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Estimates of Prevalence of Mental Health Conditions among Children and Adolescents in Texas March24,2016 MMHPI Page 2 Estimates of the Prevalence of Mental Health Conditions among Children and Adolescents in Texas Methodology • DrawingontheworkofDr.CharlesHolzer,aleadingpsychiatricepidemiologistand Galvestonresident,weareabletoapplyalgorithmsbasedonfindingsfromthebest nationalepidemiologicalstudiestoTexas’populationdata,inordertoestimatethenumber ofchildrenandadolescentswhohavesevereemotionaldisturbancesinagivenyear. • In2011,datawerepublishedfromthefirstevernationalepidemiologicalstudyof behavioraldisordersamongadolescents,theNationalComorbiditySurveyReplication– AdolescentVersion.WehaveappliedthesenationalleveldatatoTexas,inordertoexamine theprevalenceofspecifictypesofdisorders,aswellastheseverityofmentalhealth conditionsamongadolescents.1 FindingHighlights • Halfofallmentalhealthconditionsbeginbyage14. • Ina12-monthperiodtherearemorethanahalf-millionchildrenandadolescentswith severeemotionaldisturbances(SED)inTexas.SEDincludesmentalhealthconditions,such asattentiondeficitdisorders,conductdisordersanddepression,alongwithimpairedability tofunctionatschoolandathome.Thereareover300,000children/youthwithSEDlivingat orbelow200%ofthefederalpovertylevel. • Eachyear,morethan150,000adolescentsalone(ages13-17)copewithseriousdisorders. • AmongyouthwithSED,30,000areestimatedtoremaininthe“schooltoprisonpipeline,”if nothingisdonetohelpthem. 1 Epidemiologicaldataondiagnosesforyoungerchildrenareverylimited. MMHPI Page 3 PrevalenceofSelectedMentalHealthConditionsamongChildrenandAdolescentsinTexas2 Age TX12-month MentalHealthCondition Group Prevalence SevereEmotionalDisturbance3 0-17 545,453 0-17 304,429 13-17 157,126 At-Riskfor“SchooltoPrisonPipeline” 0-17 30,000 Schizophrenia ChildhoodOnset(beforeage13)6 AdolescentOnset(ages13-17)7 Depression4 BipolarDisorder4 Post-TraumaticStressDisorder4 ConductDisorder4 SubstanceUseDisorders4 Self-Injury/HarmingBehaviors8 0-12 13-18 13-17 13-17 13-17 13-17 13-17 13-17 127 4,512 160,877 41,200 76,515 105,944 162,839 186,382 Children/Adolescentsat/below200%FPL 4 SeriousDisorders–Adolescentsonly 5 2 AllprevalenceestimatesarebasedoneitherspecificalgorithmsappliedtoTexas(Holzeretal.,2015,cited below),orestimatesfromtheresearchliterature.Theseestimatesareappliedtopopulationestimatesfromthe AmericanCommunitySurvey,2013.Unlesswhereotherwiseindicated,ageofonsetestimatescomeKessler,R.C. etal.(2005).LifetimeprevalenceandageofonsetdistributionsofDSM-IVdisordersintheNationalComorbidity SurveyReplication.ArchivesofGeneralPsychiatry,62,593-768. 3 Holzer,C.,Nguyen,H.,Holzer,J.(2015).Texascounty-levelestimatesoftheprevalenceofseverementalhealth needin2012.Dallas,TX:MeadowsMentalHealthPolicyInstitute.Twentypercentaresubstanceusedisorders. 4 Kessler,R.C.,etal.(2011).Prevalence,persistenceandsociodemographiccorrelatesofDSM-IVdisordersinthe NationalComorbiditySurveyReplicationAdolescentSupplement.ArchivesofGeneralPsychiatry,E1-E-9.Kessler, R.C.,etal.(2012).Severityof12-monthDSM-IVdisordersintheNationalComorbiditySurveyReplication AdolescentSupplement.ArchivesofGeneralPsychiatry,69(4),381-389.