Psychiatric morbidity of second and third grade primary school children in Korea

Patterns of the Diagnosis Prevalence of Psychiatric Disorders in the Population Aged 0-18 Years Based on the Nationwide Insurance Sample Data

Objectives

This study aimed to examine the trend in diagnostic prevalence of psychiatric disorders in children and adolescents.

Methods

Individuals aged 0–18 years were included in the study based on the National Health Insurance Claims Data. To investigate the trends in diagnosis and diagnostic prevalence of psychiatric disorders reflecting the decrease in the birth rate, data were analyzed from 2010 as a reference year to 2015.

Results

The number of patients diagnosed with psychiatric disorder decreased annually, from 23,412 on 2010 to 18,821 on 2015. The most common disorder was hyperkinetic disorder in male and depressive episode in female. Although there was no significant change in overall diagnostic prevalence rate of psychiatric disorders, age groups <10 years and some disorders had significant changes in prevalence rate. This study classified the diagnostic prevalence by age into two unique patterns: group in which the diagnosis rate increases with age and group in which the diagnosis rate peaks at a certain age and then decreases.

Conclusion

Diagnostic prevalence of psychiatric disorders was different according to age and sex. These patterns should be reflected in the formulation of policies related to mental health and in medical practice for pediatric patients. It is urgent to identify how these patterns change in young adults.

Comorbidity and Factors Affecting Treatment Non-Persistence in ADHD

Objective: The aim of the study was to identify factors for treatment non-persistence in patients with ADHD. Method: Data for 100 patients with ADHD aged 5 to 16 who completed the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K) and Korean Wechsler Intelligence Scale for Children (K-WISC) were obtained between 2008 and 2013. Patients were classified as treatment-persistent and treatment-non-persistent based on 6-month follow-up. Sociodemographic data, comorbidities, intelligence quotient (IQ), severity, and social/school functioning were compared. Results: Adolescence and poor parental spousal relationships significantly predicted treatment non-persistence. Although comorbid major depressive disorder and absence of transient tic disorder were associated with treatment non-persistence, there was no difference in overall psychiatric comorbidity. No differences existed for IQ, Clinical Global Impressions-Severity (CGI-S) score, peer relationships, and academic achievement. Conclusion: Lower treatment persistence was associated with adolescence, comorbid depression, absence of tics, and poor parental spousal relationships, but not with symptom severity or impairment of the disorder.

Prevalence of Attention-Deficit/Hyperactivity Disorder and its Comorbidity among Korean Children in a Community Population

The aim of this study was to determine the prevalence of attention deficit hyperactivity disorders (ADHD) in children according to socio-demographic factors and the distribution of ADHD subtypes in a community in Korea. A screening survey using the Korean version of ADHD Rating Scale (K-ARS) was conducted between 2007 and 2008, and clinical interviews by a pediatric psychiatrist were performed for selected children between 2009 and 2010. A total of 49,573 elementary school students, between ages of 7 and 12, constituted the target population, among which 38,365 students (77.2%) and respective parents gave consent to participate. Of the participants, 200 screened children were clinically examined to confirm the diagnosis of ADHD. We estimated the prevalence of ADHD and its comorbidity in the population, after adjusting for nonresponse and nonparticipation. The prevalence of ADHD was 11.7% in boys and 5.2% in girls, with an overall prevalence of 8.5%. The combined type of inattentive and hyperactive was the most frequent at 4.7% of the whole population. Children were more likely to have ADHD if their parents were separated and had less education. Most commonly combined comorbidity was autism spectrum disorder (ASD) (10.1%). The prevalence of ADHD in the school-aged population is an essential information for improving the quality of public health mental services for evaluation and treatment of ADHD.

Psychometric Properties of the Self-Report Version of the Strengths and Difficulties Questionnaire in Korea

OBJECTIVE

To examine the reliability and validity of the self-report Korean version of Strengths and Difficulties Questionnaire (SDQ-Kr) in the community sample.

METHODS

The SDQ-Kr was administered to a large sample of school children and adolescents (n=2814) and youth attendees of a psychiatric clinic (n=385) aged 11-16 years. To examine temporal stability, the same questionnaire was administered to a subsample of 167 school youths five to six weeks after the initial assessment. To examine the reliability, we calculated Cronbach's alpha coefficients for internal consistency and Pearson's correlations for test-retest stability. In order to evaluate the factorial structure of the SDQ-Kr items, we conducted an exploratory factor analysis (EFA) with varimax rotation. Finally, discriminant validity was examined by using receiver operating characteristic (ROC) curves employing the area under the curve (AUC) as an index of discriminant ability.

RESULTS

Although the internal consistency of some subscales of the SDQ-Kr was somewhat less satisfactory (alpha coefficients; 0.28-0.54) than the English original, coefficients for the total difficulties scores approached sufficient levels (coefficients; 0.69). Other psychometric properties including discriminant validity (AUC for total difficulties and four subscales >0.7) were comparable to those obtained in other language studies.

CONCLUSION

The self-report SDQ-Kr exhibited a low level of reliability, indicating that some items need to be further evaluated and revised to improve the psychometric properties. We suggest that the total difficulties score could be used with more confidence for screening possible mental health problems in youths.

