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MONDAY, Aug. 4, 2003 (HealthDayNews) -- America's young people seem to be suffering from a disproportionate level of major depressive episodes, post-traumatic stress disorder (PTSD) and substance abuse problems.
In a new study appearing in the August issue of the Journal of Consulting and Clinical Psychology, about 16 percent of boys and 19 percent of girls met the current criteria for diagnosis for one of these three disorders.
Even with such high percentages, the findings are not surprising, says Dr. Jon A. Shaw, professor and director of child and adolescent psychiatry at the University of Miami School of Medicine. "It doesn't tell us anything we didn't already know, but it's nice to have a substantiation," he says.
"It's clear that it's not a rare event. There are substantial numbers of teenagers out there who are developing these problems," adds study author Dean Kilpatrick, a professor of clinical psychology and director of the National Crime Victims Research and Treatment Center at the Medical University of South Carolina in Charleston. "The fact that they still had them is also very distressing, because it's suggesting that a) most of these things don't appear to go away spontaneously; and b) the current rates indicate haven't gotten any treatment or effective treatment. There's a mental health burden on teenagers."
In truth, there is very little information on these disorders in children and adolescents, Shaw says. This is precisely why this study was undertaken. The study authors were particularly interested in how interpersonal violence might be associated with these three disorders.
To this end, they interviewed 4,023 adolescents aged 12 to 17 by phone, asking structured questions about their family, any history of trauma -- including sexual and physical assault -- as well as the three disorders being studied.
Overall, 15.5 percent of boys and 19.3 percent of girls had at least one of the three diagnoses (PTSD, major depressive disorder or substance abuse).
About twice the proportion of girls over boys met the criteria for PTSD and major depressive episode, while boys were slightly more likely to meet the criteria for substance abuse. Some 6.3 percent of girls met the criteria for PTSD versus 3.7 percent of boys in the previous six months. Almost 14 percent of girls met the criteria for major depressive disorder versus 7.4 percent of boys in the same time period. The prevalence of substance abuse/dependence among boys was 8.2 percent and 6.2 percent among girls for the previous 12 months.
Almost three quarters (71.5 percent) of participants with PTSD had either major depression or substance abuse, meaning that only 28.5 percent had PTSD only. Of those with major depression, 39.4 percent had either PTSD or substance abuse/dependency, and 61.6 percent had the depression only. And of those with substance abuse/dependency, 32.1 percent had either PTSD or major depression, while 67.9 percent had the abuse/dependency on its own.
Interpersonal violence (experiencing sexual or physical assault or having witnessed violence) significantly increased the risk for these disorders. Kilpatrick says the witnessed violence was the most surprising part of the study. "You think of some high-crime areas in which people are witnessing some pretty serious violence as something you would expect. But this is a representative sample of all teenagers throughout the entire U.S., and you're finding that 40 percent of them have witnessed in person some pretty serious violence," he says. (The study found that 47.5 percent of respondents had some kind of exposure to violence.)
While the sample was considered to be representative, Kilpatrick did point out some limitations with the methodology, namely that participants "self reported" all the information and that all interviewees were contacted by phone. That means homeless youth and adolescents residing in institutions or in homes without telephones could not be reached.
The findings speak to the challenges of adolescent and child psychiatry in general.
"The main thing is identifying people who have problems like this, helping match them up with resources and recognizing that these are complex issues," Shaw says. "You don't just treat the PTSD alone. Seventy-five percent will have additional psychiatric or psychological problems, and one has to be sensitive to context, family, community. We're just now beginning to understand how ethnicity and culture interact with response to traumatic situations."
The issues are extremely complicated ones. "Trauma, like beauty, is in the eye of the beholder. One man's stress is another's challenge," Shaw continues. "Perceived stress is almost as important as actual stress. These are very complex issues and, if you look at homogenized data like this, you get a very thin veneer impression of what's going on out there -- but it's a signal."
Certainly, the issues are complex for individuals who are suffering any one of these disorders. "There's nothing about these problems that improves your ability to concentrate, do your schoolwork, work productively at jobs, and all of that," Kilpatrick says. "If it's affecting the education of our future adults, then that's a problem. It's not true that everyone is a completely dysfunctional basket case, but it is true that it's going to be harder for these people to be productive citizens -- not to mention the fact that many of them are suffering."
An interesting, and heartening, by-product of the study was the number of participants who said that they would like to be involved in future follow-ups: 98 percent. "I attribute that to the fact that these issues are very relevant to American families and to adolescents themselves," Kilpatrick says. "It suggested to me that these topics were of great interest to adolescents because this is a big part of their lives, unfortunately."
More information
The National Center for PTSD has information on PTSD in adolescents and children. The American Academy of Child and Adolescent Psychiatry has fact sheets on depression and substance abuse.
