Research Summary: The analyses reported in this article are based on data from a longitudinal epidmiologic study of youth from 11 rural counties in North Carolina—the Great Smoky Mountains Study. Nearly half (47.4%) of the children in the population represented in this study had a parent or other parent figure who had been arrested as an adult. Analyses showed that parent risk factors (i.e., substance abuse, mental illness, and lack of education) had a significant direct effect on children's exposure to family risks. These parent risk factors were also associated with greater odds of parental involvement in the criminal justice system (CJS), which in turn, had a significant association with children's likelihood of experiencing two types of family risks (i.e., economic strain and instability), net the effect of parent risk factors. Parent CJS involvement, however, was not significantly associated with family risks related to family structure or quality of care. Exposure to risks in these latter domains was better explained by the direct effect of parental substance abuse, mental health problems, and lack of education. Policy Implications: These findings provide empirical evidence that parent CJS involvement is significantly related to children's exposure to certain types of family risks independent of the possible confounding effect of parent risks. The fact that the two domains of family risks that were associated with CJS involvement were economic adversity and family stability is noteworthy as these mirror two of the ecological correlates of crime that are thought to be perpetuated by high levels of incarceration—poverty and population mobility. Second, these findings suggest that it is unrealistic to expect correctional programs that focus on inmates' relationships with their children to single‐handedly impact intergenerational incarceration. Programs of this nature may play an important role in offsetting some of the more immediate adverse effects parental incarceration might have on children, but these analyses suggest that they need to be coupled with rehabilitation efforts that target parental substance abuse, mental health problems, and inadequate education. This conclusion is made because although parent CJS involvement carries its own risks for children experiencing certain family risks (i.e., economic strain and instability), these parent problems are still significant predictors of the same as well as other family risks, which in turn, past research has linked to adverse youth outcomes such as substance abuse and delinquency.
This study examined points of entry into the mental health service system for children and adolescents as well as patterns of movement through five service sectors: specialty mental health services, education, general medicine, juvenile justice, and child welfare.The data were from the Great Smoky Mountains Study, a longitudinal epidemiologic study of mental health problems and service use among youths. The sample consisted of 1,420 youths who were nine, 11, or 13 years old at study entry. Each youth and a parent were interviewed at baseline and every year thereafter about the use of services for mental health problems over the three-year study period.Population estimates indicated that 54 percent of youths have used mental health services at some time during their lives. The education sector was the most common point of entry and provider of services across all age groups. The specialty mental health sector was the second most common point of entry for youths up to age 13 years, and juvenile justice was the second most common point of entry for youths between the ages of 14 and 16. Youths who entered the mental health system through the specialty mental health sector were the most likely to subsequently receive services from other sectors, and those who entered through the education sector were the least likely to do so.The education sector plays a central role as a point of entry into the mental health system. Interagency collaboration among three primary sectors-education, specialty mental health services, and general medicine-is critical to ensuring that youths who are in need of mental health care receive appropriate services.
The Child and Adolescent Services Assessment (CASA) is a self- and parent-report instrument designed to assess the use of mental health services by children ages 8 years to 18 years. The CASA includes 31 settings covering inpatient, outpatient, and informal services provided by a variety of child-serving providers and sectors. This instrument collects information on whether a service was ever used and more detailed information (length of stay/number of visits, focus of treatment) on services used in the recent past. A description of the instrument, information on interviewer training and coding of data, psychometric data on clinical samples, and a case study are presented.
Social causation (adversity and stress) vs social selection (downward mobility from familial liability to mental illness) are competing theories about the origins of mental illness.To test the role of social selection vs social causation of childhood psychopathology using a natural experiment.Quasi-experimental, longitudinal study.A representative population sample of 1420 rural children aged 9 to 13 years at intake were given annual psychiatric assessments for 8 years (1993-2000). One quarter of the sample were American Indian, and the remaining were predominantly white. Halfway through the study, a casino opening on the Indian reservation gave every American Indian an income supplement that increased annually. This increase moved 14% of study families out of poverty, while 53% remained poor, and 32% were never poor. Incomes of non-Indian families were unaffected.Levels of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, psychiatric symptoms in the never-poor, persistently poor, and ex-poor children were compared for the 4 years before and after the casino opened.Before the casino opened, the persistently poor and ex-poor children had more psychiatric symptoms (4.38 and 4.28, respectively) than the never-poor children (2.75), but after the opening levels among the ex-poor fell to those of the never-poor children, while levels among those who were persistently poor remained high (odds ratio, 1.50; 95% confidence interval, 1.08-2.09; and odds ratio, 0.91; 95% confidence interval, 0.77-1.07, respectively). The effect was specific to symptoms of conduct and oppositional defiant disorders. Anxiety and depression symptoms were unaffected. Similar results were found in non-Indian children whose families moved out of poverty during the same period.An income intervention that moved families out of poverty for reasons that cannot be ascribed to family characteristics had a major effect on some types of children's psychiatric disorders, but not on others. Results support a social causation explanation for conduct and oppositional disorder, but not for anxiety or depression.
The self-reports of depressive symptomatology of the 89 children and the parental reports of 62 parents whose children had such symptoms from a sample of 220 children, aged 6 to 23 years, in a family-genetic study of children at high and low risk of depression were examined for the effects of the age and sex of the child. The age of the child at interview proved (o have a significant effect upon the dating of the onset of dysphoric episodes and the dating of the worst ever episode of dysphoria. The older girls reported about two more depressive symptoms on average than the younger girls. This finding was obscured unless account was taken of the age at which the subjects were interviewed. However, these effects did not apply to a group of melancholia-related symptoms. There were no consistent effects of age at interview or age at episode on the symptom reports of the boys or in the reports from the parents about both their male and female children. J. Am. Acad, Child Adolesc. Psychiatry, 1991, 30, 1:67–74.
Journal Article Developmental Epidemiology Get access Adrian Angold, Adrian Angold Developmental Epidemiology Program, Department of Psychiatry, Duke University Medical CenterDurham, NC Adrian Angold, MRCPsych, Developmental Epidemiology Program, Department of Psychiatry, Box 3454, Duke University Medical Center, Durham NC 27710-3454 Search for other works by this author on: Oxford Academic PubMed Google Scholar E. Jane Costello E. Jane Costello Developmental Epidemiology Program, Department of Psychiatry, Duke University Medical CenterDurham, NC Search for other works by this author on: Oxford Academic PubMed Google Scholar Epidemiologic Reviews, Volume 17, Issue 1, 1995, Pages 74–82, https://doi.org/10.1093/oxfordjournals.epirev.a036187 Published: 01 March 1995 Article history Received: 22 March 1994 Published: 01 March 1995 Revision received: 27 April 1995
Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as aDSMIII-Rdiagnosis 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 ofDSM-III-Rdisorders, 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 ofDSM-III-Rdisorder 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.
