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Biomedical subjects

Howard Meltzer

Publications and source records attributed to Howard Meltzer.

28 records · Page 2Linked to original sources
PubMed2004

Using the Strengths and Difficulties Questionnaire (SDQ) multi-informant algorithm to screen looked-after children for psychiatric disorders.

BACKGROUND: Child psychiatric disorders are common among children in foster and residential care, but often go undetected and therefore untreated. AIMS: To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community. METHOD: SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 1,028 looked-after 5-17 year olds from a nationwide English survey. RESULTS: Multi-informant SDQs (parents, teachers, older children) identified individuals with a psychiatric diagnosis with a specificity of 80 % and a sensitivity of 85%. The SDQ prediction works best when SDQs have been completed by both carers and teachers. When it is only possible to have one adult informant, carers and teachers provide information of roughly equal predictive value. By contrast, self-reports by 11-17 year olds provide little extra information when there is already an adult informant. CONCLUSION: Using multi-informant SDQs as a regular screening measure for looked-after children could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.

Adolescent↗
PubMed2004

Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology.

BACKGROUND: Despite an expanding epidemiological evidence base, uncertainties remain over key aspects of the epidemiology of the 'antisocial' disorders in childhood and adolescence. METHODS: We used cross-sectional data on a nationally representative sample of 10,438 5-15-year-olds drawn from the 1999 British Child Mental Health Survey to examine age trends, gender ratios and patterns of comorbidity in DSM-IV Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). RESULTS: CD was significantly more common in boys than girls, and increased in prevalence with age. Among children who met diagnostic criteria for CD, status violations and other non-aggressive conduct problems increased with age, while aggressive symptoms became less common. Gender differences in ODD varied by reporter. Estimates of age trends in ODD depended heavily on treatment of overlaps with CD. Following DSM-IV guidelines (where ODD is not diagnosed in the presence of CD), rates of ODD fell with age; if that constraint was released, clinically significant rates of oppositionality persisted at similar levels from early childhood to middle adolescence. CD and ODD showed high levels of overlap, and both diagnoses showed substantial comorbidity with other non-antisocial disorders. CONCLUSIONS: Results from this large-scale study confirm and extend previous findings in the epidemiology of the disruptive behaviour disorders.

Adolescent↗
PubMed2004

Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity.

BACKGROUND: Adverse early circumstances may be more common in people who later develop psychotic disorders. AIMS: To use data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences. METHOD: Psychiatric disorders were identified through structured assessment of adults resident in private households in Britain (n=8580). Respondents were asked whether they had experienced selected events displayed on cards. RESULTS: Compared with respondents with other psychiatric disorders or with none, the prevalence of every experience bar one was significantly elevated in those with definite or probable psychosis. The largest odds ratio was for sexual abuse. Controlling for depressed mood somewhat reduced the odds ratios for the individual experiences. CONCLUSIONS: In people with psychosis, there is a marked excess of victimising experiences, many of which will have occurred during childhood. This is suggestive of a social contribution to aetiology.

Accidents↗
PubMed2004

Prevalence and correlates of self-reported psychotic symptoms in the British population.

BACKGROUND: The psychosis phenotype is generally thought of as a categorical entity. However, there is increasing evidence that psychosis exists in the population as a continuum of severity rather than an all-or-none phenomenon. AIMS: To investigate the prevalence and correlates of self-reported psychotic symptoms using data from the 2000 British National Survey of Psychiatric Morbidity. METHOD: A total of 8580 respondents aged 16-74 years were interviewed. Questions covered mental health, physical health, substance use, life events and socio-demographic variables. The Psychosis Screening Questionnaire (PSQ) was used to identify psychotic symptoms. RESULTS: Of the respondents, 5.5% endorsed one or more items on the PSQ. Factors independently associated with psychotic symptoms were cannabis dependence, alcohol dependence, victimisation, recent stressful life events, lower intellectual ability and neurotic symptoms. Male gender was associated with paranoid thoughts, whereas female gender predicted hallucinatory experiences. CONCLUSIONS: Self-reported psychotic symptoms are less common in this study than reported elsewhere, because of the measure used. These symptoms have demographic and clinical correlates similar to clinical psychosis.

Adolescent↗
PubMed2004

Trends in service use and treatment for mental disorders in adults throughout Great Britain.

