somatic inpatient care was more common in those having a psychiatric diagnosis (aPR 1.65, 95% CI 1.58–1.72), with the diagnoses of psychosis and substance use exerting the greatest risk.

Conclusions

Psychiatric diagnoses were associated with increased primary-, somatic outpatient- as well as somatic inpatient care. Increased awareness of comorbidity and easy access to relevant health care could be beneficial for patients and caregivers. The results call for a review of current health care systems with distinct division between medical disciplines and levels of health care.     

Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders

The main aim of this study was to examine the frequency and patterns of mental health services utilization among 12- to 17-year-old adolescents with anxiety and depressive disorders. Another aim was to examine the factors associated with the use of mental health services. The study population comprised 1,035 adolescents randomly recruited from 36 schools. Anxiety and depressive disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. Only 18.2% of the adolescents who met DSM-IV criteria for anxiety disorders, and 23% of those with depressive disorders, used mental health services. Among adolescents with anxiety disorders, mental health services utilization was associated with past suicide attempt, older age, the presence of comorbid disorders, as well as parental anxiety and depression. The only factor that predicts the use of mental health service among adolescents with depressive disorder was a history of suicide attempt. The implication of the results in terms of tailoring services for children and adolescents with anxiety and depressive disorders are discussed.     

The associations between sleep situations and mental health among Chinese adolescents: A longitudinal study

ObjectiveFew studies are conducted to explore the longitudinal relationships between sleep situations and mental health among adolecents. This study aimed to explore the sleep situations (ie, sleep habits and sleep problems) among Chinese adolescents and the longitudinal associations between sleep situations and mental disorder symptoms (ie, depressive and anxiety symptoms).MethodsThis longitudinal study included 1957 high school students from ten schools in Guangzhou in January 2019, with 1836 students contributing valid data at a one-year follow-up (retention rate: 93.9%). Data of depressive and anxiety symptoms, sleep habits, and sleep problems were collected using a self-reported questionnaire.ResultsThe current study found that over half of the adolescents did not reach the recommended 8-h sleep-time on weekdays (63.3%). Short sleep duration, especially on weekdays, was significantly associated with subsequent depressive (AOR = 0.86, 95%CI: 0.80–0.92) and anxiety symptoms (AOR = 0.86, 95%CI: 0.77–0.96). In addition, longer weekday-weekend catch-up sleep and more sleep problems were risk factors of depressive and anxiety symptoms.ConclusionsThe health effects of insufficient sleep and suboptimal sleep quality on adolescents should not be neglected. Our longitudinal research showed that adolescents would demonstrate severer depressive and anxiety symptoms if lacking of a healthy sleeping practice. A regular sleep schedule and close attention to adolescents’ mental disorders are highly recommended.     

Prevalence of mental disorders and mental health service use in Japan

A high disease burden of mental disorders has been noted worldwide, including Japan. It is important to monitor mental disorder prevalence trends and the use of mental health services over time using epidemiological data and to plan appropriate policies and measures that consider mental health in each country. This review outlines the prevalence trends of common mental disorders (CMD) and the use of mental health services in Japan from the 2000s to the 2010s and compares them with those in other countries. This review clarifies that the prevalence of CMD in Japan has been relatively stable in the past decade. The 12‐month prevalence of mental health service use has increased about 1.2 times to 1.6 times in the past 10–15 years. Thus, it is very likely that the rise in mental health service use contributes to increased patient numbers. Regarding cross‐national comparison, the prevalence rate of CMD in Japan is much lower compared to rates in the USA and Europe. The 12‐month prevalence of mental health service use was also lower in Japan compared to prevalence rates in other high‐income countries. Mental health epidemiology has clarified that the prevalence of CMD worldwide has remained unchanged, even though mental health service use has increased in high‐income countries. Thus, the gap in treatment quality and prevention should be addressed in the future.     

Mental health service use among Canadian older adults with anxiety disorders and clinically significant anxiety symptoms

Objectives: Despite evidence of disproportionate underutilization of mental health services by older adults and by individuals with anxiety disorders, little is known specifically about service use by older adults with anxiety. This study examines the prevalence of mental health service use among older adults with anxiety disorders and clinically significant anxiety symptoms, as well as factors associated with service use.

Method: The authors used data from the Canadian Community Health Survey–Mental Health and Well-Being, a nationally representative survey of community-dwelling Canadians. This study examined past-year use of mental health services in both the specialty mental health and general medical sectors by adults aged 55+ (N = 12,792). Logistic regression analyses examined predictors of service use among those with anxiety disorders (N = 279) and clinically significant anxiety symptoms (N = 880).

Results: Only 20.8% of older adults with an anxiety disorder and no mood disorder used services in the past year, compared to 43.1% of those with a mood disorder and 72.7% of those with comorbid disorders. In the final logistic regression models, only need variables were significant predictors of service use among older adults with anxiety disorders and among those with significant anxiety symptoms.

