A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth.

BACKGROUND: Mental and substance use disorders are common and often persistent, with many emerging in early life. Compared to adult mental and substance use disorders, the global burden attributable to these disorders in children and youth has received relatively little attention. METHOD: Data from the Global Burden of Disease Study 2010 was used to investigate the burden of mental and substance disorders in children and youth aged 0-24 years. Burden was estimated in terms of disability-adjusted life years (DALYs), derived from the sum of years lived with disability (YLDs) and years of life lost (YLLs). RESULTS: Globally, mental and substance use disorders are the leading cause of disability in children and youth, accounting for a quarter of all YLDs (54.2 million). In terms of DALYs, they ranked 6th with 55.5 million DALYs (5.7%) and rose to 5th when mortality burden of suicide was reattributed. While mental and substance use disorders were the leading cause of DALYs in high-income countries (HICs), they ranked 7th in low- and middle-income countries (LMICs) due to mortality attributable to infectious diseases. CONCLUSIONS: Mental and substance use disorders are significant contributors to disease burden in children and youth across the globe. As reproductive health and the management of infectious diseases improves in LMICs, the proportion of disease burden in children and youth attributable to mental and substance use disorders will increase, necessitating a realignment of health services in these countries.

Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample.

BACKGROUND: Children with somatic complaints are at increased risk for emotional disorders during childhood. Whether this elevated risk extends into young adulthood - and to which specific disorders - has rarely been tested with long-term prospective-longitudinal community samples. Here we test whether frequent and recurring stomach aches, headaches, and muscle aches during childhood predict emotional disorders in adulthood after accounting for childhood psychiatric and physical health status and psychosocial adversity. METHOD: The Great Smoky Mountains Study is a community representative sample with 1420 participants. Children/adolescents were assessed 4-7 times between ages 9-16 years. They were assessed again up to three times between ages 19-26 years. Childhood somatic complaints were coded when subjects or their parents reported frequent and recurrent headaches, stomach aches, or muscular/joint aches at some point when children were aged 9-16 years. Psychiatric disorders were assessed with the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. RESULTS: Frequent and recurrent somatic complaints in childhood predicted adulthood emotional disorders. After controlling for potential confounders, predictions from childhood somatic complaints were specific to later depression and generalized anxiety disorder. Long-term predictions did not differ by sex. Somatic complaints that persisted across developmental periods were associated with the highest risk for young adult emotional distress disorders. CONCLUSIONS: Children from the community with frequent and recurrent physical distress are at substantially increased risk for emotional distress disorders during young adulthood. Preventions and interventions for somatic complaints could help alleviate this risk.

Generalized anxiety and C-reactive protein levels: a prospective, longitudinal analysis.

BACKGROUND: Generalized anxiety disorder (GAD) is highly co-morbid with depression. Depression is associated with elevated levels of the inflammation marker C-reactive protein (CRP), cross-sectionally and over time. To date, no studies have looked at the association between CRP and GAD. METHOD: A total of nine waves of data from the prospective population-based Great Smoky Mountains Study (n=1420) were used, covering children in the community aged 9-16, 19 and 21 years old. Structured interviews were used at each assessment to assess GAD symptoms, diagnosis and cumulative episodes. Blood spots were collected and assayed for high-sensitivity CRP levels. RESULTS: GAD was associated with increased levels of CRP in bivariate cross-sectional analyses. These bivariate associations, however, were attenuated after accounting for demographic, substance-use and health-related covariates. In longitudinal models, there was little evidence that CRP predicted later GAD. Associations from GAD to later CRP were attenuated in models adjusted for health-related coavariates and there was evidence that the GAD-CRP association was mediated by body mass index (BMI) and medication use. CONCLUSIONS: Similar to depression, GAD was associated with elevated levels of CRP, but the effect of GAD on CRP levels was explained by the effect of GAD on health-related behaviors such as BMI and medication use. This study suggests differences in the association between inflammation and depression and GAD.

Predicting persistent alcohol problems: a prospective analysis from the Great Smoky Mountain Study.

BACKGROUND: Rates of alcohol disorders peak in late adolescence and decrease substantially into the mid-20s. Our aim was to identify risk factors that predict alcohol problems that persist into the mid-20s. METHOD: Data are from the prospective, population-based Great Smoky Mountains Study (GSMS; n=1420), which followed children through late adolescence and into young adulthood. Alcohol persisters were defined as subjects with an alcohol disorder (abuse or dependence) in late adolescence (ages 19 and 21 years) that continued to meet criteria for an alcohol disorder at the mid-20s assessment. RESULTS: The 3-month prevalence of having an alcohol disorder (abuse or dependence) decreased markedly from late adolescence into the mid-20s. A third of late adolescents with an alcohol disorder continued to meet criteria for an alcohol disorder in young adulthood (37 of 144 who met criteria in late adolescence). Risk factors for persister status included multiple alcohol abuse criteria during late adolescence but no alcohol dependence criteria. Risk factors for persister status also included associated features of alcohol dependence such as craving alcohol and drinking to unconsciousness. Persister status was also associated with depression, cannabis dependence and illicit substance use, but not with other psychiatric disorders. More than 90% of late adolescents with three or more of the risk factors identified met criteria for a young adult alcohol disorder. CONCLUSIONS: Symptoms of alcohol abuse, not dependence, best predict long-term persistence of alcohol problems. The set of risk factors identified may be a useful screen for selective and indicated prevention efforts.

