Mental Health Concerns Are Nearly Universal By Age 21

Earlier this year a landmark study on the prevalence of psychological disorders in youth was published in the Journal of the American Academy of Child and Adolescent Psychiatry. Examining youth living in 11 counties in the southeastern US, it is the first to track kids’ mental health status from ages as young as 9 through age 21 (a total sample size of 1,420). The authors–Drs. William Copeland, Lilly Shanahan and E. Jane Costello and Ms. Adrian Angold–note some key findings in their report:

• Assuming that there was no incident of psychiatric disorders among the missing cases (an unlikely event), 70% of the sample met criteria for a mental health disorder, at some point, by age 21. (This is referred to as the unimputed number.)

• If one were to assume that the rates of psychiatric disturbance are the same among the missing cases, the frequency of a mental health disorder by age 21 rose to 82.5%. (This is referred to as the imputed number.)

• Child participants entered the study at one of three different ages: 9, 11 and 13. Among the youngest cohort (i.e., entered the study at age 9), the rates of having a diagnosable mental health problem by age 21 was “higher than 90%.” The authors note “This suggests that the experience of psychiatric illness is not merely common but nearly universal.”

• When examining the imputed analyses, these were the most common disorders: substance abuse–42%, behavioral disorders (e.g., ADHD, Oppositional Defiant Disorder)–23.5%, anxiety disorders–20.9% and mood disorders–14.8%.

While all research studies have their flaws, and this one is no exception (e.g., an under representation of African-American and Hispanic children), this study numbers among those contributing to the notion that mental health disorders and physical disorders, as they manifest in youth, have many similar characteristics:

• The odds of having at least one by adulthood are nearly universal.

• Most are not chronic or severe.

• Most can be cured or effectively managed through evidence-based interventions.

• Most will either worsen, or promote needless suffering, when they go unrecognized or untreated.

However, there is a key way that mental health and physical disorders in youth are substantively different. As the authors indicate: “Only about one in three individuals with a well-specified psychiatric disorder received any treatment at all, and even when treatment was obtained, it rarely conformed to best practice recommendations.” I find myself wondering when we will grow weary and intolerant of this needless suffering that our babies endure.

If you, as parent or caregiver, would like to find an ally in your neighborhood to help you to understand whether a child or teen under your charge could use help along these lines, click here. To read a consumer guide for child mental health services, see Chapter 10 in my book Working Parents, Thriving Families: 10 Strategies That Make a Difference.

You may also find value in reviewing posts I’ve written on related topics:

Affording Mental Health Care

Signs that a Kid Needs Mental Health Services

Seven Common Myths About Counseling

Millions of Teens are Suffering Needlessly


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