Conclusion: Findings indicate that anxious older adults are less likely to use mental health services than those who are depressed. While predisposing and enabling factors do not appear to impede service use, the need for help does. Anxious older adults and those they interact with may not be interpreting their anxiety symptoms as warranting services.     

Validation of a short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ) in adolescents and young adults

The Mood and Anxiety Symptoms Questionnaire (MASQ) was developed to measure the symptom-dimensions of the tripartite model of anxiety and depression. A 30-item short adaptation of the MASQ (MASQ-D30) was previously developed and validated in adult psychiatric outpatients. The aim of the present study was to evaluate the validity and reliability of the MASQ-D30 in a sample of adolescents and young adults. Help-seeking adolescents from Australia (N=147; mean age: 17.7 years; 58.8% female) completed the original, 90-item MASQ. Confirmatory Factor Analysis (CFA) was used to evaluate the construct validity (a 3-factor structure) of the original MASQ and the MASQ-D30. Internal consistencies and correlations with other instruments were calculated and compared between versions. CFA showed that the intended 3-factor structure fit adequately to the MASQ-D30 data (CFI=0.95; RMSEA=0.08). Internal consistencies ranged from 0.85 to 0.92 across the scales and patterns of correlations with the Center for Epidemiological Studies-Depression (CES-D) indicated adequate convergent/divergent properties. Importantly, the observed psychometric characteristics were comparable with the original MASQ and alternative short-forms. Results indicated that the MASQ-D30 is a valid and reliable instrument in young people, allowing for quick assessment of the tripartite dimensions of depression and anxiety.     

Anxiety and depressive disorders in offspring at high risk for anxiety: A meta-analysis

This paper presents a meta-analysis of studies examining prevalence of psychopathology among offspring of anxiety-disordered parents, with the purpose of determining overall risk among these offspring for developing anxiety and depressive disorders. Pooled odds ratios for these disorders among high-risk offspring, compared to offspring of psychiatric and non-psychiatric controls, were calculated. Sixteen papers (including three follow-up studies) were identified, encompassing 1892 offspring (ages 4–25 years). Results revealed that: (1) offspring of parents with anxiety disorders have greater risk for anxiety and depressive disorders than offspring of non-psychiatric controls (ORs = 3.91 and 2.67, respectively) and greater risk for anxiety disorders than offspring of psychiatric controls (OR = 1.84); (2) offspring of anxious parents have significantly greater odds of having each type of anxiety disorder and MDD compared to offspring of non-psychiatric controls (ORs range from 1.96 to 8.69); and (3) offspring of parents with anxiety only, anxiety plus MDD, and MDD only have similar odds of having anxiety and depressive disorders but significantly higher odds than offspring of parents without disorder. Results suggest that parental anxiety disorders confer significant risk for anxiety and depression in offspring. Additional studies are needed to examine whether there are differences among specific parental anxiety disorders.     

Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey

European Child & Adolescent Psychiatry - We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used...     

Anxiety disorders and depression among high school adolescents and youths in Nigeria: Understanding differential effects of physical abuse at home and school

Despite the exposure of children to physical abuse in more than one setting in many regions of the world, little is known about the associations of physical abuse in different settings (e.g., at home and school) with anxiety disorders and depression among adolescents and youths. Using a convenience sample of 502 adolescents and youths ages 13–23 years from five public and three private senior secondary schools in Nigeria, the study examined associations of gender and physical abuse by parents with anxiety disorders as well as associations of physical abuse by parents and/or teachers with depression in the sample, 39.6% of whom had experienced physical abuse at home and in school. Findings suggest that physical abuse by parents was associated with anxiety disorders and depression than physical abuse by teachers. Being female was equally associated with anxiety disorders. Implications of findings for mental health, practice, research, and theory are discussed.     

Mental disorders and mental health care in Canada and Australia: comparative epidemiological findings

Background  Canada and Australia although geographically distant have similarities in human geography and history. Each has had a national mental health policy for some years, but Australia has driven policy implementation in this area harder than has Canada. Comparable epidemiological surveys from Australia in 1997 and Canada in 2002 allow us to explore relative rates of mental disorders and compare estimates of access to care from mental health services. Methods  We compare findings from the Australian National Survey of Mental Health and Wellbeing (1997) with those from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (2002). Results  Differences in prevalence rates and in service utilisation emerge between the two countries: Anxiety Disorders are estimated as almost 2% higher in Canada than in Australia while there is suggestion that Major Depressive Disorder, Alcohol Dependence and Drug Dependence may be more prevalent in Australia. More of the people with co-morbid disorders in Australia than in Canada make use of mental health services and a finding of marginal significance suggests that this may be true across all disorders. Conclusions  Causation cannot be determined from this study but possible explanations for differences in prevalence include changes in global economic, political and security contexts and concerns between 1997 and 2002 and the possible role of greater availability of alcohol in Australia. The findings also provide encouragement that strenuously implementing a national mental health policy may have been of benefit to people with mental health problems in Australia.