Childhood Psychiatric Distress Produces Adult Problems

Even if they go undiagnosed or don’t persist into adulthood, psychiatric problems in childhood can adversely affect adult outcomes.

In an exclusive interview with Pharmacy Times, William E. Copeland, PhD, of Duke University Medical Center, explained that this research finding highlights the importance of detecting and treating mental health issues early in a child’s development.

“We have a number of tools at our disposal to prevent or treat psychiatric problems, but we need to start addressing these problems in early childhood,” he said. “Mental health issues can emerge early in development, so it’s really critical to get in there as soon as possible to minimize the risk of adverse outcomes in adulthood.”

Dr. Copeland emphasized that more focus needs to be placed on children who show signs of psychiatric problems but fall below diagnostic thresholds, as they are frequently left untreated.

“We often forget that there is a much larger group of affected children who aren’t identified as having a psychiatric disorder simply because they do not meet certain criteria. About 6 out of 10 children with mental health issues do not get any treatment at all,” he noted. “As health care professionals, we need to figure out how to change the system to ensure that these patients are given the help they need.”

To form these conclusions, Dr. Copeland and his co-authors evaluated 1420 children from 11 predominantly rural counties in North Carolina, assessing each participant for common psychiatric diagnoses and subthreshold psychiatric problems 6 times between ages 9 and 16.

At some point during this childhood and adolescent period, 26.2% of participants met the criteria for a common behavioral or emotional disorder, while 31% exhibited subthreshold psychiatric problems.

The research team followed up with 1273 of these participants 3 times between ages 19 and 26, assessing them for adverse outcomes related to health, finances, and social functioning, such as educational failure, criminality, addiction, suicidality, teenage parenthood, mental and physical health problems, untimely death, and social isolation.

Analyzing these data revealed that 59.5% of the participants who had a childhood psychiatric disorder reported at least 1 adverse outcome as adults, compared with 41.5% of those who had childhood subthreshold problems and 19.9% of those with neither.

Furthermore, those with either childhood psychiatric disorders or subthreshold problems in childhood accounted for almost 80% of all participants with at least 1 adverse adult outcome and nearly 90% of all those with 2 or more adverse adult outcomes.

Overall, participants with a childhood disorder were 6 times more likely to later experience at least 1 adverse adult outcome than those with no history of psychiatric problems. For individuals with subthreshold problems, those odds were 3 times higher.

While the study authors acknowledged that their evidence is insufficient to draw conclusions about causality, they noted that the association between childhood mental health and adverse outcomes in adulthood was apparent even after accounting for factors such as socioeconomic status and family stability.

“Common childhood psychiatric disorders are costly, impairing, and often a source of great distress for the child and a burden to others,” the researchers wrote. “If the goal of public health efforts is to increase opportunity and optimal outcomes, and to reduce distress, then there may be no better target than the reduction of childhood psychiatric distress—at the clinical and subthreshold levels.”

This study was published on July 15, 2015, in JAMA Psychiatry.