Prevalence and comorbidity of borderline personality traits in the Quebec general population aged 12-14 years.

PURPOSE: The early identification of borderline personality traits (BPT) in adolescents helps to prevent their progression. Data are available for the clinical population, but little has been published on the general population, especially regarding age and sex distribution in adolescence. Even less is known about the comorbidity of BPT with other mental disorders. METHODS: We estimated the prevalence of BPT, by sex, age, and comorbidity, in a sample of adolescents aged 12-14 years (n = 799) from the Quebec Mental Health Survey. A complex sampling design was used to ensure representativeness. BPT was assessed with the abbreviated-diagnostic interview for borderlines-revised, with the adolescent as an informant. Reliability coefficients were above 0.80. Several levels of severity were explored using an independent criterion, defined by impairment according to the Columbia impairment scale. RESULTS: The overall prevalence of BPT was 6.3%. Prevalence estimates for the most impaired were 3.2% for the entire sample and 1.3% for 12-year-olds. Prevalence increased significantly with age for most impairment levels but did not differ significantly between the sexes. In adolescents, BPT displayed moderate-to-strong comorbidity with anxiety (AD) and insomnia disorders, and very strong comorbidity with depressive (DD), attention deficit hyperactivity (ADHD), and oppositional defiant/conduct disorders (ODD/CD). CONCLUSION: We, therefore, make two clinical recommendations for child psychiatry practice: (1) with respect to the lower rate of male adolescents attending BPT Health Programs, increase BPT screening in male adolescents; (2) evaluate BPT when children with ADHD or ODD/CD develop AD or DD during adolescence.

Reliability, Validity, and Clinical Utility of the Dominic Interactive for Adolescents-RevisedA DSM-5-Based Self-Report Screen for Mental Disorders, Borderline Personality Traits, and Suicidality.

OBJECTIVES: The Dominic Interactive for Adolescents-Revised (DIA-R) is a multimedia self-report screen for 9 mental disorders, borderline personality traits, and suicidality defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5). This study aimed to examine the reliability and the validity of this instrument. METHODS: French- and English-speaking adolescents aged 12 to 15 years ( N = 447) were recruited from schools and clinical settings in Montreal and were evaluated twice. The internal consistency was estimated by Cronbach alpha coefficients and the test-retest reliability by intraclass correlation coefficients. Cutoff points on the DIA-R scales were determined by using clinically relevant measures for defining external validation criteria: the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, the Beck Hopelessness Scale, and the Abbreviated-Diagnostic Interview for Borderlines. Receiver operating characteristic (ROC) analyses provided accuracy estimates (area under the ROC curve, sensitivity, specificity, likelihood ratio) to evaluate the ability of the DIA-R scales to predict external criteria. RESULTS: For most of the DIA-R scales, reliability coefficients were excellent or moderate. High or moderate accuracy estimates from ROC analyses demonstrated the ability of the DIA-R thresholds to predict psychopathological conditions. These thresholds were generally capable to discriminate between clinical and school subsamples. However, the validity of the obsessions/compulsions scale was too low. CONCLUSIONS: Findings clearly support the reliability and the validity of the DIA-R. This instrument may be useful to assess a wide range of adolescents' mental health problems in the continuum of services. This conclusion applies to all scales, except the obsessions/compulsions one.

[Epidemiology of depressive and anxiety disorders among Quebec children and adolescents]. / Épidémiologie des troubles dépressifs et anxieux chez les enfants et les adolescents québécois.

Epidemiology of child and adolescent mental health is a relatively new discipline, particularly in the province of Quebec. Some work has however estimated the prevalence of the most common mental disorders among young people, such as anxiety and depression, as well as identified associated individual, family and socio-economic variables. This article has two objectives: to present a review of major epidemiological research findings in child psychiatry conducted in the province of Quebec and highlight the contribution of these findings for public health. To achieve these objectives, this article presents the results of research related to three themes: 1) measurement and identification of anxiety and depressive disorders in children and adolescents, 2) the prevalence of these disorders and comorbidity, 3) the correlates of anxiety and depressive disorders identified in epidemiological studies. The authors will then highlight future implications of these results across Québec policies in the field of public health.

