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Biomedical subjects

E J Costello

Publications and source records attributed to E J Costello.

At least 19 recordsLinked to original sources
PubMed1999

Use, persistence, and intensity: patterns of care for children's mental health across one year.

This paper explores the use, persistence, and intensity of services for children's mental health problems across a variety of service sectors during a one year period. Data come from the Great Smoky Mountains Study. Analyses focus on children's psychiatric symptomatology and impairment, service use, and factors that may influence the relationship between psychiatric problems and service use across a one year period. Findings show that approximately 20% of children used some mental health services from some sector during the year. Child's symptomatology and characteristics of parents were associated with use and persistence of services. Parent's perceptions of impact on the family were associated with service use, persistence, and intensity.

Adolescent↗
PubMed1999

Adolescent outcomes of childhood disorders: the consequences of severity and impairment.

OBJECTIVE: To examine the adolescent consequences of clinical and threshold-level psychiatric disorders, with and without significant functional impairment; to predict serious emotional disturbance (SED: clinical-level diagnosis with impairment); and to examine sex differences in the consequences of emotional and behavioral disorders. METHOD: 300 children aged 7 through 11 years were recruited from urban and suburban offices of a large health maintenance organization (HMO). Child and parent were interviewed at home using the Diagnostic Interview Schedule for Children (DISC), version 1.3. Five to 7 years later, 278 (93%) of the sample were reinterviewed using the DISC-2.1. RESULTS: There was considerable continuity of psychopathology, particularly in children with functional impairment. Behavioral disorders at every level of severity predicted adolescent SED in both sexes. For emotional disorders, girls but not boys with childhood SED had significantly higher levels of adolescent SED. CONCLUSIONS: Childhood disorders falling below the level of severity required to meet criteria for treatment set by many HMOs or insurance companies nevertheless can carry a significantly increased risk for severe pathology years later. Functional impairment played an important role in the adolescent consequences of childhood psychiatric disorder.

Adolescent↗
PubMed1999

Impaired but undiagnosed.

OBJECTIVE: To investigate the prevalence and outcomes of individuals with psychosocial impairment not meeting DSM-III-R criteria for any of 29 well-defined disorders and to suggest operational definitions for not otherwise specified (NOS) diagnoses and V codes. METHODS: Two-stage general population sampling resulted in 1,015 youths aged 9, 11, and 13 years being interviewed in the first wave of the Great Smoky Mountains Study. They were reinterviewed 1 year later using the Child and Adolescent Psychiatric Assessment. RESULTS: The weighted prevalence of sibling relational problems was found to be 1.4%. That of parent-child relational problems was 3.6% and that of relational problems NOS was 0.6%. The overall rate of symptomatic impairment was 9.4%. Across a variety of "caseness measures," those with symptomatic impairment proved to be more disturbed than those without either a diagnosis or impairment, and as disturbed as those with a diagnosis but without impairment. CONCLUSION: Children and adolescents who do not meet DSM-III-R criteria for any well-defined disorder but who have symptoms associated with psychosocial impairment should be regarded as suffering from a psychiatric disorder. It is suggested that researchers adopt this definition for the many NOS diagnoses included in the DSM nosology and implement it in their research diagnostic algorithms.

Adolescent↗
PubMed1999

Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains, and headaches.

OBJECTIVE: To examine the associations of somatic complaints with DSM-III-R-defined depression, anxiety disorders, conduct disorder, oppositional defiant disorder, and attention-deficit hyperactivity disorder in a population-based sample of children and adolescents. METHODS: Data from 4 annual waves of interviews with 9- to 16-year-olds from the Great Smoky Mountains Study were analyzed. RESULTS: Overall, somatic complaints were strongly associated with emotional disorders in girls and with disruptive behavior disorders in boys. For girls, stomach aches and headaches together and musculoskeletal pains alone were associated with anxiety disorders. For boys, stomach aches were associated with oppositional defiant disorder and attention-deficit hyperactivity disorder. Musculoskeletal pains were associated with depression in both girls and boys. CONCLUSIONS: There were gender-, illness- and complaint-specific associations between somatic complaints and psychopathology. It appears likely that there are differences in the psychobiological processes underlying these associations in boys and girls. Clinical recommendations include screening children and adolescents with persistent complaints of headaches, stomach aches, or musculoskeletal pains for psychiatric disorders with an awareness that gender may affect the type of psychopathology associated with the somatic complaints.

