Mental Health Surveillance Among Children — United States, 2005–2011

The following is a summary and introduction of a large report with references to numerous other report and research on various topics related to childrens’ mental health issues, e.g., autism, developmental disabilities, etc. Check out the web reference for the full report: Mental Health Surveillance Among Children — United States, 2005–2011

Supplements
May 17, 2013 / 62(02);1-35

Summary
Mental disorders among children are described as "serious deviations from expected cognitive, social, and emotional development" (US Department of Health and Human Services Health Resources and Services Administration, Maternal and Child Health Bureau. Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, and National Institutes of Health, National Institute of Mental Health; 1999). These disorders are an important public health issue in the United States because of their prevalence, early onset, and impact on the child, family, and community, with an estimated total annual cost of $247 billion. A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing. Suicide, which can result from the interaction of mental disorders and other factors, was the second leading cause of death among children aged 12–17 years in 2010. Surveillance efforts are critical for documenting the impact of mental disorders and for informing policy, prevention, and resource allocation. This report summarizes information about ongoing federal surveillance systems that can provide estimates of the prevalence of mental disorders and indicators of mental health among children living in the United States, presents estimates of childhood mental disorders and indicators from these systems during 2005–2011, explains limitations, and identifies gaps in information while presenting strategies to bridge those gaps.

Attention-deficit/hyperactivity disorder (6.8%) was the most prevalent parent-reported current diagnosis among children aged 3–17 years, followed by behavioral or conduct problems (3.5%), anxiety (3.0%), depression (2.1%), autism spectrum disorders (1.1%), and Tourette syndrome (0.2% among children aged 6–17 years). An estimated 4.7% of adolescents aged 12–17 years reported an illicit drug use disorder in the past year, 4.2% had an alcohol abuse disorder in the past year, and 2.8% had cigarette dependence in the past month. The overall suicide rate for persons aged 10–19 years was 4.5 suicides per 100,000 persons in 2010. Approximately 8% of adolescents aged 12–17 years reported ≥14 mentally unhealthy days in the past month.

Future surveillance of mental disorders among children should include standard case definitions of mental disorders to ensure comparability and reliability of estimates across surveillance systems, better document the prevalence of mental disorders among preschool-age children, and include additional conditions such as specific anxiety disorders and bipolar disorder. Standard surveillance case definitions are needed to reliably categorize and count mental disorders among surveillance systems, which will provide a more complete picture of the prevalence of mental disorders among children. More comprehensive surveillance is needed to develop a public health approach that will both help prevent mental disorders and promote mental health among children.

Introduction
Mental health in childhood is characterized by the achievement of development and emotional milestones, healthy social development, and effective coping skills, such that mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities (1–3). In this report, children are defined as persons aged <18 years, and adolescents are persons aged 12–17 years. In children, mental disorders are described as "serious deviations from expected cognitive, social, and emotional development" (4) and include conditions meeting criteria described by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) (5) or the International Classification of Diseases (ICD) (6,7). Recently the term mental, emotional, or behavioral disorders has been used to refer to diagnosed mental or substance use disorders (6).

Mental disorders among children are an important public health issue because of their prevalence, early onset, and impact on the child, family, and community. A total of 13%–20% of children living in the United States experience a mental disorder in a given year (6,8–10). Suicide, which can result from the interaction of mental disorders and other factors, was the second leading cause of death among children aged 12–17 years in 2010 (11). In the United States, the cost (including health care, use of services such as special education and juvenile justice, and decreased productivity) of mental disorders among persons aged <24 years in the United States was estimated at $247 billion annually (6,12,13). In 2006, mental disorders were among the most costly conditions to treat in children (14).

Two recent studies have reported substantial increases in use of services for mental disorders among children. One study included insurance claims from approximately 20% of the privately insured U.S. population aged <65 years with private insurance and weighted the data to reflect a national estimate. This study reported a 24% increase in inpatient mental health and substance abuse admissions among children during 2007–2010, as well as increases in use and cost of these services and psychotropic medications for teenagers specifically over the same period (15). A second nationally representative study, which used data on principal diagnoses for hospital stays in the United States from the Healthcare Cost and Utilization Project, reported that in 2010, mood disorders were among the most common principal diagnoses for all hospital stays among children in the United States, and the rate of hospital stays among children for mood disorders increased 80% during 1997–2010, from 10 to 17 stays per 10,000 population (16).

For some children, mental disorders might result in serious difficulties at home, with peer relationships, and in school (17–19). These disorders also can be associated with substance use, criminal behavior, and other risk-taking behaviors (20–22). Persons with mental disorders frequently have more than one type of disorder, with an estimated 40% of children with one mental disorder having at least one other mental disorder (23–26). Children with mental disorders also more often have other chronic health conditions (e.g., asthma, diabetes, and epilepsy) than children without mental disorders (6,26–30). Finally, mental disorders in children are associated with an increased risk for mental disorders in adulthood (6), which are associated with decreased productivity, increased substance use and injury, and substantial costs to the individual and society (31,32).

This report, which complements a 2011 report that focused on CDC surveillance of mental illness among adults in the United States (31), describes ongoing independent federal surveillance systems, each addressing different health issues and varying populations, that are used to estimate the prevalence of mental disorders and indicators of mental health among children in the United States and highlights selected national prevalence estimates. Availability of state-based estimates is noted in the surveillance descriptions and tables. Surveillance data from multiple federal agencies, including CDC, the Health Resources and Services Administration (HRSA), and the Substance Abuse and Mental Health Services Administration (SAMHSA), are included. Mental health conditions included in this report include those covered in DSM-IV-TR for which there were recent or ongoing surveillance data collected, including attention-deficit/hyperactivity disorder (ADHD), disruptive behavioral disorders such as oppositional defiant disorder (ODD) and conduct disorder, autism spectrum disorders (ASDs), mood and anxiety disorders including depression, tic disorders, and substance use disorders. Although some consider substance use disorders to be a group of disorders that is distinct from mental disorders, this report refers to substance use disorders as they are referred to in DSM-IV-TR and within the Institute of Medicine (IOM) definition of mental, emotional, and behavioral disorders (5,6). Selected indicators of mental health, including mentally unhealthy days and suicide, also were assessed.

 

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