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Biomedical subjects

E J Costello

Publications and source records attributed to E J Costello.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1995

Children's mental health service use across service sectors.

This DataWatch explores the roles of human service sectors (mental health, education, health, child welfare, and juvenile justice) in providing mental health services for children. The data are from the first wave of the Great Smoky Mountains Study of Youth, a population-based study of psychopathology and mental health service use among children. The results show somewhat higher rates of mental health service use than has been reported previously, while continuing to show a substantial amount of unmet need, even among children with both a psychiatric diagnosis and functional impairment. The findings point to a significant role for the education sector, suggesting that schools may function as the de facto mental health system for children and adolescents.

Adolescent↗
PubMed1993

How can epidemiology improve mental health services for children and adolescents?

Epidemiology, the study of patterns of disease distribution in time and space, can help to improve mental health services for children and adolescents by increasing understanding of the causes, development, and course of psychiatric disorders. For the purpose of service delivery, epidemiologic research on child psychopathology can provide information on need for services, availability of services, and effectiveness of services. For both scientific and planning purposes, epidemiologic research can inform us about (1) the developmental course of psychiatric disorders during childhood and adolescence, (2) the effect of psychiatric disorder on the course of normal childhood development, and (3) the effect of childhood development on the developmental course of psychiatric disorder. Information about prevalence and incidence is useful for planning primary, secondary, and tertiary prevention and treatment services. The same information is scientifically useful to the extent that it helps to answer questions about causation, course, and outcome. However, one aim of this paper is to show that epidemiology is about a great deal more than rates of disorder.

Adolescent↗
PubMed1993

Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues.

OBJECTIVE: The purpose of the study was to examine comorbidity in the context of child and adolescent depression. METHOD: The authors reviewed recent epidemiological studies using standardized interviews and DSM-III or DSM-III-R criteria. RESULTS: There was a high rate of comorbidity in children and adolescents with major depressive disorders or dysthymia. Comorbidity with conduct disorder/oppositional defiant disorder ranged from 21% to 83%; comorbidity with anxiety disorder ranged from 30% to 75%; and comorbidity with attention deficit disorder ranged from 0% to 57.1%. Rates of depressive comorbidity found in community studies were similar to the rates found in clinical studies. In almost all cases, the disorders were more common in depressed children than expected by chance, and the rates of other disorders in depressed children were higher than the rates of depression in those with depression. CONCLUSIONS: The mechanisms by which comorbidity occurs are obscure at present. Several possibilities and their implications for nosology, epidemiology, and treatment research are discussed.

Adolescent↗
PubMed1992

Above and below the threshold: severity of psychiatric symptoms and functional impairment in a pediatric sample.

Pediatricians are sufficiently concerned about the importance of "subthreshold" mental health problems to have joined in the movement to create a Diagnostic and Statistical Manual of Mental Disorders for the primary care setting (DSM-PC), with the aim of establishing a set of criteria for disorders that do not meet the severity requirements of the American Psychiatric Association's current DSM. An element in the argument for a DSM-PC is that there is a high level of functional impairment and need for treatment in children with mental health problems below the DSM threshold. This was examined in 789 children aged 7 through 11 recruited sequentially from the pediatric clinics of a health maintenance organization, compared with 134 age-matched children seen in a psychiatric clinic. Of the pediatric patients, 22% had one or more clinical-level DSM-III diagnoses, and 42% had a threshold-level disorder, compared with 65% and 34%, respectively, of psychiatric patients. In the pediatric sample, most threshold, and all clinical-level disruptive behavior disorders were associated with significant levels of functional impairment. There was little evidence that emotional disorders (anxiety and depression), even at the clinical level, were associated with significant impairment. One implication of these results is that pediatricians can expect one child in five to have a clinical-level DSM disorder. A second is that intervention at low levels of disruptive behavioral symptomatology may be needed if significant functional impairment is to be avoided.

Child↗
PubMed1992

Epidemiology of depression for clinicians.

This article reviews the epidemiology of depression and the ways this information can be useful for clinicians. The article defines frequently used epidemiological terms, presents prevalence rates and risk factors; discusses the impact and consequences of depression; and suggests arenas for prevention, early intervention, and treatment that can help clinicians in their everyday work.

Adolescent↗