Abdominal Pain↗
PubMed1999

Comorbidity.

We review recent research on the prevalence, causes, and effects of diagnostic comorbidity among the most common groups of child and adolescent psychiatric disorders; anxiety disorders, depressive disorders, attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, and substance abuse. A meta-analysis of representative general population studies provides estimates of the strength of associations between pairs of disorders with narrower confidence intervals than have previously been available. Current evidence convincingly eliminates methodological factors as a major cause of comorbidity. We review the implications of comorbidity for understanding the development of psychopathology and for nosology.

Adolescent↗
PubMed1998

Puberty and depression: the roles of age, pubertal status and pubertal timing.

BACKGROUND: Previous work has indicated that the 2:1 female:male sex ratio in unipolar depressive disorders does not emerge until some time between ages 10 and 15. METHODS: Data from four annual waves of data collection from the Great Smoky Mountains Study (GSMS) involving children aged nine to 16 were employed. RESULTS: Pubertal status better predicted the emergence of the expected sex ratio than did age. Only after the transition to mid-puberty (Tanner Stage III and above) were girls more likely than boys to be depressed. The timing of this transition had no effect on depression rates. Before Tanner Stage III, boys had higher rates of depression than girls, and the prevalence of depression appeared to fall in boys at an earlier pubertal stage than that at which it began to rise in girls. In addition, recent transition to Tanner Stage III or higher had a transient effect in reducing the prevalence of depression in boys. CONCLUSIONS: The period of emergence of increased risk for depression in adolescent girls appears to be a relatively sharply demarcated developmental transition occurring in mid-puberty. Previously reported effects of the timing of puberty (which have tended to be transient) appeared less important in increase of risk for depression than pubertal status.

Adolescent↗
PubMed1998

Life events and post-traumatic stress: the development of a new measure for children and adolescents.

BACKGROUND: A new interview measure of life events and post-traumatic stress disorder (PTSD) has been developed for children and adolescents aged 9 through 17, for use in both epidemiological and clinical studies. It includes 'high magnitude' events associated with PTSD as well as other 'low magnitude' events. METHOD: The interview is designed as a module of the Child and Adolescent Psychiatric Assessment, an interviewer-based interview conducted with parent and child separately by trained lay interviewers. The module includes: (1) questions about a wide range of events; (2) a screen for key PTSD symptoms (painful recall, avoidance, hypervigilance); and (3) a detailed interview on all PTSD symptoms, including onset, duration, severity and co-morbidity. A test-retest reliability study was conducted with 58 parents and children, who were interviewed twice by different interviewers. RESULTS: Intraclass correlations were 0.72 (child) and 0.83 (parent) for high magnitude events, and 0.62 (child) and 0.58 (parent) for low magnitude events. Kappa coefficients ranged from high for violence and sexual abuse to low for child reports of serious accidents and natural disasters. The reliability of the PTSD screen symptoms was fair to excellent (kappa = 0.40-0.79), and reliability of PTSD symptoms in those who passed the screen was excellent (ICC = 0.94-0.99). Compared with a general population sample (N = 1015), the clinic-referred subjects and their parents were twice as likely to report a traumatic event and, depending on the event, up to 25 times as likely to report symptoms of PTSD. CONCLUSIONS: The results support the reliability and discriminant validity of the measure.

Adolescent↗
PubMed1998

Headaches and psychopathology in children and adolescents.

