Reporting in the July 15 issue of JAMA Psychiatry, the Duke researchers found that children who had either a diagnosed psychiatric condition or a milder form that didn’t meet the full diagnostic criteria were six times more likely than those who had no psychiatric issues to have difficulties in adulthood, including criminal charges, addictions, early pregnancies, education failures, residential instability and problems getting or keeping a job.
“When it comes to key psychiatric problems — depression, anxiety, behavior disorders — there are successful interventions and prevention programs,” said lead author William Copeland, Ph.D., assistant clinical professor of Psychiatry and Behavioral Sciences at Duke. “So we do have the tools to address these, but they aren’t implemented widely. The burden is then later seen in adulthood, when these problems become costly public health and social issues.”
Copeland and colleagues analyzed data from the Great Smoky Mountains Study, which began nearly two decades ago and includes 1,420 participants from 11 North Carolina counties. The study is ongoing and has followed the participants from childhood through adulthood — most are now in their 30s.
Among the study group, 26.2 percent met the criteria for depression, anxiety or a behavioral disorder in childhood; 31 percent had milder forms that were below the full threshold of a diagnosis; and 42.7 percent had no identified problems.
The researchers found that as these children grew into adults, even some of those who had no psychiatric diagnosis as children — nearly one in five — stumbled in adulthood, suggesting that difficulties were not limited to those with psychiatric diagnoses.
But having a psychiatric diagnosis or a close call dramatically raised the odds that adulthood would have rough patches. This was the case even if they did not continue to have psychiatric problems in adulthood.
Of those with the milder psychiatric indicators as kids, 41.9 percent had at least one of the problems in adulthood that complicates success, and 23.2 percent had more than one such issue. For those who met the full psychiatric diagnosis criteria, 59.5 percent had a serious challenge as adults, and 34.2 percent had multiple problems.
Copeland said specific psychiatric disorders were associated with specific adult problems, but the best predictor of having adult issues was having multiple psychiatric problems as kids.
“When we went into this, it was an open question: Are these psychiatric diagnoses in childhood impairing in the moment, but something people recover from and go on?” Copeland said. “We weren’t expecting to find these protracted difficulties into adulthood.”
Copeland said the findings reinforce the need to attack problems early with effective therapies. He said only about 40 percent of children get the treatment they need for psychiatric disorders, and even fewer who have borderline problems are treated.
“A big problem with mental health in the United States is that most children don’t get treatment and those who do don’t get what we would consider optimal care,” Copeland said. “So the problems go on much longer than they need to and cost much more than they should in both money and damaged lives.”
In addition to Copeland, study authors include Dieter Wolke, Lilly Shanahan and E. Jane Costello.
The study received funding from the National Institute of Mental Health (MH080230, MH63970, MH63671, MH48085, MH075766, MH094605); the National Institute on Drug Abuse (DA/MH11301, DA011301, DA016977, DA036523); the Brain and Behavior Research Foundation; and the William T. Grant Foundation.