RELATED STUDIES

Four related studies, based on data from the National Comorbidity Survey Replication, appear in the June issue of Archives of General Psychiatry.

PREVALENCE AND SEVERITY OF MENTAL ILLNESS IN THE UNITED STATES

CHICAGO—Over the course of the previous 12 months, more than one-fourth of adults reported having symptoms that would qualify them for a diagnosis of a mental disorder; and most of those disorders can be classified as serious or moderate, according to a study in the June issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Although previous epidemiological surveys have estimated prevalence of mental disorders in the U.S. as high as 30 percent, information on severity and comorbidity (individuals with symptoms that meet criteria for two or more mental disorders at the same time) has not previously been available, according to background information in the article.

Ronald C. Kessler, Ph.D., of Harvard Medical School, and colleagues analyzed information on mental disorders in the United States collected from the U.S. National Comorbidity Survey Replication (NCS-R), a nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. The researchers determined the 12-month prevalence of different types of mental disorders (the percentage of individuals reported having symptoms that would represent a particular mental disorder in the course of the previous 12 months) as well as the level of severity of the disorder in that 12-month period and the likelihood that an individual qualifying in that 12-month period for a diagnosis for one mental disorder would also meet the criteria for at least one other (comorbidity).

The disorders were divided into four classes: anxiety disorders, including panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder; mood disorders, including major depressive disorder and bipolar disorder; impulse control disorder, including oppositional defiant disorder, attention deficit/hyperactivity disorder and intermittent explosive disorder; and substance abuse disorder, defined as alcohol and drug abuse and dependence. Severity was divided into three levels: serious, which might be defined by criteria including a serious suicide attempt or substantial work limitations as result of the disorder; moderate, which might defined by criteria including suicide ideation or substance abuse without serious impairment of functioning; and mild.

Based on data obtained from 9,282 adult respondents to the survey, the researchers determined that the 12-month prevalence for any disorder was 26.2 percent, with a 12-month prevalence of anxiety disorders of 18.1 percent; mood disorders, 9.5 percent; impulse control disorders, 8.9 percent and substance abuse disorders, 3.8 percent. Of the cases, 22.3 percent were classified as serious; 37.3 percent as moderate and 40.4 percent as mild. Fifty-five percent of individuals with a disorder met the criteria for only one disorder, 22 percent for two diagnoses and 23 percent for three or more diagnoses.

LIFETIME PREVALENCE AND AGE OF ONSET OF MENTAL ILLNESS IN THE UNITED STATES

Ronald C. Kessler, Ph.D., of Harvard Medical School, and colleagues determined that about half of Americans reported having symptoms that would qualify them for a diagnosis of a mental disorder over the course of their lifetime (lifetime prevalence), with most mental illness beginning in childhood or adolescence, based on their analysis of data from the National Comorbidity Survey Replication (NCS-R). Lifetime prevalence for the different classes of disorders were: anxiety disorder, 28.8 percent; mood disorders, 20.8 percent; impulse-control disorders, 24.8 percent; substance use disorders, 14.6 percent and lifetime prevalence for any disorder, 46.4 percent. Median age of onset is much earlier for anxiety and impulse-control disorders (11 years for both) than for substance use (20 years) and mood disorders (30 years), the researchers found. Half of all lifetime cases start by age 14 years and three fourths by age 24 years.

LONG DELAYS COMMON BETWEEN AGE OF ONSET AND FIRST TREATMENT OF MENTAL DISORDERS IN THE U.S.

Philip S. Wang, M.D., Dr.P.H., of Harvard Medical School, and colleagues determined that failure to make prompt initial treatment contact for mental health care is common in the United States, based on their analysis of data from the National Comorbidity Survey Replication (NCS-R). The researchers found that the vast majority of people with lifetime disorders eventually make treatment contact, particularly for those with mood disorders. Delay in making treatment contact ranges from six to eight years for mood disorders and nine to 23 years for anxiety disorders.