Development and Initial Validation of the Disruptive Mood Dysregulation Disorder Questionnaire Among Adolescents From Clinic Settings.

OBJECTIVES: Disruptive mood dysregulation disorder (DMDD) is a new DSM-5 diagnosis. It is observed in youths and is characterized by chronic irritability and temper outbursts. This study aimed (i) to develop a brief questionnaire administered during a semi-structured interview and (ii) to assess its psychometric properties with adolescents 12-15 years old by estimating its internal consistency and its concurrent association with measures of depressive symptoms and borderline personality traits. METHODS: A 10-item questionnaire was developed based on the DSM-5 criteria and input from mental health professionals. The questionnaire was administered to 192 adolescents from youth centres, inpatient units and specialized outpatient clinics in Montreal, as were the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-PL), the Abbreviated version of the Diagnostic Interview for Borderlines revised (Ab-DIB), and the Dominic Interactive for Adolescents-Revised (DIA-R). RESULTS: A DMDD Questionnaire among adolescents from clinic settings is obtained. The content of the instrument's items was initially developed based on DSM-5 criteria and expert judgment to ensure that this new instrument covered the theoretical concepts of DMDD in English and French. Twelve participants (6.3%) met nine or more criteria and 11 youths (5.7%) met the three main criteria of DMDD (A, C, and D), which suggested the likely presence of DMDD. The total Cronbach's alpha was 0.90. In addition, the DMDD Questionnaire was significantly associated with depressive symptoms and borderline personality traits. CONCLUSION: The reliability and concurrent validity indices suggest that the questionnaire as a decision-support tool may be used with adolescents in clinical settings. It highlights that the DSM-5 DMDD criteria seem associated with depressive symptoms and borderline personality traits. Finally, future studies will be necessary to establish more robust calculations in relation to the validity and reliability of this questionnaire.

Psychometric properties of a pictorial instrument for assessing psychopathology in youth aged 12 to 15 years: the Dominic Interactive for Adolescents.

OBJECTIVES: Over the last 15 years, adequate psychometric properties of the different versions of the Dominic led to the development of the Dominic Interactive for Adolescents (DIA). The DIA is a Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, Text Revision-based self-administered computerized pictorial instrument for assessing the most frequent mental disorders in adolescents aged 12 to 15 years. Our study aims to verify the internal consistency, the test-retest estimate of reliability, and the criterion-related validity of this instrument. METHOD: The total sample included 607 adolescents living in the Montreal urban area recruited from the community (465 French-speaking) and the clinical population (142 French-speaking). Internal consistency was evaluated by Cronbach's alpha coefficients and test-retest estimate of reliability by the kappas and intraclass correlation coefficients (ICCs). Two criteria are indicative of criterion-related validity of the DIA: clinical judgment on the presence or absence of symptoms (scored independently by 3 judges) and the adolescents' referrals to outpatient psychiatric clinics. RESULTS: For most symptom scales of the DIA, Cronbach's alpha coefficients varied from 0.69 to 0.89, test-retest kappas were 0.50 or greater, and ICCs ranged from 0.78 to 0.87. The criterion-related validity was demonstrated for symptoms, symptom scales, and the categories based on the symptom scale cut-off points. CONCLUSION: As no informant can be considered the criterion standard of psychopathology, the interview with adolescents regarding their own symptoms is necessary. Findings from our study reasonably support adequate psychometric properties of the DIA in adolescents aged 12 to 15 years.

Psychometric properties of the Dominic Interactive in a large French sample.

