Mental health problems in Austrian adolescents: a nationwide, two-stage epidemiological study applying DSM-5 criteria
Eur Child Adolesc Psychiatry
Mental health problems in Austrian adolescents: a nationwide, two‑stage epidemiological study applying DSM‑5 criteria
Gudrun Wagner 0 1 2 4
Michael Zeiler 0 1 2 4
Karin Waldherr 0 1 2 4
Julia Philipp 0 1 2 4
Stefanie Truttmann 0 1 2 4
Wolfgang Dür 0 1 2 4
Janet L. Treasure 0 1 2 4
Andreas F. K. Karwautz 0 1 2 4
0 FernFH Distance - Learning University of Applied Sciences , Zulingergasse 4, 3200 Wiener Neustadt , Austria
1 Ludwig Boltzmann Institute Health Promotion Research , Untere Donaustraße 47/3, 1020 Vienna , Austria
2 Department for Child and Adolescent Psychiatry, Medical University of Vienna , Waehringer Guertel 18-20, 1090 Vienna , Austria
3 Andreas F. K. Karwautz
4 Institute of Psychiatry, Psychology and Neuroscience, Kings College University , London , UK
This is a nationwide epidemiological study using DSM-5 criteria to assess the prevalence of mental disorders in a large sample of Austrian adolescents between 10 and 18 years including hard-to-reach samples. A sample of 3615 adolescents from four cohorts (school grades 5, 7, 9, 11; age range 10-18 years) was recruited from 261 schools, samples of unemployed adolescents (n = 39) and adolescents from mental health institutions (n = 137) were added. The Youth Self-Report and SCOFF were used to screen for mental health problems. In a second phase, the Childrens' Diagnostic Interview for Mental Disorders was used to make point and lifetime psychiatric diagnoses. Mental health service use was also assessed. Point prevalence and lifetime prevalence rates for at least one psychiatric disorder were 23.9% and 35.8%. The highest lifetime prevalence rates were found for anxiety disorders (15.6%), neurodevelopmental disorders (9.3%; ADHD 5.2%) and depressive disorders (6.2%). Forty-seven percent of adolescents with a lifetime psychiatric disorder had a second diagnosis. Internalising disorders were more prevalent in girls, while neurodevelopmental disorders and disruptive, impulse control and conduct disorders were more prevalent in boys. Of those with a lifetime psychiatric disorder, 47.5% had contacted mental health services. Of the residual 52.5% who had not contacted mental health services, 18.1% expressed an interest in treatment. DSM-5 mental health disorders are highly prevalent among Austrian adolescents. Over 50% had or were interested in accessing treatment. Early access to effective interventions for these problems is needed to reduce burden due to mental health disorders.
Mental disorders; DSM-5; Adolescents; Epidemiology
Introduction
Epidemiological studies are essential not only to provide
data on children and adolescents who are affected by
mental health problems, but also to provide information on
the need, availability and access to mental health services.
Information about prevalence and incidence is useful for
planning primary, secondary and tertiary prevention and
treatment services [
1
].
A meta-analysis of population studies assessing the
prevalence of mental disorders in children and adolescents
found a worldwide pooled prevalence rate of 13.4% for
any mental disorder, surveys including epidemiological
studies from 1970 to 2000 found median prevalence rates
of 18%, and a US sample in 2010 revealed 20% of
adolescents between 13 and 18 years with mental health problems
who need treatment [
2–7
]. The most frequent psychiatric
disorders in childhood and adolescence are anxiety
disorders (up to 31.9%), behaviour disorders (16.3–19.1%),
substance use disorders (8.3–11.4%), emotional
disorders (3.7–14.3%), hyperkinetic disorders (2.2–8.6%) and
aggressive dissocial disorders (2.1–7.6%) [2]. In
childhood, mental health problems in general are more frequent
in boys than in girls (2:1), but from the age of 13 years
onward, the prevalence rates are higher for girls. However,
there are gender differences between various disorders. For
example, adolescent boys suffer more often from
externalising and substance use disorders, while female adolescents
are more often affected by internalising disorders, such as
eating disorders and depressive disorders [
3
].
The severity and persistence of adolescent mental
health problems are also of relevance [
8–11
]. In the Dutch
TRAILS report, 22% out of 45% youth with a lifetime
mental health disorder showed severe impairment.
Functional impairment can be assessed from disorder-specific
measures or a global measure such as the CGAS (Child
Global Assessment Scale) [12]. Although anxiety disorders
are most prevalent they are usually less severe, whereas
the less prevalent mood and behaviour disorders are more
severe [
11
]. The longitudinal BELLA study in Germany
revealed a high persistence rate of mental health problems
(>30% in a 6 year follow-up). Mental health service use
was limited to only 33% with acute or recurrent mental
health problems and 63.9% with persistent mental health
problems [
13
]. A similar pattern was identified in the Dutch
TRAILS cohort stud (...truncated)