Mental Illness: Acquired Young, Diagnosed Late
Half of lifetime cases of mental illness begin by age 14, and despite effective treatments, there are long delays--sometimes decades--between the onset of symptoms and when people seek and receive treatment, according to research supported by the National Institute of Mental Health.
The National Comorbidity Survey Replication study, published last year in the Archives of General Psychiatry, also reveals that untreated mental disorders can lead to more-severe and difficult-to-treat illnesses, and to the development of co-occurring mental illnesses.
Unlike heart disease or most cancers, young people with mental disorders suffer disability when they are in the prime of their lives and normally most productive. For example, the study found that anxiety disorders often begin in late childhood, mood disorders in late adolescence, and substance abuse in the early 20s.
Pervasive delays in treatment tend to occur in nearly all mental disorders, according to the study. The median delay across disorders is nearly a decade; the longest delays are 20-23 years for social phobia and separation anxiety disorders, possibly due to the relatively early age of onset and fears of therapy that involve social interactions.
The study notes that delays in treatment can have many public health implications, including frequent, more-severe episodes and resistance to treatment. Moreover, untreated mental illnesses are associated with school failure, teenage childbearing, unstable employment, early marriage, and marital instability and violence.
Unfortunately, the researchers say, 45% of those with one mental disorder meet the criteria for two or more. And the study indicates the U.S. mental health care system is not keeping up with consumers' needs. Over a 12-month period, 60% of people with mental health disorders received no treatment.
The good news is that the proportion of people who reported 12-month use of mental health services is higher today, at 17%, compared with 13% a decade ago. People with mental or substance abuse disorders were more likely to get treatment from a primary care physician, nurse, or other general medical doctor (23%), or from a nonpsychiatrist mental health specialist (16%), such as a psychologist, social worker, or counselor, than from a psychiatrist (12%).
Issue Brief Highlights Ups and Downs in Childhood Poverty
A recent issue brief from CWLA's National Data Analysis System (NDAS) outlines how the number of children under age 18 who are living in poverty has fluctuated widely since 1969, even though the overall poverty rate for the general population has remained fairly stable.
Two out of every five young children in the United States are at risk for living in poor or low-income families. According to the brief, Child Poverty, in 2003, 19.8% of children under age 6 were living in poverty, compared with 17.6% of children under 18 the same year. The worst year was 1992, when 25.7% of children under age 6 were in poverty. The best year was 1969, when 15.3% of children under 6 lived in poverty.
The issue brief also examines how children are more likely to live in impoverished homes when no male is present in the household. In 2003, 35.5% of female-headed households with children younger than 18 were in poverty, 41.7% of children in families headed by a single female lived below 200% of the poverty threshold. Also that year, 17.2% of children under 18 were living in low-income households.
Children who grow up in poverty have poorer health, nutrition, housing, and education outcomes and are more likely to remain in poverty as adults.
In 2002, households with incomes below the poverty line and female-headed households with children had much higher rates of food insecurity than the national average. In 2001, 7% of households with children had inadequate housing, compared with 9% in 1978, and 31% of very low-income renter households with children reported severe housing problems.
The issue brief is available on the NDAS website under "Publications."
Depression's Side Effects for Black Teens
A range of adverse health consequences may accompany depression in black adolescent females. Doctors need to be alert to the coexistence of depression and low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behaviors among these youth, according to data published in the July 2005 issue of Pediatrics.
The study that produced the data recruited 460 black female adolescents from high-risk neighborhoods in Birmingham, Alabama. Within this group, depressed adolescents were compared with peers who were not depressed regarding low self-esteem; emotional, physical, and verbal abuse; poor body image; and antisocial behavior.
Depressed adolescents were 5.3 times more likely to report low self-esteem than were nondepressed adolescents, 4.3 times more likely to report emotional abuse, 3.7 times more likely to report being physically abused, and almost 3 times as likely to report being verbally abused. Depressed adolescents were more than twice as likely to report poor body image and nearly twice as likely to report engaging in antisocial behaviors.
Reading, Writing, and Computer Technology
The use of computers and the Internet by students is commonplace and begins early, according to an issue brief by the National Center for Education Statistics (NCES). In fact, even before kindergarten, most nursery school children use computers, and about one-quarter use the Internet.
The brief, Rates of Computer and Internet Use by Children in Nursery School and Students in Kindergarten Through Twelfth Grade: 2003, analyzes data gathered during the October 2003 Computer and Internet User Supplement to the Current Population Survey, which collected information from 29,075 children, from nursery school through 12th grade.
Overall, the survey found that 91% of students used computers, and 59% used the Internet. Broken down by age group, 67% of nursery school students used computers, and 23% used the Internet. Among kindergartners, 80% used computers, and 32% used the Internet. By high school, almost all students used computers (97%), and most used the Internet (80%).
Although most students are computer savvy, the data revealed that students from low-income families with limited education used computers and the Internet less--differences in computer use were as much as 13 percentage points, and differences in Internet use were as high as 36 percentage points between students from low-income families and other students.
Characteristics of students with lower computer and Internet use included being from families with annual incomes less than $20,000, parents lacking a high school diploma, being black or Hispanic, and living in households where Spanish was the only language spoken.
The report can be downloaded from the NCES website.
It's Dinnertime...Where Is Your Child?
Research has shown links between frequent family dinners and positive teen outcomes. Teens who regularly eat with their families are less likely to get into fights, think about suicide, smoke, drink, and use drugs, and are more likely to delay sexual activity and do better academically. Are American families paying attention to these factors and gathering around the dinner table?
Child Trends, a nonprofit, nonpartisan research organization dedicated to improving the lives of children, has found that in 2003, 42% of adolescents ages 12-17 ate a meal with their family six to seven days a week, 27% ate a meal as a family four to five days a week, and 31% ate meals with family three days a week or less.
Children ages 6-11 were more likely to sit down to family meals--56% ate a meal as a family six to seven days a week, 25% did so four to five days a week, and 20% three days a week or less.
In its report, Family Meals, Child Trends notes a number of factors affecting family mealtime:
The report is available on the Child Trends DataBank.
- Foreign-born adolescents are more likely than their native-born peers with native-born parents to eat meals together six to seven times a week--62% versus 40%.
- Hispanic adolescents and children are more likely than both non-Hispanic whites and non-Hispanic blacks to eat meals together six or seven days a week.
- Of adolescents living in households at 100% of the poverty level, 55% ate meals six to seven days a week together, compared with 44% of those living at 100%-200% of the poverty level, and 37% of those living at 200% or more of the poverty level.
Future Implications for Girls Growing Up Poor
The link between childhood poverty and poor health in old age is well established. But a recent study by Duke University sociologists examines the issue further and finds that women with disadvantaged childhoods are more likely to have heart attacks in old age, but men who grow up under similar conditions are not.
Researchers examined specifically the risk of heart attack, because the link between childhood poverty and cardiovascular disease in later life is strong, and because heart attacks are so common. Heart attacks and cardiovascular disease have been the leading cause of death among American men and women since 1919.
Looking at data from the Health and Retirement study, a national study of nearly 10,000 people born between 1931 and 1941, researchers found that women who grew up in poor homes were 15% more likely to have had a heart attack in their 50s than were women who did not experience such disadvantages. The study found no such link for men.
Additionally, women who grew up without fathers were 12% more likely to have had a heart attack in their 50s; men who grew up in fatherless homes did not have an increased risk of heart attack.
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