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Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities
national surveys of health and drug abuse, these include very little on child and adolescent mental illness, and so there are almost no national prevalence and incidence estimates.
Table 2-1 is a summary of various nationally representative studies, sponsored by federal agencies, that have made some effort to produce estimates of the prevalence of MEB disorders of youth and, in some cases, the need for or use of mental health services. There is a dramatic contrast between the richness of the data on drug use and abuse from the National Health and Nutrition Examination Survey (NHANES), the National Survey on Drug Use and Health (NSDUH), and Monitoring the Future (MTF), and the paucity and lack of continuity of measures of MEB disorders. MTF has been collecting information on drug use and abuse since 1975, and NSDUH since 1988. However, the latter added some mental health questions only in 1994, and the results have not yet been published. NHANES used selected modules of a diagnostic interview for about five years, but since 2004 has limited its relevant data collection to a screener for depression for two years (2005, 2006) and some questions about conduct disorder since 1999. For three years, the National Health Interview Survey (NHIS) included the Strengths and Difficulties Questionnaire (Goodman and Gotlib, 1999), a 25-item parent report that produces symptom scales but not diagnoses. The current NHIS includes only three to five mental health questions. The new National Children’s Study, which will begin recruiting participants in 2009, offers a wonderful opportunity for nationally representative, longitudinal data collection on the development of MEB disorders, the need for services, and the role of prevention and treatment in their course. No plans have been published for the data to be collected beyond the first few months, so it is unknown whether this opportunity will be realized.
Given the limitations of national surveys, conclusions about prevalence and incidence of MEB disorders among young people have to be drawn from (1) national surveys from other countries and (2) local population surveys in the United States. Despite being the best available data, both of these also have limitations. In the first case, rates can be very different in different countries, so that extrapolation to the United States is difficult. For example, using the same diagnostic interview (Development and Well-Being Assessment) with 8- to 10-year-olds in three different countries produced rates of conduct disorder in Norway that were much lower than those found in the United Kingdom (Heiervang, Stormark, et al., 2007) or the United States (see below). Within the United States, local surveys also show variation in rates. For example, in a set of studies using identical methods, the prevalence of disruptive behavior disorders was lowest in Puerto Rican youth living in Puerto Rico, higher in mainland Hispanic and white youth, and highest in mainland African Americans, even after controlling for a range of risk factors (Bird, Canino, et al., 2001).