Investigacion

RESEARCH UPDATE REVIEW

10-Year Research Update Review: The Epidemiology of Child and Adolescent Psychiatric Disorders: I. Methods and Public Health Burden
E. JANE COSTELLO, PH.D., HELEN EGGER, M.D.,
AND

ADRIAN ANGOLD, M.R.C.PSYCH.

ABSTRACT Objective: To review recent progress in child and adolescent psychiatric epidemiology in the area of prevalence and burden. Method: The literaturepublished in the past decade was reviewed under two headings: methods and findings. Results: Methods for assessing the prevalence and community burden of child and adolescent psychiatric disorders have improved dramatically in the past decade. There are now available a broad range of interviews that generate DSM and ICD diagnoses with good reliability and validity. Clinicians and researchers canchoose among interview styles (respondent based, interviewer based, best estimate) and methods of data collection (paper and pencil, computer assisted, interviewer or self-completion) that best meet their needs. Work is also in progress to develop brief screens to identify children in need of more detailed assessment, for use by teachers, pediatricians, and other professionals. The median prevalenceestimate of functionally impairing child and adolescent psychiatric disorders is 12%, although the range of estimates is wide. Disorders that often appear first in childhood or adolescence are among those ranked highest in the World Health Organization’s estimates of the global burden of disease. Conclusions: There is mounting evidence that many, if not most, lifetime psychiatric disorders willfirst appear in childhood or adolescence. Methods are now available to monitor youths and to make early intervention feasible. J. Am. Acad. Child Adolesc. Psychiatry, 2005;44(10):972–986. Key Words: epidemiology, services, methods.

The focus of these two 10-year reviews is, unlike most in this series, not on a disorder or treatment but on an approach to thinking about disease. Many years ago, TonyEarls (1979) defined epidemiology as ‘‘an exact and basic science of social medicine and public health.’’ Epidemiology provides the scientific underpinnings for the prevention and control of disease across the spectrum of medicine, from infectious diseases like acquired immunodeficiency syndrome to chronic conditions like
Accepted April 25, 2005. All of the authors are with the Center forDevelopmental Epidemiology, Duke University Medical School, Durham, NC. Work on this paper was supported in part by grants 06937, 01002, and 01167 from the National Institute of Mental Health, grants 011301 and 016977 from the National Institute on Drug Abuse, and a Pfizer Faculty Scholar Award in Clinical Epidemiology to Dr. Egger. Correspondence to Dr. E. Jane Costello, Box 3454, Duke University HealthSystems, Durham NC 27710; e-mail: elizabeth.costello@duke.edu. 0890-8567/05/4410–0972Ó2005 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/01.chi.0000172552.41596.6f

diabetes. Here we discuss how epidemiology in the past decade has increased our understanding of psychiatric disorders of childhood and adolescence. Child and adolescent psychiatry came late to epidemiologicalresearch, and in one respect this is fortunate because a tremendous amount of empirical, theoretical, and statistical work has been done in other branches of medicine and psychology, from which we have been able to benefit. In the past 30 years, and outstandingly in the past decade, research in our area has caught up, and even, as in the innovative use of longitudinal epidemiological samples tostudy gene–environment interactions (Caspi et al., 2002, 2003; Foley et al., 2004), moved to the forefront of epidemiological research. First, we explain what an epidemiological approach to child and adolescent psychiatry can offer, making clear Earls’s distinction between ‘‘public health epidemiology,’’ whose task is to monitor and reduce the burden of disease on the community, and ‘‘scientific...