OBJECTIVE: To examine the association between chronic headaches and DSM-III-R-defined psychiatric disorders, including depression, anxiety disorders, conduct disorder, oppositional defiant disorder and attention-deficit hyperactivity disorder, in a population-based sample of children and adolescents. METHOD: 1,013 children aged 9 to 15 years in the Great Smoky Mountains Study were evaluated annually over a 3-year period using the Child and Adolescent Psychiatric Assessment, a child and parent diagnostic psychiatric interview. Headaches that lasted at least 1 hour and occurred at least once a week during the 3 months prior to the interview were studied. RESULTS: Girls with depression and anxiety disorders had a significantly greater prevalence of headaches than girls without an internalizing disorder. This association was not found for boys. Conduct disorder was significantly associated with headaches in boys. Each of these associations was constant with age. CONCLUSIONS: This study suggests that a distinct gender difference exists between boys and girls in the associations between headaches and psychopathology. Carroll's theory of dysfunction in central pain regulation as an underlying cause of depression is discussed in relation to the proposed serotonergic dysregulation common to headaches, depression, anxiety, aggression, and pain.

Adolescent↗
PubMed1998

Perceived parental burden and service use for child and adolescent psychiatric disorders.

OBJECTIVES: Pediatric chronic physical illness and adult psychiatric disorders are substantial sources of burden for family care-takers, but little attention has been paid to parental burden resulting from children's or adolescents' psychiatric disorders. This paper describes the predictors of perceived parental burden and its impact on the use of specialty mental health and school services. METHODS: A representative general population sample of 1015 9-, 11-, and 13-year-olds and their parents completed structured psychiatric diagnostic interviews and the Child and Adolescent Burden Assessment. RESULTS: Weighted estimates indicated that 10.7% of parents in the general population perceived burden resulting from their children's symptomatology. Significant predictors of perceived burden were levels of child symptomatology and impairment and parental mental health problems. Children's depressive and anxiety disorders were associated with less burden than other diagnoses. The effects of child disorder severity on specialty mental health service use appeared to be mediated by the level of burden induced. CONCLUSIONS: Substantial levels of parental burden resulted from child psychiatric disorders and were a major reason for specialist mental health service use.

Adolescent↗
PubMed1997

Development of substance use and psychiatric comorbidity in an epidemiologic study of white and American Indian young adolescents the Great Smoky Mountains Study.

The progression of substance use and the patterns of comorbidity of substance use and psychiatric disorders are explored prospectively in young adolescents enrolled in the Great Smoky Mountains Study. This study is an epidemiologic study of white and American Indian youths living in rural Southern Appalachia. Results from this study indicate that alcohol use without permission predicts subsequent use of illicit drugs and regular tobacco use. Use of tobacco was not associated with either later alcohol or drug use. Patterns of comorbidity showed strong cross-sectional relationships between substance use and behavioral disorders, but not emotional disorders. Use of alcohol was also associated with psychiatric diagnosis at a later interview. There were some differences between white and American Indian youths in the pattern of comorbidity of tobacco use and psychiatric disorder and the relationship between prior psychiatric disorder and later alcohol use. These findings suggest that alcohol use without permission may be an important marker for youths who are at risk for illicit drug use and/or psychiatric diagnoses.

Adolescent↗
PubMed1997

Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study.

OBJECTIVES: This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health care among Appalachian youth. METHODS: All 9-, 11-, and 13-year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. RESULTS: Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. CONCLUSIONS: This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder.

Adolescent↗
PubMed1996

The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders.

BACKGROUND: The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. METHODS: A multistage, overlapping cohorts design was used, in which 4500 of the 11758 children aged 9, 11, and 13 years in an 11-county area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n = 1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N = 323 at wave 1). RESULTS: The 3-month prevalence (+/-SE) of any DSM-III-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3% +/- 1.7%. The most common diagnoses were anxiety disorders (5.7% +/- 1.0%), enuresis (5.1% +/- 1.0%), tic disorders (4.2% +/- 0.9%), conduct disorder (3.3% +/- 0.6%), oppositional defiant disorder (2.7% +/- 0.4%), and hyperactivity (1.9% +/- 0.4%). CONCLUSIONS: The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.

