Practitioner Review: How can epidemiology help us plan and deliver effective child and adolescent mental health services?

Institute of Health and Social Care, Peninsula College of Medicine and Dentistry, Exeter, UK.
Journal of Child Psychology and Psychiatry (Impact Factor: 6.46). 07/2008; 49(9):900-14. DOI: 10.1111/j.1469-7610.2008.01927.x
Source: PubMed


This review focuses on ways in which epidemiological research can inform mental health service development and clinical practice. Data from epidemiological studies can provide cross-sectional and secular estimates of the prevalence of psychopathology to support rational service development. Epidemiological surveys have difficulties in finding large enough samples of children with rare disorders, although these disorders are often severely debilitating and require extensive service input. Systematic surveillance provides a rigorous method for studying rare disorders and events. Only a minority of children with impairing psychopathology reach mental health services, although a larger proportion have mental health related contacts with other services. The gap in provision is such that an expansion of mental health services is unlikely to reach all children who could benefit, suggesting that mental health professionals need to develop innovative strategies to increase the number of children seen and the effectiveness of interventions that they receive. Training and supervision of non-mental-health professionals working with children in the identification and management of mental health problems is also extremely important. Most studies suggest that the children with the severest problems are getting to specialist mental health services, and service contact is more likely if important adults can perceive the child's difficulty or find it to be burdensome. The latter suggests that education of key adults would improve detection if services had the capacity to cope. Studies consistently suggest that the region in which the child lives affects the likelihood of service contact, but studies of other characteristics predicting service contact are so contradictory that studies should only be (cautiously) applied to similar populations to assess which types of children may currently be falling through gaps in service provision. Academics are beginning to explore the use of structured measures developed for epidemiological studies in clinical assessment and outcome monitoring.

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    • "21 Because of the impact of ADHD on patient and their family, the 22 disorder is likely to have significant economic implications for the 23 patient, family and society as a whole (Coghill et al., 2008; 24 Hakkaart-van Roijen et al., 2007; Pelham et al., 2007; Harpin, 2005; 25 Klassen et al., 2004). 26 It has been seen that despite the availability of evidence-based 27 treatments of psychiatric disorders in general and ADHD in 28 particular, there is low use of specialist services and only a 29 minority of children with mental health problems access specialist 30 mental health services (Ford, 2008; Canino et al., 2004; Sayal and 31 Taylor, 2004; Garralda, 2001). 32 Early identification and interventions are more important in 33 child psychiatric disorders like attention deficit hyperactivity 34 disorder, because delay in initiation of appropriate treatment, due 35 to any reason, often leads to poor outcome. "
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    ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is associated with impairment in all aspects of the patient's life. Despite availability of effective treatments for ADHD, a majority of the patient lack access to or have a significant delay in seeking help. This study aimed to assess the pathway of care in ADHD among patients attending the outpatient psychiatric services of a tertiary care centre in India. 57 newly registered cases of the age group 6-16 years with the diagnosis of ADHD as per DSM-IV-TR criteria were included in the study. Pathway of care was assessed on the semi structured proforma. The mean duration of delay in seeking help for ADHD symptoms was 3.96 Years (SD=1.96). Only 50% of the subjects consulted psychiatrists as first contact. Majority of the patients (45.61%) were referred by school teachers. Major reason given by the family members was that the patient was naughty rather than having any disorder for not seeking treatment in (89.47%). Our study showed that there was lack of recognition of ADHD at the level of other qualified practitioners and subsequent delay in referral to CAMHS. Sociocultural beliefs affected the help seeking by the parents. Copyright © 2015 Elsevier B.V. All rights reserved.
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    • "Two large community surveys have shown that up to 20% of Irish adolescents have signifi cant behavioural problems (Lynch et al., 2004; Martin et al., 2006), a fi gure consistent with results of epidemiological studies of youth mental health problems in other countries (Costello, 2004; Ford, 2008). In Ireland, young people with behavioural problems at risk for juvenile delinquency and their families may receive help and support from a range of services including the HSE, schools, educational support services, the Irish Youth Justice Service and various community agencies. "

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    • "Recent estimates suggest that depression will become the second leading medical cause of disability in the world by 2020 (World Health Organization, 2001), and that the prevalence rate is rising among young people (Collishaw, Maughan, Goodman, & Pickles, 2004). There is also evidence highlighting increasing rates of antisocial behavior problems among children and adolescents internationally (Ford, 2008). Depression and antisocial behavior often co-occur (Angold, Costello, & Erkanli, 1999), yet most research in the field of developmental psychopathology continues to focus on single problem behaviors with considerably less attention given simultaneously to multiple problem domains. "
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    ABSTRACT: Past research has identified maternal depression and family of origin maltreatment as precursors to adolescent depression and antisocial behavior. Caregiving experiences have been identified as a factor that may ameliorate or accentuate adolescent psychopathology trajectories. Using a multilevel approach that pools the unique attributes of two geographically diverse, yet complementary, longitudinal research designs, the present study examined the role of maternal caregiver involvement as a factor that promotes resilience-based trajectories related to depressive symptoms and antisocial behaviors among adolescent girls. The first sample comprises a group of US-based adolescent girls in foster care (n = 100; mean age = 11.50 years), each of whom had a history of childhood maltreatment and removal from their biological parent(s). The second sample comprises a group of UK-based adolescent girls at high familial risk for depression (n = 145; mean age = 11.70 years), with all girls having biological mothers who experienced recurrent depression. Analyses examined the role of maternal caregiving on girls' trajectories of depression and antisocial behavior, while controlling for levels of co-occurring psychopathology at each time point. Results suggest increasing levels of depressive symptoms for girls at familial risk for depression but decreasing levels of depression for girls in foster care. Foster girls' antisocial behavior also decreased over time. Maternal caregiver involvement was differentially related to intercept and slope parameters in both samples. Results are discussed with respect to the benefits of applying multilevel (multisample, multiple outcome) approaches to identifying family-level factors that can reduce negative developmental outcomes in high-risk youth.
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