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Up to half of all cases of adult mental disorder could be prevented by the effective treatment of children and teenagers with psychiatric disorders. This is the conclusion of a study carried out at the Institute of Psychiatry.

Most adults with a psychiatric disorder had a diagnosable disorder as children, according to the study, published in the Archives of General Psychiatry this week. In fifty percent of cases this first diagnosis was between the ages of 11 and 15.

The study was carried out by

Prof Terrie Moffitt, Dr Julia Kim-Cohen and Prof Avshalom Caspi in collaboration with colleagues in New Zealand. 1037 people born between the first of April 1972 and March the thirty-first 1973 in Dunedin, New Zealand took part in the study, which forms part of the Dunedin Multidisciplinary Health and Development Study.

The mental health of the participants was assessed every two to three years from the age of eleven using the Diagnostic Interview Schedule (DIS) and the DIS for Children, commonly used psychiatric assessment tools. The rates of childhood mental disorders were examined in adults with a range of psychiatric conditions and compared with rates amongst participants with no psychiatric symptoms.

Childhood mental disorders examined included depression, anxiety and Attention Deficit Hyperactivity Disorder (ADHD). ADHD is a persistent pattern of poor attention and/or overactive, impulsive behaviour. Also examined were rates of conduct disorder and oppositional defiant disorder. Conduct disorder is characterised by aggressive behaviour that causes or threatens physical harm to others, destructive behaviour, deceitfulness or theft, and serious violations of rules. Children with oppositional defiant disorder have difficulty following rules and behaving in a socially acceptable way.

The team found that:

- 26% of adult anxiety disorder might have been prevented if childhood depression, ADHD, conduct and/or oppositional defiant disorder, and anxiety had been effectively treated

- 23% of adult depression might have been prevented if childhood anxiety, depression and conduct and/or oppositional defiant disorder had been effectively treated

- 25% of adult schizophrenia-type disorders such as schizophrenia and psychosis might have been prevented if childhood depression, anxiety, conduct and/or oppositional defiant disorder and ADHD had been effectively treated

- 32% of adult mania might have been prevented if childhood depression and conduct and/or oppositional defiant disorder had been effectively treated

- 46% of adult eating disorders might have been prevented if childhood conduct and/or oppositional defiant disorder had been effectively treated

- 41% of adult antisocial personality disorder might have been prevented is childhood conduct and/or oppositional defiant disorder had been effectively treated

Currently few children with psychiatric conditions receive treatment. The report's authors call for screening by GPs and in schools to detect children with psychiatric conditions and provide appropriate treatment. Such preventative methods could reduce the rate of adult mental disorder by up to 46%.

This article is a summary of: Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R.

Prior Juvenile Diagnoses in Adults With Mental Disorder - Developmental Follow-Back of a Prospective-Longitudinal Cohort, 2003. Archives of General Psychiatry. 60 pp709-717.

Summarised by: Caroline Moran & Dr Julia Kim-Cohen

Original report published: July 2003
Published on Mental Health Care: 18 July 2003
This article will be reviewed and updated: 18 December 2003
PubMed Citation