Original article
Vol. 140 No. 3334 (2010)
Mental disorders in the paediatric setting – results of a Swiss survey
- T In-Albon
- U Zumsteg
- D Müller
Summary
Theoretical background: Mental disorders emerge in childhood and adolescence and are important risk factors for mental disorders in adolescence and adulthood. Since paediatricians are typically the first to see children with psychological problems, the aim of this study was to obtain a survey of mental disorders of children in paediatric settings.
Methods: 250 paediatricians completed a questionnaire especially developed for this study, which asked for the estimated frequency and type of mental disorders in their patients, assurance in identifying mental disorders, diagnostic and treatment strategies used for these disorders and requests for training.
Results: Paediatricians estimated that 15% percent of children in their paediatric setting reported psychological difficulties. The most frequent mental disorders indicated by the paediatricians were attention-deficit hyperactivity disorder (ADHD), anxiety disorders, depression and aggressive disorders. Comfort in assigning diagnoses for anxiety disorders and depression was lower than for externalizing disorders. Counselling was the treatment approach most often reported in treating mental disorders, followed by psychopharmacological medication. Psychotherapy, however, was reported very rarely. Paediatricians’ wish for continuing education included diagnostics and screening instruments for psychological problems in childhood.
Conclusions: Estimated prevalence rates reported by paediatricians are comparable with rates in epidemiological studies. As paediatricians are often confronted with psychological problems, they have the important role in recognising the early signs of mental problems.
References
- The questionnaire can be obtained from the first author.
- Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:593–603.
- Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R. Prior juvenile diagnoses in adults with mental disorders. Arch Gen Psychiatry. 2003;60:709–17.
- Briggs-Gowan MJ, Owens PL, Schwab-Stone ME, Leventhal JM, Leaf PJ, Horwitz SM. Persistence of psychiatric disorders in pediatric settings. J Am Acad Child Adolesc Psychiatry. 2003;42(11):1360–9.
- Ihle W, Esser G. Epidemiologie psychischer Störungen im Kindes- und Jugendalter: Prävalenz, Verlauf, Komorbidität und Geschlechtsunterschiede. Psychol Rundsch. 2002;53 (4):159–69.
- Woodward LJ, Fergusson DM. Life course outcomes of young people with anxiety disorders in adolescence. J Am Acad Child Adolesc Psychiatry. 2001;40:1086–93.
- NIMH. The National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment. Blueprint for Change: Research in Child and Adolescent Mental Health. 2001. Washington: NIMH.
- Ravens-Sieberer U, Erhart M, Wille N, Bullinger M, et al. Health-related quality of life in children and adolescents in Germany: results of the BELLA study. Eur Child Adoles Psy. 2008;17:148–56.
- Van Ameringen M, Mancini C, Farvolden P. The impact of anxiety disorders on educational achievement. J Anxiety Disord. 2003;17:561–71.
- Steinhausen H-C, Metzke CW, Meier M, Kannenberg R. Prevalence of child and adolescent psychiatric disorders: the Zurich Epidemiological Study. Acta Psychiatr Scand. 1998;98:262–71.
- Costello JE, Mustillo S, Erkanli A, Keeler G, Aangold A. Prevalence and development of psychiatric disorders in childhood and adolescent. Arch Gen Psychiatry. 2003;60:837–44.
- Wittchen H-U, Nelson CB, Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28(1):109–26.
- Briggs-Gowan MJ, Horwitz S, Schwab-Stone ME, Leventhal J, Leaf P. Mental health in pediatric settings: Distribution of disorders and factors related to service use. J Am Acad Child Adolesc Psychiatry. 2000;39(7):841–9.
- Lavigne JV, Gibbons RD, Christoffel KK, Arend R, Rosenbaum D, Binns H, et al. Prevalence rates and correlates of psychiatric disorders among preschool children. J Am Acad Child Adolesc Psychiatry. 1996;35(2):204–14.
- Chavira DA, Murray B, Stein MD, Kelly Bailey MA, Stein MT. Child anxiety in primary care: prevalent but untreates. Depress Anxiety. 2004;20:155–64.
