Michael Sawyer

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.

Validity of DSM-IV ADHD Subtypes in a Nationally Representative Sample of Australian Children and Adolescents

ABSTRACT Objective To examine the discriminant validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) subtypes in a nationally representative sample of Australian youths. Method The Diagnostic Interview Schedule for Children, including the symptom-specific impairment questions, was administered to 3,597 parents of children aged 6 to 17 years (response rate=70%). Parents also completed questionnaires assessing childrens emotional and behavioral problems and quality of life. Results Current DSM-IV ADHD prevalence was 7.5% (6.8% with impairment) with inattentive types being more common than hyperactive-impulsive and combined types. ADHD was more prevalent among young males and was linked to social adversity, particularly for combined types. Compared with non-ADHD controls, all three ADHD subtypes were rated as having more emotional and behavioral problems and lower psychosocial quality of life, with combined types consistently rated the most impaired. Combined types received higher ratings than hyperactive-impulsive and inattentive types on externalizing behavior problems, disruption to family activities, and symptom-specific impairments with schoolwork and peer-related activities. Inattentive types were rated as having lower self-esteem, more social and school-related problems, but fewer externalizing problems than hyperactive-impulsive types. Conclusion These findings support the view of DSM-IV ADHD subtypes as distinct clinical entities with impairments in multiple domains.

The Generalizability of the Youth Self-Report Syndrome Structure in 23 Societies.

As a basis for theories of psychopathology, clinical psychology and related disciplines need sound taxonomies that are generalizable across diverse populations. To test the generalizability of a statistically derived 8-syndrome taxonomic model for youth psychopathology, confirmatory factor analyses (CFAs) were performed on the Youth Self-Report (T. M. Achenbach & L. A. Rescorla, 2001) completed by 30,243 youths 11-18 years old from 23 societies. The 8-syndrome taxonomic model met criteria for good fit to the data from each society. This was consistent with findings for the parent-completed Child Behavior Checklist (Achenbach & Rescorla, 2001) and the teacher-completed Teachers Report Form (Achenbach & Rescorla, 2001) from many societies. Separate CFAs by gender and age group supported the 8-syndrome model for boys and girls and for younger and older youths within individual societies. The findings provide initial support for the taxonomic generalizability of the 8-syndrome model across very diverse societies, both genders, and 2 age groups.

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.

Overweight, obesity and girth of Australian preschoolers: prevalence and socio-economic correlates

Objective:(1) To determine the prevalence of overweight and obesity in Australian 4–5-year-old children. (2) To investigate associations between socio-economic characteristics and (a) overweight/obesity and (b) waist circumference.Design:Cross-sectional population survey.Setting:Wave 1 (2004) of the Longitudinal Study of Australian Children.Participants:Nationally representative sample of 4983 4–5-year-old children (2537 boys and 2446 girls; mean age 56.9 months (s.d. 2.64 months; range 51–67 months)).Main outcome measures:Prevalence of overweight and obesity (International Obesity TaskForce definitions) and waist circumference (cm).Analysis:Prevalence estimates were obtained as weighted percentages. Uni- and multivariable ordinal logistic regression (using the proportional odds model) were used to assess associations between potential predictors and the risk of higher child body mass index status and a multivariable linear regression model to assess relationships between the same potential predictors and waist circumference.Results:15.2% of Australian preschoolers are estimated to be overweight and 5.5% obese. In univariate analyses, seven of the 12 variables were associated with higher odds of being in a heavier body mass index category. In a multivariable regression model, speaking a language other than English (particularly for boys), indigenous status and lower disadvantage quintile were the clearest independent predictors of higher body mass index status, with children in the lowest quintile of social disadvantage having 47% higher odds (95% CI 14, 92%) of being in a heavier body mass index category compared to those in the highest quintile. Waist circumference was not related to any socio-economic variable.Conclusions:This nationally representative survey confirms high rates of overweight and obesity in preschoolers throughout Australia. The recent emergence of a substantial socio-economic gradient should bring new urgency to public health measures to combat the obesity epidemic.