OBJECTIVES: To examine the psychometric properties of the Dominic Interactive (DI) in school-aged children in a different cultural environment than Quebec. METHODS: In a large French region, 100 schools and 25 children (aged 6 to 11 years) per school were randomly selected. Data were collected using self-administered questionnaires to children (DI), parents (sociodemographic characteristics, mental health services use), and teachers (child school achievement). DI psychometric properties were assessed by examining: the distribution of each DI diagnosis; comorbidity between diagnoses; alpha coefficients measuring internal consistency; and correlates of psychopathologies with sociodemographic status and health care services use. Estimates of DI properties were compared with those from a sample of community children in Quebec. RESULTS: Complete data were available for 1274 children (54.4%). The internal consistency of each DI diagnosis of the French version was reasonable, with Cronbach's alpha coefficients ranging from 0.62 to 0.89. The psychometric properties and comorbidity were consistent with the version from Quebec. CONCLUSIONS: The satisfactory psychometric properties of the DI along with other demonstrated advantages of this instrument (children enjoy the activity, parents approve of it, and it is cost-effective) and its cultural adaptability support the consideration of the DI for epidemiologic studies in diverse cultures.

Reliability and diagnostic efficiency of the abbreviated-diagnostic interview for borderlines in an adolescent clinical population.

Examine the reliability as well as the concurrent validity and diagnostic efficiency of the Abbreviated version of the diagnostic interview for borderlines revised (Ab-DIB) as a screening measure of borderline psychopathology in an adolescent clinical population. The Ab-DIB is a DIB-R-derived self-report covering the impulsiveness as well as the affect and cognitive components of the borderline construct. Its administration lasts 10 min. The Ab-DIB was tested on 139 suicidal youths for reliability and concurrent validity against the DIB-R and the Columbia Impairment Scale (CIS). Internal consistencies and test-retest Intra-Class-Correlations ranged from 0.80 to 0.86 and 0.77 to 0.95, respectively. ROC analysis yielded an area under the curve of 0.87 (p < 0.001). Sensitivity was 0.88 and specificity ranged from 0.82 to 0.73 depending on the age-range. Correlation of the Ab-DIB's continuous score with the CIS was 0.42 (p < 0.001). In conclusion, The Ab-DIB's brief duration and psychometric properties suggest its utility in time-limited settings.

Correlates of depressive disorders in the Quebec general population 6 to 14 years of age.

There are relatively few community-based epidemiological studies in which correlates of depressive disorders were identified through multivariate analyses in children and adolescents aged 6--14 years. Moreover, several family characteristics (e.g., parent-child relationship) have never been explored in this regard. The purpose of this study was twofold. Using data from the Quebec Child Mental Health Survey, it sought: (1) to identify psychosocial correlates associated with depressive disorder in two age-groups (6--11 and 12-14 years) according to informant (child/adolescent, parent); and (2) to interpret the relative importance of correlates by ranking variables according to strength and consistency of association across age-groups. Logistic regression models show correlates to be inconsistent across informants. The ranking of correlates indicates a major contribution of only-child status/ordinal position, parent's major depressive disorder, stressful family events, and parent-child relationship, thereby supporting the hypothesis of the relevance of family context in the development of depression.

Informant-specific correlates of suicidal behavior in a community survey of 12- to 14-year-olds.

OBJECTIVES: To arrive at a better estimation of informant-specific correlates of suicidal behavior in young adolescents and to see how agreements and discrepancies between child and parent informants can contribute to the development of research and interventions. METHOD: The weighted sample from the Quebec Child Mental Health Survey conducted in 1992 included 825 adolescents, aged 12 to 14 years, and their parents. The adolescent and one parent were questioned by two different interviewers. The response rate was 80.3%. Three categories of independent variables were assessed: adolescent, family, and socioeconomic characteristics. Logistic regression models were based on the adolescent and parent informant reports. RESULTS: Parents identified 6 of the 59 adolescents having reported suicidal ideation and 2 of the 36 adolescents having reported suicide attempts. Two informant-specific models of correlates of suicidal behavior were found. The adolescent model included internalizing and externalizing mental disorders, family stressful events, and parent-adolescent relationship difficulties, while the parent model included perceiving a need for help for the adolescent, parent's depressive disorders, and parent-adolescent relationship difficulties. CONCLUSION: The study shows the relevance of considering informant-specific correlates of suicidal behavior in the development of research and interventions targeting youths suicidal behavior.

