childhood mental health: early intervention as prevention william copeland, phd center for...
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Childhood Mental Health: Early intervention as Prevention
William Copeland, PhD
Center for Developmental EpidemiologyDuke University Medical Center
Mental Health American Atlanta, GA
Sept 11th 2014
No conflicts of interest or financial disclosures
Grant support from NIMH, NIDA, NARSAD, and W.T. Grant
The best plan to reduce the burden of mental illness is to reduce the number of
childhood cases
Early Intervention is Prevention
Childhood MH problems can be easily identified
Substantial number of childhood cases Childhood MH problems predict adult MH
problems Adult MH issue often start in childhood Setting in which children can be screened Treatments are efficacious/effective
GSMS
0
200
400
600
800
1000
1200
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24+
Age
Su
bje
cts
Ass
esse
d
Great Smoky Mountain Study
No Dx86.8%
1 dx7.1%
3+ dx 2.9%
How common is MI?3 month Prevalence
Another 16% have a impairment but not a disorders
Of those with a disorder, about half also have a functional impairment (SED)
How common are psychiatric disorders?
Cumulative Burden
13 14 15 16 17 18 19 20 21 22 23 24 250
20
40
60
80
100
Age
Pre
vale
nce
Global Burden of Disease 2010
Females 15-19 Females 20-24 Males 15-19 Males 20-240%
10%20%30%40%50%60%70%80%90%
100%
55.9 54.134.8 33.0
12.6 12.239.3 37.2
Mental Health Substance Use Other NeuropsychMaternal Conditions Injuries Other CommunicableOther Non Communicable HIV/TB
Gore, FM., Bloem, PJN, Patton, GC, Ferguson, J, Joseph, V, Coffey, C, Sawyer, SM, & Mathers, CD (2011). Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet, DOI:10.1016/S0140-6736(11)60512-6
53%
24%
23%
Childhood diagnosis Sub-clinical problemsNo childhood diagnosis
How often does mental illness early?
Risk for adult disorders
No dx or impair.
Impair. Only
Any dx.
Anxiety
Depression
Behavior
0 20 40 60 80
Continuity from childhood:Adult status
Childhood dx Any dx No Sub.No dx or impair. 20.8 11.3Impairment only 29.9 22.8Any disorder 59.1 40.5 Anxiety 60.6 44.2 Depression 67.1 52.3 DBD 55.8 39.9 Substance 71.4 37.6
Key Outcomes
Multiple mental health problems Dropping out of high school Death Serious criminal activity Unable to keep job Early parenthood Extended unemployment No social support network
Any key outcome
2+ key outcomes
0
25
50
75
100
Noncases Subclinical onlyCases
Pe
rce
nt
18.76
37.41
43.8
Any key outcome
Noncases Subclinical only Psychiatric cases
8.5
43.6
48
2+ key outcomes
Noncases Subclinical only Psychiatric cases
As compared to noncases, childhood cases were: 7 times as likely to report a key outcome 12 times as likely to report 2 outcomes
6 times as likely to have multiple MH issues 8 time as likely to have 2+ addictions 14 times as likely to be incarcerated 6 times as likely to drop out of high school 8 times as likely to lack all social support
Do they get help?Service Utilization Rates
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 260
25
50
75
100
Service use Conditional service use
Pre
vale
nce
Childhood Young Adulthood
Conditional Service Utilization Rates
Childhood %
Young Adulthood%
Any* 50.7 24.2
Specialty Psych* 19.0 10.0
Gen. Med. 10.4 7.2
Education/Job* 23.7 0.3
Crim. Justice 5.4 5.4
Informal* 16.8 7.6
Early Intervention is Prevention
Childhood MH problems can be easily identified
Childhood MH problems predict adult MH problems
Adult MH issues often start in childhood Treatments are efficacious/effective Early problems can be avoided
Childhood present a distinct
challenge for mental health public policy
Many children affected High levels of unmet need Care not always optimal Story gets worse in young adulthood
It also presents an opportunity
Prevent adult MH problems Improve the transition to adulthood for
many Change MH trajectories that can last for
decades
Ideas Early identification
Universal home visitation Universal MH screening in schools
Reduce parental burden Universal child care
Improve access Integrated MH clinics
1 3 5 7 9 11 13 15 17 19 21 23$0
$500
$1,000
$1,500
$2,000
$2,500
Hospital Costs: Control Families Hospital Costs: DC FamiliesChild Age in Months
Cu
mu
lati
ve P
er C
hil
d C
ost
Mean Cumulative ED-Related costs
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