(Theestimatefordepressionincludes majordepressionanddysthymia) 5 Fabelo,T.,etal.(2011,July).Breakingschoolrules:Astatewidestudyofhowschooldisciplinerelatestostudents’ successandjuvenilejusticeinvolvement.NewYork:TheCouncilofStateGovernmentsJusticeCenter. 6 Childhoodonsetschizophreniahasbeenestimatedtohaveaprevalenceofonein40,000childrenundertheage of13.SeeGochman,P.,Miller,R,&Rapoport,J.L.(2011).Childhood-onsetschizophrenia:Thechallengeof diagnosis.CurrPsychiatryRep,13(5),321-322. 7 Androutsos,C.(2012).Schizophreniainchildrenandadolescents:relevanceanddifferentiationfromadult schizophrenia.Psychiatriki,23(Supl),82-93.(OriginalarticleinGreek).Theestimateisthatamongadolescents ages13-18,0.23%meetcriteriaforthediagnosisofschizophrenia.AnotherstudyfromSwedenreportedthat 0.54%ofadolescentsweretreatedforpsychoticdisordersatleastonceduringtheagesof13-19:Gillberg,C.etal. (2006).Teenagepsychoses-epidemiology,classificationandreducedoptimalityinthepre-,per-,andneonatal periods.JournalofChildPsychologyandPsychiatry,27(1),87-98. 8 Muehlenkamp,J.J.,etal.(2012).Internationalprevalenceofadolescentnon-suicidalself-injuryanddeliberate self-harm,ChildandAdolescentPsychiatryandMentalHealth,doi:10.1186/1753-2000-6-10 MMHPI Page 4 AgesofOnsetofSelectedMentalHealthConditions9 50%haveonset byage: 25%haveonset byage: AllConditions MoodDisorders MajorDepressiveDisorder 14 30 32 7 18 19 Dysthymia(mild/moderatedepression) 31 17 BipolarDisorder Schizophrenia10 25 22 17 (nodata) MentalHealthCondition ChildhoodOnset(beforeage13)11 AdolescentOnset(ages13-17)12 AnxietyDisorders(selectedconditions) Post-TraumaticStressDisorder SeparationAnxietyDisorder SocialPhobia BehavioralDisorders(selectedconditions) ConductDisorder AttentionDeficitHyperactivityDisorder 13 Self-Injury/Harm(adolescentsonly) DrugAbuse (Childhood) (Adolescence) 11 23 7 13 11 13 7 Adolescence 19 6 15 6 8 6 10 7 17 9 Unlesswhereotherwiseindicated,ageofonsetestimatescomeKessler,R.C.etal.(2005).Lifetimeprevalence andageofonsetdistributionsofDSM-IVdisordersintheNationalComorbiditySurveyReplication.Archivesof GeneralPsychiatry,62,593-768. 10 Kessler,R.C.etal.(2007).Ageofonsetofmentaldisorders:Areviewofrecentliterature.CurrOpinPsychiatry, 20(4),359-364. 11 Childhoodonsetschizophreniahasbeenestimatedtohaveaprevalenceofonein40,000childrenundertheage of13.SeeGochman,P.,Miller,R,&Rapoport,J.L.(2011).Childhood-onsetschizophrenia:Thechallengeof diagnosis.CurrPsychiatryRep,13(5),321-322. 12 Androutsos,C.(2012).Schizophreniainchildrenandadolescents:relevanceanddifferentiationfromadult schizophrenia.Psychiatriki,23(Supl),82-93.(OriginalarticleinGreek).Theestimateisthatamongadolescents ages13-18,0.23%meetcriteriaforthediagnosisofschizophrenia.AnotherstudyfromSwedenreportedthat 0.54%ofadolescentsweretreatedforpsychoticdisordersatleastonceduringtheagesof13-19:Gillberg,C.etal. (2006).Teenagepsychoses-epidemiology,classificationandreducedoptimalityinthepre-,per-,andneonatal periods.JournalofChildPsychologyandPsychiatry,27(1),87-98. 13 Muehlenkamp,J.J.,etal.