Background Child psychiatric disorders are common and treatable, but often go undetected and therefore remain 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 7984 5- to 15-year-olds from the 1999 British Child Mental Health Survey. Results Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% CI 94.1–95.1%) and a sensitivity of 63.3% (59.7–66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive and some anxiety disorders, but under 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs. Conclusions Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.
The findings described in this report and summarized here focus on the prevalence of mental disorders among 5-15 year olds and on the associations between the presence of a mental disorder and biographic, sociodemographic, socio-economic, and social functioning characteristics of the child and the family. Causal relationships should not be assumed for any of the results presented in this report.
The needs of patients in medium secure psychiatric units are well documented, but little is known of the range of clinical and security needs of those assessed but put on waiting lists or not admitted. The aim of the study was to quantify needs for treatment and care of a nationally representative sample of patients assessed for admission to medium secure care. 34 units containing 98% of medium secure beds in England and Wales in 1999 participated. All assessments were logged. A random sub-sample was selected for detailed interviews with assessing clinicians. Higher sampling fractions were used in smaller units. Unit monthly waiting lists averaged 5 patients for each available bed. Common reasons for referral were aggressive behaviour, deteriorating mental state, need for diagnostic assessment, and non-compliance with treatment. 42 per cent of assessed patients needed medium secure care, one-third on a long-term basis. The assessing units refused some patients who needed medium secure care, and accepted some psychotic patients who did not require security. 4 weeks after assessment, 65% of waiting list patients had still not been admitted. The conclusion was that a substantial shortage in medium secure beds existed, especially for long-term placements. A third of those needing medium secure care required it on a long-term basis, but assessing units did not admit many of these patients. Further work is needed on the low levels of assessed need for interventions relating to substance abuse.
Child psychiatric disorders are common and treatable, but often go undetected and therefore remain untreated. To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community, SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 7984 5-15 year olds from the 1999 British Child Mental Health Survey. Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% Cl, 94.1-95.1%) and a sensitivity of 63.3% (59.7-66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive, and some anxiety disorders, but fewer than 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs. Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.
A shortage of medium secure psychiatric beds is widely recognized, but there is little data on patients referred for admission but not accepted. This paper examines the relationships between assessed need for and admission to medium security. The method used was interview survey with principal clinical assessors of patients assessed for admission to medium secure units in England and Wales in the first half of 1999. A stratified random sample totalling 418 patients from 34 medium secure units, including 98% of relevant beds nationally was used. Factors associated with being assessed as needing medium security (but not necessarily being admitted) included having features of acute schizophrenia, non-compliance with treatment, a history of sexually inappropriate behaviour, and being referred because of self-harm. A ‘grave’ current offence and a history of recent or many past custodial sentences were also important. For patients seen in prison, NHS or community services, just under a fifth of those assessed as needing medium security (especially long term) were not admitted, and just under a quarter of those admitted needed low or no security. It was concluded that the match between need for and admission to medium security is poor. Insufficient range of provision leads to inappropriate use of medium secure beds.
The Development and Well-Being Assessment (DAWBA) is a novel package of questionnaires, interviews, and rating techniques designed to generate ICD-10 and DSM-IV psychiatric diagnoses on 5-16-year-olds. Nonclinical interviewers administer a structured interview to parents about psychiatric symptoms and resultant impact. When definite symptoms are identified by the structured questions, interviewers use open-ended questions and supplementary prompts to get parents to describe the problems in their own words. These descriptions are transcribed verbatim by the interviewers but are not rated by them. A similar interview is administered to 11-16-year-olds. Teachers complete a brief questionnaire covering the main conduct, emotional, and hyperactivity symptoms and any resultant impairment. The different sorts of information are brought together by a computer program that also predicts likely diagnoses. These computer-generated summary sheets and diagnoses form a convenient starting point for experienced clinical raters, who decide whether to accept or overturn the computer diagnosis (or lack of diagnosis) in the light of their review of all the data, including transcripts. In the present study, the DAWBA was administered to community (N = 491) and clinic (N = 39) samples. There was excellent discrimination between community and clinic samples in rates of diagnosed disorder. Within the community sample, subjects with and without diagnosed disorders differed markedly in external characteristics and prognosis. In the clinic sample, there was substantial agreement between DAWBA and case note diagnoses, though the DAWBA diagnosed more comorbid disorders. The use of screening questions and skip rules greatly reduced interview length by allowing many sections to be omitted with very little loss of positive information. Overall, the DAWBA successfully combined the cheapness and simplicity of respondent-based measures with the clinical persuasiveness of investigator-based diagnoses. The DAWBA has considerable potential as an epidemiological measure, and may prove to be of clinical value too.
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