methods for testing trends in mental health – is it really possible to compare ‘like with...
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Methods for testing trends in mental health – is it really possible to compare ‘like with like’?. Dr Stephan Collishaw Cardiff University [email protected]. NCRM Research Methods Festival, Oxford, July 2014. Outline. Prevalence and burden - PowerPoint PPT PresentationTRANSCRIPT
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Methods for testing trends in mental health – is it really possible to compare ‘like with like’?
Dr Stephan CollishawCardiff University
NCRM Research Methods Festival, Oxford, July 2014
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Outline• Prevalence and burden
• Trends in diagnosis – need for epidemiological data
• Cross-cohort comparisons using symptom screens• Issues to think about in comparing ‘like with
like’• Results – adolescent mental health 1970s-
2000s
• Replication and validation
• Trends in child mental health 1999-2008
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1 in 10 has a clinically significant psychiatric disorder
Impact on family life, friendships, learning Suicide and self harm (3rd leading cause of death)
Long-term prognosis Most child/adolescent disorders persist to adulthood >50% of adult mental disorders have onset <18 years Parenting, employment, social exclusion, illness, mortality Economic burden
Child psychiatric disorders: Burden and prognosis
Green et al., 2005; Kim-Cohen et al, 2003; Thapar et al., 2012; Windfuhr et al., 2008; Maughan et al., 2014
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Diagnosis and treatment: autism, ADHD, depression, anxiety
• Increased help seeking, diagnosis and treatment
• Substantial increases in psychotropic medication
• Rates increased 3-5 fold per decade 1990s and 2000s
• Similar trends in many countries
Getahun et al., 2013; Kosidou et al, 2010; Olfson et al., 2014; Stephenson et al, 2013
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Trends in diagnosis and treatment
• Important for planning service provision
But: Increases in referrals and diagnoses may be due to
• Increased public awareness & clinical recognition• Changing diagnostic criteria and practice• Treatment availability and perceived efficacy• ‘Medicalisation’ of normal behaviour?
Also:Majority still don’t access services
Ford et al., 2007; Potter et al., 2012
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Epidemiological evidence
Two major meta-analyses of depression and ADHD
Epidemiological studies using structured diagnostic interviews
Meta-analyses: no evidence of increase in depression or ADHD
But
Variability in methods (samples, measures, diagnostic system)
Rates of depression range from <1% to >25%
‘Noise’ and variability likely to make trends difficult to detectCostello et al., 2006; Polanczyk et al., 2014
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‘Like-for-like’ cross-cohort comparisons
Comparable representative cohorts with equivalent measures e.g. UK cohorts since 1960s have included Rutter/SDQ
Threats to comparability Selective attrition
Minor changes to questionnaire make a big difference Disobedience: “applies somewhat” (33%) vs “sometimes”
(75%) Calibration can be effective for aligning non-identical
instruments
Change in reportingGoodman et al., 2007
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UK cross-cohort comparisons: 1974-1999
Collishaw et al, 2004
• Large nationally representative surveys (NCDS, BCS70, BCAMHS) assessed in 1974, 1986, 1999
• Age 15-16
• Parent rated Rutter or SDQ• Emotional problems• Conduct problems• Hyperactivity/inattention
• Calibration data used to align SDQ and Rutter questionnaires
• Study-specific weights using prior predictors of non-response
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Emotional problems: high scores
1974 1986 19990
5
10
15
20
25
BoysGirls
% h
igh
scor
es
Cohort 3 vs. cohort 2OR = 1.72
Collishaw et al, 2004
N = 10,499 N = 868N = 7,293
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Conduct problems: high scores
1974 1986 199902468
1012141618
BoysGirls
% h
igh
scor
es
Total OR = 1.56 per cohortCollishaw et al, 2004
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Hyperactivity: mean scores
1974 1986 19990.25
0.5
0.75
1
1.25
1.5
BoysGirls
mea
n hy
pera
ctiv
e sc
ore
Collishaw et al, 2004
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Limitations
• Only parent reports
• Imperfection of Rutter/SDQ calibration?
• Crude measures
• Are population shifts also occurring at extremes?
• What about ‘change in reporting’?
Need for replication and validation
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Replication: The Youth Trends study (1986 & 2006)
Two nationally representative surveys of English youth 1986: BCS70 age 16 (N = 9,766) 2006: HSE follow-up ages 16-17 (N = 747) Identical self rated symptom screens (GHQ/Malaise)
Questions Increase in youth-reported symptoms Variation in trends by severity?