Reliability, validity, and clinical use of the Dominic Interactive: a DSM-based, self-report screen for school-aged children.

OBJECTIVES: As no single informant can be considered the gold standard of child psychopathology, interviewing of children regarding their own symptoms is necessary. Our study focused on the reliability, validity, and clinical use of the Dominic Interactive (DI), a multimedia self-report screen to assess symptoms for the most frequent Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, mental disorders in school-aged children. METHODS: A sample of 585 children aged 6 to 11 years from the community and psychiatric clinics was used to analyze the internal consistency, the test-retest estimate of reliability, and the criterion-related validity of the DI against the referral status. In addition, cross-informant correlation coefficients between this instrument (child report) and the Child Symptom Inventory (parent report) were explored in a subsample of 292 participants. RESULTS: For the total sample, Cronbach alpha coefficients ranged from 0.63 to 0.91. Test-retest kappas varied from 0.42 to 0.62 for categories based on cut-off points, except for specific phobias. Intraclass correlation coefficients ranged from 0.70 to 0.81 for symptom scales. The DI discriminated between referred and non-referred children in psychiatric clinics for all symptom scales. Significant cross-informant correlation coefficients were higher for the externalizing symptoms (0.35 to 0.48) than the internalizing symptoms (0.14 to 0.27). CONCLUSIONS: Findings of our study reasonably support adequate psychometric properties of the DI. This instrument offers a developmentally sensitive screening method to obtain unique information from young children about their mental health problems in front-line services, psychiatric clinics, and research settings.

Objectifs : Comme aucun indicateur unique ne peut être considéré comme étant l'étalon de référence de la psychopathologie pédiatrique, il est nécessaire d'interviewer les enfants à l'égard de leurs propres symptômes. Notre étude portait sur la fiabilité, la validité et l'utilisation clinique du Dominique interactif (DI), un instrument multimédia auto-déclaré servant à évaluer chez les enfants d'âge scolaire, les symptômes des troubles mentaux les plus fréquents du Manuel diagnostique et statistique des troubles mentaux, 4e édition, texte révisé. Méthodes : Un échantillon de 585 enfants de 6 à 11 ans de cliniques communautaires et psychiatriques a été utilisé pour analyser la cohérence interne, l'estimation test­retest de la fiabilité, et la validité liée à un critère du DI contre l'état des sujets référés. En outre, les coefficients de corrélation inter-indicateurs entre cet instrument (rapport des enfants) et l'inventaire des symptômes des enfants (rapport des parents) ont été explorés dans un sous-échantillon de 292 participants. Résultats : Pour le total de l'échantillon, les coefficients alpha de Cronbach se situaient entre 0,63 et 0,91. Les kappas test­retest variaient de 0,42 à 0,62 pour les catégories basées sur les seuils d'inclusion, excepté pour les phobies spécifiques. Les coefficients de corrélation intraclasse allaient de 0,70 à 0,81 pour les échelles de symptômes. Le DI discriminait entre les enfants référés et non référés à des cliniques psychiatriques pour toutes les échelles de symptômes. Les coefficients de corrélation inter-indicateurs significatifs étaient plus élevés pour les symptômes externalisants (0,35 à 0,48) que pour les symptômes internalisants (0,14 à 0,27). Conclusions : Les résultats de notre étude soutiennent raisonnablement les propriétés psychométriques adéquates du DI. Cet instrument offre une méthode de dépistage sensible au stade du développement afin d'obtenir des renseignements uniques de la part des jeunes enfants sur leurs problèmes de santé mentale dans les services de première ligne, les cliniques psychiatriques, et les milieux de recherche.