Lifetime exposure to environmental lead and children's intelligence at 11-13 years: the Port Pirie cohort study

Abstract Objective: To examine the association between environmental exposure to lead and childrens intelligence at age 11-13 years, and to assess the implications of exposure in the first seven years of life for later childhood development. Design: Prospective cohort study. Subjects: 375 children born in or around the lead smelting town of Port Pirie, Australia, between 1979 and 1982. Main outcome measure: Childrens intelligence quotient (IQ) measured at 11-13 years of age. Results: IQ was inversely associated with both antenatal and postnatal blood lead concentrations. Verbal, performance, and full scale IQ were inversely related to blood lead concentration with no apparent threshold. Multivariate analyses indicated that after adjustment for a wide range of confounders, the postnatal blood lead concentrations (particularly within the age range 15 months to 7 years) exhibited inverse associations with IQ. Strong associations with IQ were observed for lifetime average blood lead concentrations at various ages. The expected mean full scale IQ declined by 3.0 points (95% confidence interval 0.07 to 5.93) for an increase in lifetime average blood lead concentration from 0.48 to 0.96 µmol/l (10 to 20 µg/dl). Conclusions: Exposure to environmental lead during the first seven years of life is associated with cognitive deficits that seem to persist into later childhood. Key messages Few longitudinal data have yet been reported on the time course of the effects of exposure to environmental lead Exposure to environmental lead early in life is associated with cognitive deficits that persist into middle childhood The duration, intensity, and timing of exposure to lead, as well as other social and familial factors, may influence the nature and degree of reversibility The formulation of a public health policy for preventing any possible effects of lead exposure should be based on a composite consideration of the childs health and the best use of existing resources

Childhood cancer: a 4-year prospective study of the psychological adjustment of children and parents.

PURPOSE The objective of this 4-year prospective study was to assess the psychological adjustment of children treated for cancer and their parents. PATIENTS AND METHODS Children aged 2 to 12 years with cancer diagnosed and their parents and families (n = 39) were assessed immediately after their diagnosis and then annually for the next 4 years. At each assessment, the psychological adjustment of the children and their families was compared with the adjustment of a cohort of children and families in the general community (n = 49). RESULTS Immediately after the diagnosis of cancer in the children, the children and their parents had significantly more psychological problems than children and parents in the community. However, at subsequent assessments, there was no difference in the number of psychological problems experienced by children and parents in the two groups. CONCLUSIONS In the longer term, the prevalence of psychological problems experienced by children treated for cancer and their parents does not differ from that found in children and parents in the general community. Future research should give greater attention to other aspects of the lives of children treated for cancer and their parents, including their broader health-related quality of life.

The national survey of mental health and wellbeing: the child and adolescent component

Objective: This paper describes the Child and Adolescent Component of the National Survey of Mental Health and Wellbeing. Method: The aims of the study, critical decisions in planning for the study, progress to date and key issues which influenced the course of the study are described. Results: The Child and Adolescent Component of the National Survey of Mental Health and Wellbeing is the largest study of child and adolescent mental health conducted in Australia and one of the few national studies to be conducted in the world. Results from the study will provide the first national picture of child and adolescent mental health in Australia. Conclusions: Large-scale epidemiological studies have the potential to provide considerable information about the mental health of children and adolescents. However, having a clear set of aims, ensuring that the scope of the study remains within manageable proportions and paying careful attention to the details of fieldwork are essential to ensure that high-quality data is obtained in such studies.

Cross-Informant Agreement Between Parent-Reported and Adolescent Self-Reported Problems in 25 Societies

We used population sample data from 25 societies to answer the following questions: (a) How consistently across societies do adolescents report more problems than their parents report about them? (b) Do levels of parent–adolescent agreement vary among societies for different kinds of problems? (c) How well do parents and adolescents in different societies agree on problem item ratings? (d) How much do parent–adolescent dyads within each society vary in agreement on item ratings? (e) How well do parent–adolescent dyads within each society agree on the adolescents deviance status? We used five methods to test cross-informant agreement for ratings obtained from 27,861 adolescents ages 11 to 18 and their parents. Youth Self-Report (YSR) mean scores were significantly higher than Child Behavior Checklist (CBCL) mean scores for all problem scales in almost all societies, but the magnitude of the YSR–CBCL discrepancy varied across societies. Cross-informant correlations for problem scale scores varied more across societies than across types of problems. Across societies, parents and adolescents tended to rate the same items as low, medium, or high, but within-dyad parent–adolescent item agreement varied widely in every society. In all societies, both parental noncorroboration of self-reported deviance and adolescent noncorroboration of parent-reported deviance were common. Results indicated many multicultural consistencies but also some important differences in parent–adolescent cross-informant agreement. Our findings provide valuable normative baselines against which to compare multicultural findings for clinical samples.

The role of the family for behavioral outcome in children and adolescents following traumatic brain injury.

This study assessed the behavioral outcome of 51 children with traumatic brain injury (TBI) up to 2 years following injury. Children with severe injuries, but not those with mild or moderate injuries, were reported by parents to have a greater incidence of behavior problems following TBI. Regression analyses indicated that the presence of a partner for the primary caregiver of the child and the acute emotional reaction of the parent to the injury were both predictive of child behavioral outcome, although not by 2-year follow-up. These findings suggest that parental coping resources may impact on the development of child behavioral sequelae following TBI, emphasizing the role of the family in the childs response and the importance of supportive intervention.