The influence of unsupervised time on elementary school children at high risk for inattention and problem behaviors

In the last few decades, changing socioeconomic and family structures have increasingly left children alone without adult supervision. Carefully prepared and limited periods of unsupervised time are not harmful for children. However, long unsupervised periods have harmful effects, particularly for those children at high risk for inattention and problem behaviors. In this study, we examined the influence of unsupervised time on behavior problems by studying a sample of elementary school children at high risk for inattention and problem behaviors. The study analyzed data from the Children's Mental Health Promotion Project, which was conducted in collaboration with education, government, and mental health professionals. The child behavior checklist (CBCL) was administered to assess problem behaviors among first- and fourth-grade children. Multivariate logistic regression analysis was used to evaluate the influence of unsupervised time on children's behavior. A total of 3,270 elementary school children (1,340 first-graders and 1,930 fourth-graders) were available for this study; 1,876 of the 3,270 children (57.4%) reportedly spent a significant amount of time unsupervised during the day. Unsupervised time that exceeded more than 2h per day increased the risk of delinquency, aggressive behaviors, and somatic complaints, as well as externalizing and internalizing problems. Carefully planned afterschool programming and care should be provided to children at high risk for inattention and problem behaviors. Also, a more comprehensive approach is needed to identify the possible mechanisms by which unsupervised time aggravates behavior problems in children predisposed for these behaviors.

Emotional/behavioral problems and functional impairment in clinic- and community-based children with attention-deficit/hyperactivity disorder in Taiwan

Using a sample of 268 patients and 137 community-based children with DSM-IV ADHD, and 268 school controls, aged 6-15, this study aimed to compare the emotional/behavioral problems and functional impairment between clinic- and community-based children with ADHD. Children's ADHD-related symptoms, a wide range of emotional/behavioral problems, and functional impairments were assessed by the psychiatric interviews and self-, parent- and teacher-reported questionnaires. Both ADHD groups scored higher in parent- and teacher-reported ADHD-related symptoms, wide-ranging emotional/behavioral problems, and impairments in the school, peer, family, and leisure time domains than school controls. However, clinic-based children with ADHD had more physical/developmental problems, more severe functional impairments and teacher-reported hyperactivity/impulsivity symptoms, and higher family burdens than their community counterparts. Our findings suggest that a higher maternal educational level, parent's perceived child functional impairment, teacher's perceived impaired peer relationship and hyperactivity-impulsivity, and child physical and developmental problems may be related to the psychiatric referrals of children with ADHD.

Full syndrome and subthreshold attention-deficit/hyperactivity disorder in a Korean community sample: comorbidity and temperament findings

OBJECTIVE

The main objective of this study was to investigate the comorbid disorders and temperamental profiles of full syndrome and subthreshold attention-deficit/hyperactivity disorder (ADHD).

METHOD

A sample of 2,493 students was randomly selected from six representative elementary schools in Seoul, Korea. Among 245 children with full syndrome and subthreshold ADHD diagnosed by the diagnostic interview schedule for children-4th version, parents of 185 subjects (mean age 9.0 +/- 1.7 years) and of a random sample of 185 age- and gender-matched non-ADHD children have completed the parent's version of the children behavior checklist (CBCL) and the juvenile temperament and character inventory (JTCI).

RESULTS

The prevalence rates of full syndrome and subthreshold ADHD were, respectively, 5.90% (95% confidence interval = 4.74-7.06) and 9.00% (95% confidence interval = 7.58-10.41). Subthreshold ADHD cases did not differ from full syndrome ADHD in any JTCI profile, showing high novelty seeking/low persistence/low self-directedness than controls. Subthreshold ADHD also showed increased risk for externalizing disorders and higher scores in eight CBCL scales (somatic complaints, anxious/depressed, social problems, attention problems, delinquent behaviors, aggressive behaviors, externalizing problems and total behavioral problems) compared to the controls.

CONCLUSIONS

These results support the clinical relevance of subthreshold ADHD in Asian culture. Increased clinical awareness for children with subthreshold ADHD is needed.

Perceived need and use of child mental health services in Korea

This study examined the degree of perceived need and use of child mental health services in Korea, as well as the factors associated therewith. The sample consisted of 3,477 children aged 8-13 years. Overall, 10.4% of the parents demonstrated a perceived need for mental health services regarding their children's emotional or behavioral problems, while 1.9% used mental health services. Although the perceived need for mental health services is high, only a small proportion of children receive them. Whether a child receives mental health care is influenced by the child's psychopathology, especially when social and/or thought problems exist.

Epidemiologic considerations in attention deficit hyperactivity disorder: a review and update

Epidemiologic data on attention deficit hyperactivity disorder (ADHD) are essential for planning health services and implementing strategies of detection and early intervention, with possible substantial benefits on public health. This article addresses methodological aspects of prevalence studies, recent findings on the prevalence of ADHD in childhood and adolescence based on a systematic review, current findings on the persistence of the disorder over time and prevalence in adulthood, and factors associated with ADHD. Evidence from the reviewed literature indicates the importance of methodological aspects in the understanding of epidemiologic findings and the necessity of large-scale cross-national studies. Moreover, governments clearly must direct attention to childhood mental disorders to guarantee a healthy future for their countries.