Maternal Lifetime Depressive/Anxiety Disorders and Children's Internalizing Symptoms: The Importance of Family Context.

OBJECTIVES: This study investigated the interaction effects between mothers' lifetime depressive/anxiety disorders and other psychosocial correlates of 6 to 11 year-old children's self-reported internalizing symptoms in the Quebec Child Mental Health Survey. METHOD: A representative subsample of 1,490 Quebec children aged 6 to 11 years was selected from the original sample. Multiple linear regression analyses were performed using children's internalizing symptoms and child, family and socioeconomic characteristics. RESULTS: Four variables interacted significantly with mothers' lifetime depressive/anxiety disorders to predict 6 to 11 year-old children's internalizing symptoms: child age (t=2.415, P=0.016), mother's caring behaviours (t=2.950, P=0.003), mother's punitive behaviours (t=2.629, P=0.009) and parental social support (t=2.272, P=0.023). CONCLUSION: Results highlight the important contribution of the family context to the intergenerational transmission of internalizing symptoms and the relevance of taking into account children's developmental period. They support the importance of early screening of children's self-reported internalizing symptoms, among children of depressed/anxious parents. It is suggested to develop preventive intervention programs oriented towards children of depressed/anxious parents and exposed to relational difficulties.

Correlates of depressive and anxiety disorders among young Canadians.

OBJECTIVE: The current study presents data on the prevalence of depressive and anxiety disorders in the Canadian population aged between 15 and 24 years and examines their potential correlates. METHODS: The study is based on the 2002 Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). This survey was administered to a representative sample of 36,984 Canadians. A subsample of 5673 Canadians aged between 15 and 24 years was available for the analyses. We used descriptive analyses to calculate lifetime and 12-month prevalence of depressive and anxiety disorders, and we used logistic regressions to measure odds ratios. RESULTS: Among Canadian youths, 10.2% had suffered from depressive disorders during their lifetime, whereas 12.1% had suffered from anxiety disorders. For 12-month prevalence, the rates were 6.4% and 6.5% for depressive and anxiety disorders, respectively. Depressive disorders were more frequent among youth aged 20 to 24 years and among those no longer in school. Both disorders were more common among women and people under extreme stress. CONCLUSIONS: The prevalence rates found are comparable with other studies, and most of the correlates are concordant with the literature. Results indicate that there is a turning point for depression between late adolescence and adulthood that could be crucial for intervention planning.

Development and reliability of a pictorial mental disorders screen for young adolescents.

OBJECTIVE: To report psychometric data from preliminary studies of the Adolescent Dominic (AD), a pictorial screen for the most frequent Axis I youth mental disorders. METHODS: We created 113 picture items based on DSM-III-R diagnostic criteria and assessed them for comprehension (sample 1, n = 114; sample 2, n = 40) and reliability (sample 3, n = 128) in a group of adolescents aged 12 to 16 years living in the community. We used the kappa statistic to estimate test-retest reliability of symptoms, criteria and diagnoses, and intraclass correlation coefficients (ICCs) for symptom and criterion scores. We assessed internal consistency of symptom scores with the alpha coefficient. RESULTS: For symptoms, 54.4% of kappas were higher than 0.60, while only 2% were poor. ICCs for symptom scores yielded higher values (0.81 to 0.89) than for criterion scores (0.51 to 0.86). Internal consistency of symptom scores ranged from 0.52 to 0.83. Kappas for diagnoses ranged from 0.52 to 0.76. CONCLUSIONS: Symptom reliability compared favourably with data from other assessment interviews of youth mental disorders. Following these positive results, a computerized DSM-IV version of the AD has focused on the assessment of symptoms and is currently being tested for reliability and criterion validity.