Prudence Fisher

The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, Acceptability, Prevalence Rates, and Performance in the MECA Study

OBJECTIVE To describe the NIMH Diagnostic Interview Schedule for Children (DISC) Version 2.3 and to provide data on its performance characteristics in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. METHOD Data were collected on the DISC-2.3 at four sites on 1,285 randomly selected children, aged 9 through 17 years, and their parents. Two hundred forty-seven of these child-parent pairs were reassessed on the DISC-2.3 by a clinician interviewer, 1 to 3 weeks later. RESULTS Administration time was approximately 1 hour and the interview was acceptable to more than 90% of subjects. The reliability of questions to parents assessing impairment and age of onset was generally good to acceptable for most diagnoses but was less satisfactory for the child interview. Using information from parent and child, the prevalence for any diagnosis ranged from 50.6 if no impairment criteria were required to 5.4 if a Global Assessment Scale score of 50 or less was necessary. The prevalence of anxiety disorders and enuresis was markedly reduced by requiring attributable impairment. CONCLUSIONS The DISC-2 is a reliable and economical tool for assessing child psychopathology. Reliability of the DISC-P-2.3 is superior to that of the child DISC for most diagnoses but is least good for anxiety disorders. The 2.3 version of the instrument provides a significant improvement over earlier versions.

Prevalence and Treatment of Mental Disorders Among US Children in the 2001–2004 NHANES

OBJECTIVE: This article presents the 12-month prevalence estimates of specific mental disorders, their social and demographic correlates, and service use patterns in children and adolescents from the National Health and Nutrition Examination Survey, a nationally representative probability sample of noninstitutionalized US civilians. METHODS: The sample includes 3042 participants 8 to 15 years of age from cross-sectional surveys conducted from 2001 to 2004. Data on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for mental disorders were derived from administration of selected modules of the National Institute of Mental Health Diagnostic Interview Schedule for Children, version IV, a structured diagnostic interview administered by lay interviewers to assess psychiatric diagnoses of children and adolescents. RESULTS: Twelve-month prevalence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–defined disorders in this sample were 8.6% for attention-deficit/hyperactivity disorder, 3.7% for mood disorders, 2.1% for conduct disorder, 0.7% for panic disorder or generalized anxiety disorder, and 0.1% for eating disorders. Boys had 2.1 times greater prevalence of attention-deficit/hyperactivity disorder than girls, girls had twofold higher rates of mood disorders than boys, and there were no gender differences in the rates of anxiety disorders or conduct disorder. Only approximately one half of those with one of the disorders assessed had sought treatment with a mental health professional. CONCLUSION: These data constitute a first step in building a national database on mental health in children and adolescents.

Psychopathology Associated With Suicidal Ideation and Attempts Among Children and Adolescents

OBJECTIVE To identify the independent and differential diagnostic and symptom correlates of suicidal ideation and suicide attempts and determine whether there are gender- and age-specific diagnostic profiles. METHOD The relationships between suicidal ideation, suicide attempts, and psychiatric disorders were examined among 1,285 randomly selected children and adolescents, aged 9 to 17 years, of whom 42 had attempted suicide and 67 had expressed suicidal ideation only. Youths and their parents were interviewed as part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, using the Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3). RESULTS Logistic regression analyses indicated that mood, anxiety, and substance abuse/dependence disorders independently increased the risk of suicide attempts, after controlling for sociodemographic characteristics. There was no significant independent contribution of disruptive disorders to suicide attempts, although its association with suicidal ideation was significant. Substance abuse/dependence independently differentiated suicide attempters from ideators. Noncriterion symptoms that remained significant predictors of suicide risk, after adjusting for psychiatric disorder, included panic attacks and aggressiveness. Perfectionism did not significantly increase suicide risk after adjusting for psychiatric disorder. The association of specific disorders and noncriterion symptoms with suicidality varied as a function of gender and age. CONCLUSION A monolithic diagnostic risk profile for suicidality, ignoring gender- and age-specific risks, is inadequate. The contribution of substance abuse/dependence in the escalation from suicidal thoughts to suicide attempts is underscored.

Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Preventing Teenage Suicide: A Critical Review

Abstract This paper reviews the risk factors for suicide in teenagers to which prevention procedures could rationally be directed. A range of suicide preventive interventions, including hotline and crisis services, school based educational and screening procedures, effective treatment of suicide attempters, minimizing opportunities for suicide imitation, and controlling access to the methods most often used to commit suicide are described, and evidence for their efficacy is presented. Most suicides among teenagers occur in those with identifiable mental or character disorders, and increasing knowledge about risk factors may facilitate prediction in the future. The evidence for the efficacy of any existing intervention, however, is slender, and there is a clear need for more effective research into the management of high-risk groups.