(2012).Internationalprevalenceofadolescentnon-suicidalself-injuryanddeliberate self-harm,ChildandAdolescentPsychiatryandMentalHealth,doi:10.1186/1753-2000-6-10 MMHPI Page 5 Twelve-MonthPrevalenceandSeverityofSelectedMentalHealthConditionsamongTexas Adolescents,Ages13-1714 Mild/ AllSeverity MentalHealthConditions15 Serious Moderate Levels AllDisorders(somenotlistedbelow)16 Depression 834,941 157,126 57,272 677,815 103,605 BipolarDisorder 12,566 28,634 Post-TraumaticStressDisorder 21,195 55,320 ConductDisorder 63,354 42,589 76,515 105,944 SubstanceUseDisorders 47,386 115,453 162,839 N/A 4,512 17 Schizophrenia ExperiencePsychoticSymptoms18 Self-Injury/HarmingBehaviors19 4,512 196,192 186,382 160,877 41,200 196,192 186,382 14 MostofthedataaredrawnfromtheNationalComorbiditySurveyReplication–AdolescentVersion,which focusesonages13-17.However,wenotewheredataaredrawnfromothersources.Pleasenotethatconditions overlap(are“comorbid”). 15 Disordersincludeallmentalhealthandsubstanceusedisorders.Allseverityestimates(“serious”vs.“mildand moderate”)aretakenfrom:Kessler,R.C.,etal.(2012).Severityof12-monthDSM-IVdisordersintheNational ComorbiditySurveyReplicationAdolescentSupplement.ArchivesofGeneralPsychiatry,69(4),381-389.Wehave notincludedalldiagnoses.Diagnosescanoverlap(canbe“comorbid”). 16 Alldisordersincludesomenotlistedbelow,butdonotinclude“ExperiencePsychoticSymptoms”and“SelfInjury/HarmingBehaviors”whicharenotdisorders. 17 Androutsos,C.(2012).Schizophreniainchildrenandadolescents:relevanceanddifferentiationfromadult schizophrenia.Psychiatriki,23(Supl),82-93.(OriginalarticleinGreek).Theestimateisthatamongadolescents ages13-18,0.23%meetcriteriaforthediagnosisofschizophrenia.AnotherstudyfromSwedenreportedthat 0.54%ofadolescentsweretreatedforpsychoticdisorders(abroaderbutoverlappingsetofconditions)atleast onceduringtheagesof13-19:Gillberg,C.etal.(2006).Teenagepsychoses-epidemiology,classificationand reducedoptimalityinthepre-,per-,andneonatalperiods.JournalofChildPsychologyandPsychiatry,27(1),87-98. Weareconsideringallschizophreniacasestobeserious. 18 Stevens,J.R.etal.(2014,March).Psychoticdisordersinchildrenandadolescents:Aprimeroncontemporary evaluationandmanagement.PrimCareCompanion,16(2),doi:10.4088/PCC.13f01514Stevensetalcitestudies thatfindanywherefrom9%to14%ofadolescentsindicatetheyhaveexperiencedpsychoticsymptoms.We conservativelyappliedthe10%figuretotheTexaspopulationof13to17yearolds.Stevensetal.alsonotedthat whilepsychoticsymptomsdonotindicateapersonmeetscriteriaforadiagnosablepsychoticdisorder,theyare stronglycorrelatedwithsuicideattempts. 19 Muehlenkamp,J.J.,etal.(2012).Internationalprevalenceofadolescentnon-suicidalself-injuryanddeliberate self-harm,ChildandAdolescentPsychiatryandMentalHealth,doi:10.1186/1753-2000-6-10.Whileweare definingallself-harmingandself-injurybehaviorsas“serious,”thesebehaviorsalonedonotconstituteadisorder, andthuswouldnotbeincludedintheNCSR-Aestimateof“seriousdisorders.”Notethatweusedanaverage12monthprevalenceestimateof9.5%acrossthestudiesreportedbyMuehlenkampetal. MMHPI Page 6 IncidenceandPrevalenceofSeriousMentalIllnessandSeriousEmotionalDisturbancesin ThreeLargeTexasCounties20 MentalHealthCondition 12-MonthPrevalence SevereEmotionalDisturbance(SED) AnySeriousDisorder 12-MonthIncidence(newcases) FirstEpisodeofPsychosis(notadiagnosis) Age Group Harris Dallas Bexar 0-17 13-17 92,006 25,179 53,482 13,945 37,523 10,744 15-34 678 381 280 20 Allestimatesarebasedonthecomparablestatewidefiguresprovidedinprevioustables.