MANY INDIVIDUALS WITH MENTAL DISORDERS MAY BE UNTREATED OR POORLY

Philip S. Wang, M.D., Dr.P.H., of Harvard Medical School, and colleagues determined that only 41.1 percent of individuals with symptoms that qualify them for a diagnosis of a mental disorder in the previous 12 month period (12-month prevalence) were likely to receive any treatment, based on their analysis of data from the National Comorbidity Survey Replication (NCS-R). Of those who received treatment, 12.3 percent were treated by a psychiatrist, 16 percent by another mental health specialist, 22.8 percent by a general practitioner, 8.1 percent by a human services professional and 6.8 percent by a complementary or alternative medical provider. More patients in specialty than general medical treatment received treatment that exceeded a minimal threshold of adequacy. "Unmet need for treatment is greatest in traditionally underserved groups, including elderly persons, racial-ethnic minorities, those with low incomes, those without insurance, and residents of rural areas," the authors write.

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Media Advisory: To contact Danice K. Eaton, Ph.D., call Anita Blankenship at 770-488-5131. To contact editorial author, Alain Joffe, M.D., M.P.H., call Staci Vernick Goldberg at 410-516-4958.

PERCEPTIONS OF WEIGHT APPEAR TO BE A MORE IMPORTANT RISK FACTOR FOR SUICIDAL BEHAVIOR IN ADOLESCENTS THAN ACTUAL BODY WEIGHT

CHICAGO—How adolescents perceive their body weight may be more important than their actual weight in terms of increased likelihood of suicidal thoughts and attempts, according to a study in the June issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

The percentage of U.S. adolescents who are overweight has tripled during the past 20 years, from five percent in 1980 to 15 percent by 2000, according to background information in the article. Negative mental health outcomes are the most widespread health consequence associated with overweight and obesity in adolescents. Adolescents, particularly girls, who are overweight are at increased risk for considering suicide and suicide attempts. However, it is unclear whether one's actual weight or one's perception of body weight is a more important risk factor for suicidal behavior.

Danice K. Eaton, Ph.D., from the Centers for Disease Control and Prevention, Atlanta, and colleagues used data from the 2001 Youth Risk Behavior Survey (YRBS) to determine how body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) and perceived weight were associated with thoughts of suicide and suicide attempts in adolescents. Study participants (n = 13,601) were in grades nine through 12 from a national sample of schools. Students were asked whether they would describe their weight as very underweight, slightly underweight, about the right weight, slightly overweight, or very overweight. They were also asked whether they had seriously considered attempting suicide during the past 12 months, and how many times they had actually attempted suicide in the past 12 months.

The researchers found that the prevalence of self-reported suicidal ideation (i.e., seriously considering suicide in the past 12 months) was 14.2 percent for males and 23.6 percent for females, whereas the self-reported prevalence of attempting suicide in the past 12 months was 6.2 percent for males and 11.2 percent for females. When perceived weight was not taken into account, BMI was associated with suicidal ideation, with the odds of suicidal ideation greater among students who were underweight or overweight compared to those of normal weight. However, once perceived weight was taken into account, there no longer was an association between BMI and suicidal ideation but there was an association between perceived weight and suicidal ideation. Compared to students who perceived themselves as about the right weight, those who saw themselves as very underweight, slightly underweight, slightly overweight, or very overweight had a greater likelihood of suicidal thoughts. Similarly, among white and Hispanic students, BMI was associated with suicide attempts when perceived weight was not taken into account, but there was no longer an association between BMI and suicide attempts when perceived weight was taken into account. White students who perceived themselves as very underweight or very overweight were more likely to have attempted suicide compared to those who perceived themselves as about the right weight. Black and Hispanic students who perceived themselves as very underweight were more likely to have attempted suicide compared to those who perceived themselves as about the right weight.

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Media Advisory: To contact Paul L. Geltman, M.D., call Gina DiGravio at 617-638-8491.