Adolescent↗
PubMed1996

The Great Smoky Mountains Study of Youth. Functional impairment and serious emotional disturbance.

BACKGROUND: Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as a DSM-III-R diagnosis in the presence of impaired functioning in 1 or more areas. We reviewed the published data on SED and examined rates and correlates of SED in an ongoing epidemiologic study of children. METHODS: Rates of DSM-III-R disorders, functional impairment, and their co-occurrence (SED) were examined in a representative population sample of 9-, 11-, and 13-year-olds from a predominantly rural area of North Carolina. Three measures of functional impairment were used, and their interrelationship and impact on rates of SED were examined. RESULTS: Serious emotional disturbance was identified in 4% to 8% of the study population, depending on the measure of impairment; the rate of DSM-III-R disorder ignoring impairment was 20.3%. One quarter of children identified as having SED on any measure were identified by all 3, and one half by 2 or more. Behavioral disorders, emotional disorders, and comorbidity were associated with a significant increase in the likelihood of SED; enuresis and tic disorders in the absence of comorbidity were not. Diagnosis and impairment made independent contributions to the increase in service use seen in children with SED. Poverty greatly increased the likelihood of SED. CONCLUSIONS: Specific areas of functional impairment should be examined when SED is assessed and treatment is planned. Plans to target mental health care resources to children with SED need to be accompanied by efforts to ensure access to those resources.

Affective Symptoms↗
PubMed1996

Toward establishing an empirical basis for the diagnosis of oppositional defiant disorder.

OBJECTIVES: (1) To determine the frequency of occurrence of oppositional defiant behaviors in the general population with a view to establishing empirical frequency cutoffs for the evaluation of oppositional defiant disorder (ODD). (2) To examine the effects of changes in the definition of ODD between DSM-III-R and DSM-IV. METHOD: The Great Smoky Mountains Study is a general population study of 9-, 11-, and 13-year-olds. Subjects and their parents were interviewed with the Child and Adolescent Psychiatric Assessment at baseline and again 1 year later. RESULTS: Ninetieth percentile frequency cutoffs for ODD symptoms are given. Although rates of ODD were little different between DSM-III-R and DSM-IV, fewer than half of those who met criteria by one or the other definition met criteria according to both. DSM-IV defined a more disturbed group of children than did DSM-III-R. Requiring only two or three ODD symptoms plus impairment identified children with substantial evidence of disturbance who did not otherwise meet criteria for any diagnosis. CONCLUSIONS: The DSM-IV criteria represent an improvement over DSM-III-R. However, a reduction in the number of ODD symptoms required for diagnosis is indicated. Symptom frequency criteria for ODD symptoms are suggested for clinical use.

Female↗
PubMed1996

Precision, reliability and accuracy in the dating of symptom onsets in child and adolescent psychopathology.

Dates of onset of psychiatric symptoms are required in determining whether diagnostic criteria are met for a number of disorders and for a variety of research questions. However, little attention has been paid to the precision and reliability of their recall by parents and children. We present data from two studies indicating that when symptoms have lasted longer than around 3 months, the month of onset usually cannot be accurately reported, while with symptoms that have lasted a year or more, the year of onset is usually uncertain. The implications of these findings for diagnosis and research are discussed.

Adolescent↗
PubMed1995

A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment (CAPA-C).

Seventy-seven 10-18-year-old psychiatric in-patients and out-patients took part in a test-retest study of the Child and Adolescent Psychiatric Assessment (CAPA). They were interviewed on two occasions several days apart. Overall reliability of diagnosis ranged from kappa = 0.55 (conduct disorder) to 1.0 (substance abuse or dependence). In general, reliability for scale scores of psychopathology was somewhat lower in out-patients than in-patients, though the opposite was the case for anxiety disorders and psychosocial incapacity and the reliability of the diagnosis of conduct disorder--the only individual diagnosis sufficiently common to permit this comparison. Unreliability of reports of behavioural problems was found to be related to admitting to being a liar in the first interview. The implications of these results for the use of the CAPA are discussed.

Adolescent↗