Collishaw et al, 2010
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Adolescent emotional symptoms (youth reports)
1986 20060
0.5
1
1.5
2
2.5GirlsBoys
yout
h ra
ted
sym
ptom
s
ES = 0.36; p < .001
ES = 0.13; p = .06
Collishaw et al., 2010
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Trends by severity
Collishaw et al, 2010
1+ 2+ 3+ 4+ 5+ 6+ 7+ 8+0
0.5
1
1.5
2
2.5
3 Chart Title
Youth emotional problem score
OR
(200
6 vs
198
6)
cohort differences significant at all thresholds, p<.01; Interaction p < .05
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General shift in reporting?No change in hyperactivity
Boys Girls-0.5-0.4-0.3-0.2-0.1
00.10.20.30.40.5
19862006
hype
ract
ivity
(z-s
core
)
Collishaw et al, 2010
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Do trends reflect a change in reporting?
• Shift in informant ‘thresholds’? (e.g. different expectations about normal behaviour)
• Greater willingness to report problems than in the past?
But
• Specificity of findings (no increase in hyperactivity)• Validation using external criteria desirable…
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Conduct problems:Age 30 outcomes NCDS & BCS70 cohorts
Unemployed Sacked Benefits Homeless Teen parent Poor health0
1
2
3
4
NCDSBCS70
Odd
s ra
tio
Collishaw et al, 2004
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Adolescent conduct problems and risk of pervasive adult dysfunction: 4+ adverse outcomes age 30
NCDS BCS700
1
2
3
4
5
Odd
s ra
tio
Collishaw et al, 2004
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1999: BCAMHS 7-year olds (n = 1034) 2004: BCAMHS 7-year olds (n = 648) 2008: MCS 7-year collection (n = 13,489)
Parent & teacher SDQ symptoms & impact
Weights used to adjust for attrition and stratified design
Child mental health trends: 1999-2008
Sellers et al, in press
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SDQ total and subscale mean scores all declined
Boys: total score effect size = -0.27 Girls: total score effect size = -0.12 Bigger drop in problem scores for boys than girls (p = 0.027)
Similar conclusions based on parent and teacher reports
Drop in children scoring in abnormal range (11%, 10%, 8%)
But: increase in impact of problems, e.g. classroom learning
Child mental health trends: 1999-2008
Sellers et al, in press
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Conclusions
• Comparing ‘like-with-like’ essential for testing trends
• Replication and validation important
• Long-term change in adolescent mental health
• Recent data: improvements in child mental health
• Latest data 2008, what has happened since?
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Barbara Maughan (KCL)
Andrew Pickles (KCL)
Robert Goodman (KCL)
Anita Thapar (Cardiff)
Ruth Sellers (Cardiff)
Frances Gardner (Oxford)
Jacqueline Scott (Cambridge)
Ginny Russell (Exeter)
National Centre for Social Research; Department of Health
Medical Research Council; Nuffield Foundation; Waterloo Foundation
Acknowledgements
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Collishaw et al (2004). Time trends in adolescent mental health. J Child Psychol Psych, 45, 1350-1362.Collishaw et al (2010). Trends in adolescent emotional problems in England. J Child Psychol Psych, 51, 885-94.Costello et al (2006). Is there an epidemic of child and adolescent depression? J Child Psychol Psych, 47, 1263-71Ford et al (2007). Child mental health is everybody’s business. Child Adolescent Mental Health, 12, 13-20.Getahun et al (2013). Recent trends in childhood ADHD. JAMA Pediatrics, 167, 282-8.Goodman et al (2007). Seemingly minor changes to a questionnaire. Soc Psych Psych Epi, 42, 322-327.Green et al (2005). Mental health of children and young people in GB, 2004. Palgrave MacmillanKim-Cohen et al (2003). Prior juvenile diagnoses in adults with mental disorders. Archives General Psychiatry, 60. 709-17Kosidou et al (2010). Recent trends. Acta Psychiatrica Scandinavica, 22, 47-55.Maughan et al (2014). Adolescent conduct problems and premature mortality. Psych Med, 44, 1077-86.Olfson et al (2014). National trends in the mental health care of children, adolescents and adults. JAMA Psych, 71, 81-90Polanczyk et al (2014). ADHD prevalence estimates across three decades. Int J Epidemiology, online firstPotter et al (2012). Missed opportunities mental disorder in children of parents with depression. BJGP, 62, e487Sellers et al (in press). Trends in parent- and teacher-rated emotional, conduct. J Child Psychol Psych, in press.Stephenson et al (2013). Trends in the utilisation of psychotropic medication. Austr New Zealand J Psychiatry, 47, 74-87.Thapar et al (2012). Depression in adolescence. Lancet, 379, 1056-67.Windfuhr et al (2008). Suicide in juveniles and adolescents in the United Kingdom. J Child Psychol Psych, 49, 1155-65
References