Child-, adolescent- and young adult-onset depressions: differential risk factors in development?

BACKGROUND: Previous research reported that childhood adversity predicts juvenile- onset but not adult-onset depression, but studies confounded potentially genuine differences in adversity with differences in the recency with which adversity was experienced. The current study paper took into account the recency of risk when testing for differences among child-, adolescent- and young adult-onset depressions. METHOD: Up to nine waves of data were used per subject from two cohorts of the Great Smoky Mountains Study (GSMS; n=1004), covering children in the community aged 9-16, 19 and 21 years. Youth and one of their parents were interviewed using the Child and Adolescent Psychiatric Assessment (CAPA) between ages 9 and 16; these same youth were interviewed using the Young Adult Psychiatric Assessment (YAPA) at ages 19 and 21. The most common psychosocial risk factors for depression were assessed: poverty, life events, parental psychopathology, maltreatment, and family dysfunction. RESULTS: Consistent with previous research, most childhood psychosocial risk factors were more strongly associated with child-onset than with adolescent-/adult-onset depression. When potentially genuine risk differences among the depression-onset groups were disentangled from differences due to the recency of risk, child- and young adult-onset depression were no longer different from one another. Adolescent-onset depression was associated with few psychosocial risk factors. CONCLUSIONS: There were no differences in putative risk factors between child- and young adult-onset depression when the recency of risk was taken into account. Adolescent-onset depression was associated with few psychosocial risk factors. It is possible that some adolescent-onset depression cases differ in terms of risk from child- and young adult-onset depression.

Dynamic urethral pressure/profilometry pressure transmission ratio determinations in stress-incontinent and stress-continent subjects.

Bladder-to-urethra pressure transmission ratios were calculated in each quarter (designated Q1 through Q4) of the dynamic urethral pressure profile in 110 subjects. Thirty-seven subjects had genuine stress urinary incontinence, whereas 73 were stress continent. Subjects with genuine stress incontinence had significantly lower mean (+/- SD) pressure transmission ratios in all four urethral quarters compared with stress-continent subjects: 71% +/- 14% versus 94% +/- 38% for Q1 (p = 0.004), 69% +/- 16% versus 101% +/- 42% for Q2 (p = 0.00001), 79% +/- 19% versus 113% +/- 46% for Q3 (p = 0.0001), and 90% +/- 22% versus 117% +/- 36% for Q4 (p = 0.001). A pressure transmission ratio value less than 90% in the proximal half of the dynamic profile had a sensitivity of 97%, a specificity of 56%, an abnormal predictive value of 53%, and a normal predictive value of 97%. Calculation of pressure transmission ratios, as opposed to declaring the stress profile positive or negative based on whole urethra/bladder pressure equalization with stress, enhances the utility of the dynamic urethral pressure profile and allows quantification of one of the several variable in the equation of stress urinary incontinence.

Non-neuromuscular determinants of intraluminal urethral pressure in the female baboon: relative importance of vascular and nonvascular factors.

The female urethral sphincteric mechanism has both neuromuscular and non-neuromuscular components. The latter component has several determinants, including the urethral mucosa, the connective tissue of the urethra and periurethra, and the submucosal vascular bed. This study was designed to characterize the non-neuromuscular component of the urethral pressure profile (UPP) by quantitating the relative contributions of its vascular and non-vascular determinants in four female baboons. Following minimization of the smooth muscle and striated muscle determinants (the neuromuscular component) with halothane and pancuronium bromide, UPPs were performed before and after aortic occlusion. It is concluded that vascular and non-vascular factors contribute nearly equally to the non-neuromuscularly generated portion of intraluminal urethral pressure.

Urethral isolation of the genital mycoplasmas and Chlamydia trachomatis in women with chronic urologic complaints.

Eighty-six abacteriuric women with chronic urologic complaints were studied to determine the relationship of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum to their symptoms or diagnoses. All patients had urethral scrape specimens for isolation of the three organisms as well as a detailed urologic history and urodynamic evaluation. Thirty-three of 86 patients (38%) had positive urethral ureaplasma cultures; seven had concurrent M. hominis isolation. No patient had M. hominis as the only urethral isolate and none had a positive C. trachomatis culture. There were no significant differences in urologic symptoms or in urodynamic diagnoses between Ureaplasma culture-positive and culture-negative subjects. It was also found that colonization of the urethra with Ureaplasma decreased with increasing age and with hypoestrogenism.

Plasma renin and aldosterone in an abdominal pregnancy with toxemia.

The first reported measurement of plasma renin and aldosterone in toxemia with an abdominal pregnancy is presented. In contrast to toxemia where plasma renin and aldosterone are either normal or low, extraordinarily high levels of both were found in this patient which returned to normal after delivery. The role of extrarenal renin in the hypertension of toxemia is discussed and the possibility raised that the elevated renin in this case was of placental origin.