The diagnostic interview schedule for children-revised version (DISC-R). I: Preparation, field testing, interrater reliability, and acceptability

OBJECTIVE To describe the history and assessment strategies used to investigate and revise the Diagnostic Interview Schedule for Children (DISC), a highly structured interview form used by lay interviewers to elicit diagnostic criteria for the common psychiatric disorders of childhood and adolescence. METHOD Revision was based on clinical and community data that identified unreliable and undiscriminating items in an earlier version of the instrument (DISC-1). A field study was carried out with 74 parent-child pairs. Interrater reliability and acceptability to patients was high. Accompanying papers describe the test-retest and construct validity of the instrument. CONCLUSIONS Taken together, the findings suggest that the DISC is an acceptable, brief, inexpensive, and convenient instrument for ascertaining a comprehensive range of child and adolescent diagnoses whose methodological properties are comparable with other child diagnostic instruments.

Criterion Validity of the NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3)

OBJECTIVE To examine the criterion validity of the NIMH Diagnostic Interview Schedule for Children (DISC) Version 2.3 in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, using a design that permitted several comparisons of DISC-generated diagnoses with diagnoses based on clinician symptom ratings. METHOD Two hundred forty-seven youths were selected from the 1,285 parent-youth pairs that constituted the four-site MECA sample. Subjects who screened positive for any of the five diagnostic areas under investigation in the validity study (attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, depressive disorder, and the major anxiety disorders) were recruited, as well as a comparable number of screen negatives. Clinicians reinterviewed separately both the youth and the primary caregiver using the DISC followed by a clinical-style interview, and then they rated the presence of symptoms and impairment. Computer algorithms combined this information into diagnoses using comparable rules for both DISC and clinical rating diagnoses. RESULTS In general, the DISC showed moderate to good validity across a number of diagnoses. CONCLUSIONS Results suggest some specific diagnostic areas in which further revision of the DISC is warranted. Three main sources of variability in DISC-clinician diagnostic agreement were evident over and above that due to the instrument itself, including (1) the informant used, (2) the algorithm applied in synthesizing symptom reports, and (3) the design of the validity comparison.

The DISC Predictive Scales (DPS): Efficiently Screening for Diagnoses

OBJECTIVE To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry. METHOD Secondary data analysis of a large epidemiological data set (n = 1,286) produced a series of gate and contingent items for each diagnosis. Findings were replicated in a second retrospective analysis from a residential care sample (n = 884). The DISC Predictive Scales (DPS) were then used prospectively as a self-report questionnaire in two studies, in which parents (n = 128) and/or adolescents (n = 208) had subsequent diagnostic interviewing with the Diagnostic Interview Schedule for Children or the Schedule for Affective Disorders and Schizophrenia for School-Age Children. RESULTS All analyses showed that gate item selection was valid and that any missed cases were due solely to inconsistent reports on the same questions. Screening performance of the full scales was shown to be good, and substantial reductions in scale length were not associated with significant changes in discriminatory power. CONCLUSIONS The DPS can accurately determine subjects who can safely be spared further diagnostic inquiry in any diagnostic area. This has the potential to speed up structured diagnostic interviewing considerably. The full DPS can be used to screen accurately for cases of specific DSM-III-R disorders.

The Voice DISC-IV With Incarcerated Male Youths: Prevalence of Disorder

OBJECTIVES (1) To accurately assess rate of psychiatric disorder in incarcerated juveniles, and (2) to examine the feasibility of using a self-administered, comprehensive structured psychiatric assessment with those youths. METHOD In 1999-2000, 292 recently admitted males in secure placement with New Jersey and Illinois juvenile justice authorities provided self-assessments by means of the Voice Diagnostic Interview Schedule for Children-IV, a comprehensive, computerized diagnostic instrument that presents questions via headphones. RESULTS Assessments were well tolerated by youths, staff, and parents; 92% of approached youths agreed. Rates of disorder were comparable to prior diagnostic assessment studies with interviewers. Beyond expectable high rates of disruptive and substance use disorders, youths reported high levels of anxiety and mood disorders, with over 3% reporting a past-month suicide attempt. Youths with substance use disorder were significantly more likely to be incarcerated for substance offenses than were youths with no disorder or those with other, non-substance use disorders. CONCLUSIONS Although the study identified rates of disorder generally comparable to those of prior investigations, some differences, understandable in the context of measurement variations, are apparent. Those variations offer recommendations for mental health assessment practices for youths in the justice system that would include using a comprehensive self-report instrument, pooling across parent and youth informants for certain disorders, focusing on current disorder, and flexibility regarding consideration of impairment.

The epidemiology of suicide in children and young adolescents

Abstract Suicidal behavior in children and adolescents was investigated using an epidemiological approach that compared different age groups. After taking into account the probable biases in suicide statistics, we conclude that the suicide rate in children has in general remained at a very low level, and secular changes in the rate of adolescent suicide may be part of a more general “cohort” effect rather than age-specific. Secular changes and cross-cultural comparisons are also discussed with respect to different etiological models of suicide, and possible “protective” factors are considered to explain the low incidence of suicide in young children.