Joseph M. Rey

The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being

Objective: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4–17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems. Method: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess healthrelated quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours. Results: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25%% of those with mental health problems had attended a professional service during the six months prior to the survey. Conclusion: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders.

Health-Related Quality of Life of Children and Adolescents With Mental Disorders

OBJECTIVE To compare the health-related quality of life (HRQL) between children aged 6-17 years with one of three mental disorders (attention-deficit/hyperactivity disorder, major depressive disorder, or conduct disorder), a physical disorder, and those with none of these disorders. METHOD Parent reports describing the HRQL, mental disorders, and physical disorders of a national sample of 3,597 children and adolescents in Australia, aged 6-17 years (response rate = 70%), were obtained by means of a structured diagnostic interview and questionnaires. RESULTS After controlling for age, gender, and family structure, children with mental disorders were reported to have a significantly worse HRQL in several domains than children with no disorder. In many areas they were reported to have a worse HRQL than children with physical disorders. Parents also reported that the problems of children with mental disorders interfered significantly with the daily lives of children, parents, and families. CONCLUSIONS The findings are consistent with previous studies which have reported that adults with mental disorders have substantial impairment in their HRQL. The findings suggest that children with a mental disorder require help in many areas of their lives. Achieving this will require an integrated approach to health care delivery rather than the current distinction between physical and mental health services.

Characteristics of Adolescents with School Refusal

Objective: To describe the characteristics of young people presenting with school refusal to a child and adolescent psychiatric unit and examine differences between those admitted for inpatient treatment and the rest. Method: One hundred and ninety-two adolescents who had been assessed or treated for school refusal between 1994 and 1998 at the Rivendell Unit, Sydney, Australia were identified. An instrument was developed and used to gather data from files. Diagnoses were made by the consensus of two of the investigators using DSM IV criteria from all sources of information. Results: The commencement of school refusal generally occurred in the first 2 years of high school. School refusers had a high prevalence not only of anxiety, but also of mood and disruptive behaviour disorders. A family history of psychiatric illness was present in over half the sample. There were no differences between those subsequently admitted as inpatients and the rest in terms of symptom scores, family composition, family conflict, family separation or history of abuse. Those admitted for inpatient treatment were more likely to have a diagnosis of mood disorders and comorbid diagnoses and to have a maternal history of psychiatric illness. Conclusions: School refusal in adolescence can be a symptom of a variety of disorders, particularly anxiety and mood disorder. Treatment programs need to be geared to the range of diagnoses which occur in this patient group and to the various circumstances associated with the onset of the problem.

Parent-Child Agreement on Children's Behaviours Reported by the Child Behaviour Checklist (CBCL).

The authors examined agreement between parent and child ratings on the Child Behaviour Checklist in a sample of 1299 referred adolescents over a period of three years. Correlations ranged between 0.72 and 0.08 (mean = 0.28), while agreement using kappa was similar but slightly lower (mean = 0.24; range 0.71-0.07). Agreement on externalizing was higher than on internalizing items, and concordance increased with age for boys, while there were no differences in parent-child agreement between boys and girls. Agreement was higher for dimensions of behaviour, e.g. depression (r = 0.40).

Cannabis and mental health

Papers pp 1195, 1199, 1212 In the 1990s the use of cannabis increased much among young people so that it is now becoming more common than tobacco smoking in some countries.1–2 The ready availability of the drug, the increasing social disapproval of cigarette smoking, stern drink driving laws, and perceptions that cannabis is safe or less harmful than cigarettes or alcohol may explain these changes. The increase in use is of concern because cannabis may be a gateway to other drugs,3 and it may cause psychiatric illnesses. The link between cannabis and psychosis is well established, and recent studies have found a link between use of marijuana and depression.3–7 Does cannabis cause these conditions, or do patients use cannabis to relieve their distress? The explanation most accepted is that cannabis triggers the onset or relapse of schizophrenia in predisposed people and also exacerbates the symptoms generally. 4 5 Establishing direction of causality is difficult and is most appropriately assessed in non-clinical samples, but a low incidence of the illness and the fact that most drug users take …

Juvenile obsessive—compulsive disorder

Objective: To describe the characteristics of a series of children and adolescents with obsessive—compulsive disorder (OCD) and evaluate the outcome of treatment. Method:Type of symptoms, severity before and after treatment and factors associated with outcome were examined in a large group (n = 82) of consecutive OCD cases referred for treatment. Results:Most children (95%) had both obsessions and compulsions. Symptoms had been present for 2 years on average. Seventy-one per cent (n = 57) of all eligible patients completed a combined behavioural and pharmacological protocol. Among these, there was a 68% remission rate and a 60% decrease of symptoms at 4 weeks. Comorbidity with oppositional defiant disorder and high aggression scores were associated with poor outcome. Conclusions:Juvenile OCD can be treated effectively in a standard clinical setting. Treatment programs of the kind described are accepted by young people. It remains to be seen whether in this age group a combined treatment produces better results than medication alone or cognitive—behaviour therapy alone.