BACKGROUND: Trends in health treatments and outcomes in the general population may be used to monitor achievement of health targets. AIMS: To investigate changes in mental health services and treatment in Britain over a 7-year period. METHOD: National surveys of psychiatric morbidity were completed in 1993 and 2000 in households throughout Great Britain. Standardised interviews were used to establish psychiatric case status and service and treatment utilisation in adults aged 16-64 years. RESULTS: Use of psychotropic medication doubled in those designated as psychiatric cases. In the non-case-status population antidepressant use rose from 0.16% in 1993 (95% CI 0.07-0.25) to 2.02% in 2000 (95% CI 1.69-2.35). However, the overall prevalence of neurotic and psychotic disorder hardly changed from 1993 to 2000. Use of specialised 'talking treatments'did not increase significantly, except in the non-case group. CONCLUSIONS: Treatment with psychotropic medication alone is unlikely to improve the overall mental health of the nation. A policy based almost exclusively on treatment of identified cases should be augmented by preventive approaches.

Adolescent↗
PubMed2003

Service utilisation by children with conduct disorders--findings from the GB National Study.

BACKGROUND: Children with conduct disorders and their families come into contact with a range of community and specialist agencies. METHODS: The aim of this study was to establish the lifetime service utilisation rates among children with conduct disorders from the Great Britain National Study (N = 10,438), and to examine the association between comorbid disorders, family and social factors, and service utilisation. The Development and Well-Being Assessment, a service checklist, and a battery of family and social functioning measures were used. RESULTS: The weighted prevalence of oppositional and conduct disorders was 5.4%. Within this group (N = 403), 241 (59.8%) had conduct disorder only, 79 (19.6%) comorbid emotional, 72 (17.9%) comorbid hyperkinetic, and 11 (2.7%) comorbid emotional and hyperkinetic disorders. These subgroups were compared on service utilisation with children with other psychiatric disorders (N = 351). Children with conduct disorders had significantly higher lifetime rates of utilisation of social and educational services than children with other psychiatric disorders. Contact with primary health, specialist health, and educational services was significantly associated with comorbid physical and psychiatric disorders. In contrast, contact with social services was associated with family discord and social sector tenancy. CONCLUSIONS: The findings are discussed in the context of organisation and co-ordination of health, other statutory, and non-statutory services, also taking into account previous research on interventions for children with conduct disorders and their families.

Adolescent↗
PubMed2003

The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders.

OBJECTIVE: To describe the prevalence of DSM-IV disorders and comorbidity in a large population-based sample of British children and adolescents. METHOD: Using a one-phase design, 10,438 children were assessed using the Development and Well-Being Assessment (DAWBA), a structured interview with verbatim reports reviewed by clinicians so that information from parents, teachers, and children was combined in a manner that emulated the clinical process. The authors' analysis examined comorbidity and the influence of teacher reports. RESULTS: The overall prevalence of DSM-IV disorders was 9.5% (95% confidence interval 8.8-10.1%), but 2.1% of children were assigned "not otherwise specified" rather than operationalized diagnoses. After adjusting for the presence of a third disorder, there was no longer significant comorbidity between anxiety and conduct disorder or attention-deficit/hyperactivity disorder (ADHD), or between depression and oppositional defiant disorder. A comparison of the disorders in children with and without teacher reports suggested that the prevalence of conduct disorders and ADHD would be underestimated in the absence of teacher information. CONCLUSIONS: Roughly 1 in 10 children have at least one DSM-IV disorder, involving a level of distress or social impairment likely to warrant treatment. Comorbidity reported between some childhood diagnoses may be due to the association of both disorders with a third. Diagnoses of conduct disorder and ADHD may be missed if information is not sought from teachers about children's functioning in school.

Adolescent↗
PubMedDate not supplied

Predictors of mental health service utilization in the 12 months before imprisonment: analysis of results from a national prisons survey.

OBJECTIVE: To describe the self-reported history of health service utilization and help-seeking to those who are drug-dependent in the period of time prior to imprisonment. METHOD: A cross-section survey of 3142 sentenced or remand prisoners in English prisons completed private, face-to-face interviews with trained Office for National Statistics staff covering a full structured psychiatric assessment interview. Specific questions about service utilization prior to imprisonment were included, as were questions on patterns of drug use and dependence prior to imprisonment. RESULTS: Receipt of any form of help was demographically most strongly associated with being older, white and female. Women were about twice as likely as men to report having received help for mental or emotional problems. Older age was also consistently associated with greater levels of reporting having received help, for both genders but only for use of general practitioners. Being black was strongly associated with reduced likelihood of receiving help and this was maintained after adjusting for other sociodemographic variables. Opioid dependence alone or opioid dependence with stimulant dependence, psychiatric disorder alone and probable psychosis were all most predictive of service use in the 12 months prior to imprisonment. CONCLUSIONS: In the year prior to imprisonment, the majority of mental health needs of these individual prisoners were not able to access help prior to imprisonment. Future strategies should aim for better health access before, during and after imprisonment.

Adolescent↗