- Williams J, Klinepeter K, Palmes G, Pulley A, Foy JM. Diagnosis and Treatment of Behavioural Health Disorder in Pediatric Practice. Pediatrics. 2004;114(3):601–6.
- Essau CA. Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders. Depress Anxiety. 2005;22:130–7.
- Runge AJ, Beesdo K, Lieb R, Wittchen HU. Wie häufig nehmen Jugendliche und junge Erwachsene mit Angststörungen eine psychotherapeutische Behandlung in Anspruch? Verhaltenstherapie. 2008;18:26–34.
- Christiana JM, Gilman SE, Guardino M, Mickelson K, Morselli PL, Olfson M. Kessler RC. Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: an international survey of members of mental health patient advocate groups. Psychol Med. 2000;30:693–703.
- Meltzer H, Gatward R, Goodman R, Ford T. Mental health of children and adolescents in Great Britain. London: Stationery Office; 2000.
- Weisz JR, Jensen PS. Efficacy and effectivness of child and adolescent psychotherapy and pharmacotherapy. Mental Health Services and Research. 1999;1(3):125–57.
- Roth B, Munsch S, Meyer A, Winkler Metzke C, Isler E, Steinhausen HC, Schneider S. The mental status of overweight children. Z Kinder Jugendpsychiatr Psychother. 2008;36(3):163–76.
- Wolke D. Feeding and sleeping across the lifespan. In Sir M. Rutter & D. Hay (Hrsg.), Development through Life: A Handbook for Clinicians Oxford: Blackwell Scientific Publications, 517–57.
- Brown Th. Brown ADD-scales for children. The psychological corporation, San Antonio; 2001.
- Conners C. Conner’s rating scales-revises technical manual. North Tonawand (NY): Multi-Health System; 1997.
- Ruf-Bächtiger L. Das frühkindliche psychoorganische Syndrom: minimale zerebrale Dysfunktion. Diagnostik und Therapie. Stuttgart: Thieme; 1987.
- Munsch S, Roth B, Michael T, Meyer AH, Biedert E, Roth S, et al. Randomized controlled comparison of two cognitive behavioural therapies for obese children: mother versus mother-child cognitive behavioural therapy. Psychother Psychosom. 2008;77:235–46.
- Mindell J. Empirically supported treatments in pediatric psychology: Bedtime refusal and night wakings in young children. J Pediatric Psychol. 1999;24:465–81.
- Fricke L, Lehmkuhl G. Schlafstörungen im Kindes- und Jugendalter. Ein Therapiemanual für die Praxis. Göttingen: Hogrefe; 2006.
- Wolke D, Gray P, Meyers R. Excessive infant crying: A controlled study of mothers helping mothers. Pediatrics. 1994;94:322–32.
- Leitlinien der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie und –psychotherapie. Hyperkinetische Störungen.
- Clinical practice guidelines: Treatment of the school-aged child with attention-deficit/hyperactivity disorder. Pediatrics. 108(4):1033–44.
- Brückl TM, Wittchen H-U, Höfler M, Pfister H, Schneider S, Lieb R. Childhood separation anxiety and the risk for subsquent psychopathology: Results from a community study. Psychother Psychosom. 2007;76:47–56.
- Cartwright- Hatton S, McNicol K, Doubleday E. Anxiety in a neglected population: Prevalence of anxiety disorders in pre-adolescent children. Clin Psychol Rev. 2006;26:817–33.
- Lavigne JV, Arend R, Rosenbaum D, Binns HJ, Christoffel KK, Burns AA. Mental health service use among young children receiving pediatric primary care. J Am Acad Child Adolesc Psychiatry. 1998;37(11):1175–83.
- Schmidt MH. Das MCD-Konzept ist überholt. Deutsches Ärzteblatt. 1992;89(6):239–42; 273–6; 378–84.
- Stewart RE, Chambless DL. Does psychotherapy research inform treatment dicisions in private practice. J Clin Psychol. 2007;63(3):267–81.
- Stewart RE, Chambless DL. Interesting practitioners in training in empirically supported treatments: Research reviews versus case studies. J Clin Psychol. 2010;66(1):73–95.