The validity of the DSM-IV subtypes of attention-deficit/hyperactivity disorder

Objective: To examine the validity of the three subtypes of ADHD defined by DSM-IV. Method: Studies published in English were identified through searches of literature databases. Results: Estimates of the prevalence of ADHD have increased as a result of the introduction of DSM-IV criteria. Factor analytical and genetic studies provide some support for the validity of the distinction between the three subtypes. However, diagnosis of the combined subtype seems more reliable than the other two subtypes, although reliability is largely unknown for the latter. The hyperactive-impulsive subtype, the least common, differs from the other two subtypes in age distribution, association with other factors and neuropsychological parameters. Almost all treatment trials are based on participants with the combined type. Conclusion: Data supporting the validity of the inattentive and hyperactive-impulsive subtypes of ADHD a decade after the publication of DSM-IV are still scarce. Given that inattention is the hypothesized core ADHD symptom, it remains to be demonstrated that hyperactive-impulsive children who are not inattentive have the same condition. One of the main research deficits refers to data on treatment of the inattentive and hyperactive impulsive subtypes.

An epidemiological study of the use of ECT in adolescents

OBJECTIVE There is little knowledge about the use of electroconvulsive therapy (ECT) in adolescents. Given the prevalence and severity of psychiatric disorders in this age group, it is important to determine the frequency, indications, effectiveness, and side effects of ECT. METHOD Persons younger than 19 years who received ECT between 1990 and 1996 in the Australian state of New South Wales were identified. Detailed information about diagnosis, treatment, and outcome was then obtained. RESULTS Forty-two patients aged 14 to 18 years underwent a total of 49 courses comprising 450 ECTs (0.93% of all treatments given to all persons). Marked improvement or resolution of symptoms occurred in half of the completed courses. Mood disorders derived most benefit from ECT. Side effects were transient and minor. Prolonged seizures were observed in 0.4% of treatments. Comorbid personality disorder predicted poorer response, and the anesthetic propofol was associated with shorter seizures. CONCLUSIONS Although ECT is an effective treatment for some mental disorders in adolescents and has few side effects, it is seldom used. Indications, response, and unwanted effects were similar to those observed in adults. The use of propofol may reduce the risk of prolonged seizures.

Oppositional Disorder: Fact or Fiction?

Abstract The authors found that 36 patients from a series of 283 referrals to an adolescent unit met DSM-III criteria for Oppositional Disorder (OD). The kappa coefficient of agreement for OD between two clinicians making independent diagnoses in that series was 0.52. There seemed to be considerable overlap among OD, Conduct Disorder, and Adjustment Disorder. A comparison between a group of 25 adolescents with a single diagnosis of OD and a group of 43 adolescents diagnosed as suffering only from Conduct Disorder showed significant differences in measures of social functioning and on scores of the overall level of disturbance. J. Am. Acad. Child Adolesc. Psychiatry , 1988. 27. 2:157–162.

Electroconvulsive therapy in adolescents: experience, knowledge, and attitudes of recipients.

OBJECTIVE To ascertain the experience, knowledge, and attitudes regarding electroconvulsive therapy (ECT) of persons who received the treatment in adolescence. METHOD A 53-item survey was administered by telephone to persons who received ECT before the age of 19 years in the Australian state of New South Wales between 1990 and 1998. RESULTS Twenty-six patients were interviewed. Experiences and opinions about ECT were generally positive. Fifty percent stated ECT had been helpful. Approximately three quarters believed their illness was worse than either ECT or pharmacotherapy. Frequencies of recalled side effects with ECT and medication were similar. Some patients perceived deficiencies in the consent process. A slight majority had attempted to conceal the history of ECT treatment. The vast majority considered ECT a legitimate treatment and, if medically indicated, would have ECT again and would recommend it to others. CONCLUSIONS The findings are consistent with and complement evidence showing ECT to be an effective and safe treatment for seriously ill adolescents. The mostly favorable experiences and attitudes reported by interviewees will be reassuring to adolescent patients, their families, and treating health professionals when ECT is being considered.