RESETTLING THE "LOST BOYS OF SUDAN" IN THE UNITED STATES

CHICAGO—Although young unaccompanied Sudanese refugees settling in the United States have done well in general, they may have behavioral and emotional problems in their personal and home life, according to a study in the June issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Refugee children who are not accompanied by parents or family members when resettled in other countries seem to be at particularly high risk for symptoms of emotional distress related to their experiences with violence, according to background information in the article. In 2000, the U.S. began the resettlement of unaccompanied minors from a Kenyan refugee camp, a group called the "Lost Boys of Sudan" by the news media. As very young children in the Sudan in the 1980s, they had been forced to flee their burning villages as their parents and families were often killed. Seeking shelter in Ethiopia, an estimated 25,000 children trekked hundreds of miles across the savannah and desert, stalked by hyenas and lions. Expelled by force from Ethiopia in 1991, they fled to Kenya, fording rivers in which many drowned or were killed by crocodiles.

Paul L. Geltman, M.D., of Boston University School of Medicine, and colleagues assessed the functional and behavioral health of the unaccompanied Sudanese refugee minors approximately one year after resettlement in the United States. A sample of the refugees in foster care were interviewed using questionnaires, adapted from standardized questionnaires using feedback from foster parents, resettlement program staff and the children themselves, to assess trauma, coping and quality of life.

Of the 304 individuals who returned questionnaires, most had directly witnessed or were victims of war-related violence. Ninety-three percent of the youths reported that their villages had been attacked; many reported witnessing close friends or family members being tortured, injured or killed; 20 percent reported being tortured themselves. Although many of the children said they were at least a little comfortable with U.S. society and culture in general, many also expressed a desire for more detailed and ongoing orientation in social and cultural issues both before and after coming to the U.S.

The youths scored well on measures related to functioning at school and with peers. They tended to score less well on measures of general and mental health, family activities and family cohesion. A number of factors were associated with increased risk of post-traumatic stress disorder (PTSD) in the youths, including separation from immediate family, direct personal injury and head trauma. Experiences in the U.S. that increased risk of post-traumatic stress disorder included living in a group home or being in foster care alone with an American family, feeling lonely or isolated and less participation in group activities. Feeling safe at home and at school reduced the risk of post-traumatic stress disorder. "This suggests that relative levels of family and community engagement after arriving in the United States may mediate the ultimate impact of early trauma on later psychosocial functioning," the authors write.

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Media Advisory: To contact Alan Meyers, M.D., M.P.H., call Gina DiGravio at 617-638-8491.

HOUSING SUBSIDIES MAY HELP PREVENT CHILDREN'S UNDERNUTRITION

CHICAGO—The children of low-income families who receive public housing rent subsidies had greater weight for age, an indicator of better nutrition, than children whose families did not receive rent subsidies, according to a study in the June issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Poor families in the United States are increasingly unable to afford basic necessities, including food and shelter, according to background information in the article. Household food insecurity, defined as a household with limited or uncertain availability of enough food for an active healthy life, affects children's health and well-being. Poor families who receive housing subsidies may be protected from excessive pressure on their food budget compared to comparable poor families without subsidies, the authors suggest. The current study tested whether the nutritional status of low-income children, as measured by growth parameters (weight for age) and health status would be better among children whose families received housing subsidies.

Alan Meyers, M.D., M.P.H., of the Boston Medical Center, and colleagues assessed data from the Children's Sentinel Nutritional Assessment Program, which interviewed caregivers of children younger than three years in pediatric clinics and emergency departments in six sites, Arkansas, California, Maryland, Massachusetts, Minnesota and Washington, D.C. The child's weight was recorded at the time of the interview, which collected data including information on the family, the child's health, the U.S. Household Food Security Scale and public assistance participation.

Using data for 11,723 children of families who lived in rented housing and were identified as low-income, the researchers found that children of food-insecure families not receiving housing subsides had lower weight for age compared with children in food-insecure families receiving housing subsidies. "The importance of this measure derives both from its value as a public health indicator of nutritional and health status in populations of young children and from evidence that undernutrition in early childhood causes increased susceptibility to infectious disease as well as concurrent delayed mental development and later poor school performance and reduced intellectual capacity," the authors write.