RESUMEN
This paper explores the use, persistence, and intensity of services for children's mental health problems across a variety of service sectors during a one year period. Data come from the Great Smoky Mountains Study. Analyses focus on children's psychiatric symptomatology and impairment, service use, and factors that may influence the relationship between psychiatric problems and service use across a one year period. Findings show that approximately 20% of children used some mental health services from some sector during the year. Child's symptomatology and characteristics of parents were associated with use and persistence of services. Parent's perceptions of impact on the family were associated with service use, persistence, and intensity.
Asunto(s)
Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adolescente , Niño , Colorado/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos Mentales/diagnóstico , Servicios de Salud Mental/normas , Servicios de Salud Mental/provisión & distribución , Escalas de Valoración Psiquiátrica , Población Rural/estadística & datos numéricos , Factores de TiempoRESUMEN
The National Institute of Mental Health (NIMH) Collaborative Study of Long-Term Maintenance Drug Therapy in Recurrent Affective Illness was a multicenter randomized controlled clinical trial designed to determine the efficacy of a pharmacotherapy for the prevention of the recurrence of unipolar affective disorders. The outcome of interest in this study was the time until the recurrence of a depressive episode. The data show much heterogeneity between centers for the placebo group. The aim of this paper is to use Bayesian hierarchical survival models to investigate the heterogeneity of placebo effects among centers in the NIMH study. This heterogeneity is explored in terms of the marginal posterior distributions of parameters of interest and predictive distributions of future observations. The Gibbs sampling algorithm is used to approximate posterior and predictive distributions. Sensitivity of results to the assumption of a constant hazard survival distribution at the first stage of the hierarchy is examined by comparing results derived from a two component exponential mixture and a two component exponential changepoint model to the results derived from an exponential model. The second component of the mixture and changepoint models is assumed to be a surviving fraction. For each of these first stage parametric models sensitivity of results to second stage prior distributions is also examined.
Asunto(s)
Efecto Placebo , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Teorema de Bayes , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/prevención & control , Humanos , Tablas de Vida , Estudios Multicéntricos como Asunto/estadística & datos numéricos , Recurrencia , Análisis de SupervivenciaRESUMEN
BACKGROUND: The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services. METHODS: A multistage, overlapping cohorts design was used, in which 4500 of the 11758 children aged 9, 11, and 13 years in an 11-county area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n = 1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N = 323 at wave 1). RESULTS: The 3-month prevalence (+/-SE) of any DSM-III-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3% +/- 1.7%. The most common diagnoses were anxiety disorders (5.7% +/- 1.0%), enuresis (5.1% +/- 1.0%), tic disorders (4.2% +/- 0.9%), conduct disorder (3.3% +/- 0.6%), oppositional defiant disorder (2.7% +/- 0.4%), and hyperactivity (1.9% +/- 0.4%). CONCLUSIONS: The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.
Asunto(s)
Trastornos Mentales/epidemiología , Servicios de Salud Mental/provisión & distribución , Servicios de Salud Mental/estadística & datos numéricos , Adolescente , Región de los Apalaches/epidemiología , Niño , Desarrollo Infantil , Estudios de Cohortes , Comorbilidad , Familia , Salud de la Familia , Estado de Salud , Humanos , Pobreza , Prevalencia , Distribución Aleatoria , Población Rural/estadística & datos numéricos , Muestreo , Sudeste de Estados Unidos/epidemiología , Población Urbana/estadística & datos numéricosRESUMEN
BACKGROUND: Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as a DSM-III-R diagnosis in the presence of impaired functioning in 1 or more areas. We reviewed the published data on SED and examined rates and correlates of SED in an ongoing epidemiologic study of children. METHODS: Rates of DSM-III-R disorders, functional impairment, and their co-occurrence (SED) were examined in a representative population sample of 9-, 11-, and 13-year-olds from a predominantly rural area of North Carolina. Three measures of functional impairment were used, and their interrelationship and impact on rates of SED were examined. RESULTS: Serious emotional disturbance was identified in 4% to 8% of the study population, depending on the measure of impairment; the rate of DSM-III-R disorder ignoring impairment was 20.3%. One quarter of children identified as having SED on any measure were identified by all 3, and one half by 2 or more. Behavioral disorders, emotional disorders, and comorbidity were associated with a significant increase in the likelihood of SED; enuresis and tic disorders in the absence of comorbidity were not. Diagnosis and impairment made independent contributions to the increase in service use seen in children with SED. Poverty greatly increased the likelihood of SED. CONCLUSIONS: Specific areas of functional impairment should be examined when SED is assessed and treatment is planned. Plans to target mental health care resources to children with SED need to be accompanied by efforts to ensure access to those resources.
Asunto(s)
Síntomas Afectivos/epidemiología , Trastornos Mentales/epidemiología , Síntomas Afectivos/diagnóstico , Factores de Edad , Niño , Trastornos de la Conducta Infantil/diagnóstico , Trastornos de la Conducta Infantil/epidemiología , Evaluación de la Discapacidad , Política de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Estudios Longitudinales , Trastornos Mentales/diagnóstico , Servicios de Salud Mental/estadística & datos numéricos , Servicios de Salud Mental/provisión & distribución , North Carolina/epidemiología , Planificación de Atención al Paciente , Prevalencia , Sudeste de Estados Unidos/epidemiologíaRESUMEN
This paper uses Bayesian hierarchical models to analyse multi-centre clinical trial data where the outcome variable of interest is continuous, but not normally distributed, and where censoring has occurred. The goal of such an analysis is the same as for any subgroup analysis, to provide survival estimates for specific subgroups as well as for the population and to provide estimates of the degree of heterogeneity between subgroups. An analysis of the Collaborative Study of Long-Term Maintenance Drug Therapy in Recurrent Affective Illness, a multi-centre clinical trial funded by the National Institute for Mental Health's Pharmacologic Research Branch, serves to illustrate the proposed methodology. A feature of this data set is that one treatment group was withdrawn from medication at the time of randomization. The paper contains comparison of models, one that accounts for the drug washout period through the use of a changepoint model as well as a comparison of results across several choices of prior parameter values. In addition, the paper considers sensitivity to model choice and priors in a decision theory context.