Children with even mild or passing bouts of depression,
anxiety and/or behavioral issues were more inclined to have serious problems
that complicated their ability to lead successful lives as adults, according to
research from Duke Medicine.
Reporting in the July 15 issue of JAMA Psychiatry,
the Duke researchers found that children who had either a diagnosed psychiatric
condition or a milder form that didn't meet the full diagnostic criteria were
six times more likely than those who had no psychiatric issues to have
difficulties in adulthood, including criminal charges, addictions, early
pregnancies, education failures, residential instability and problems getting
or keeping a job.
"When it comes to key psychiatric problems --
depression, anxiety, behavior disorders -- there are successful interventions
and prevention programs," said lead author William Copeland, Ph.D.,
assistant clinical professor of Psychiatry and Behavioral Sciences at Duke.
"So we do have the tools to address these, but they aren't implemented
widely. The burden is then later seen in adulthood, when these problems become
costly public health and social issues."
Copeland and colleagues analyzed data from the Great
Smoky Mountains Study, which began nearly two decades ago and includes 1,420
participants from 11 North Carolina counties. The study is ongoing and has
followed the participants from childhood through adulthood -- most are now in
Among the study group, 26.2 percent met the criteria for
depression, anxiety or a behavioral disorder in childhood; 31 percent had
milder forms that were below the full threshold of a diagnosis; and 42.7
percent had no identified problems.
The researchers found that as these children grew into
adults, even some of those who had no psychiatric diagnosis as children --
nearly one in five -- stumbled in adulthood, suggesting that difficulties were
not limited to those with psychiatric diagnoses.
But having a psychiatric diagnosis or a close call
dramatically raised the odds that adulthood would have rough patches. This was
the case even if they did not continue to have psychiatric problems in
Of those with the milder psychiatric indicators as kids,
41.9 percent had at least one of the problems in adulthood that complicates
success, and 23.2 percent had more than one such issue. For those who met the
full psychiatric diagnosis criteria, 59.5 percent had a serious challenge as
adults, and 34.2 percent had multiple problems.
Copeland said specific psychiatric disorders were
associated with specific adult problems, but the best predictor of having adult
issues was having multiple psychiatric problems as kids.
"When we went into this, it was an open question:
Are these psychiatric diagnoses in childhood impairing in the moment, but
something people recover from and go on?" Copeland said. "We weren't
expecting to find these protracted difficulties into adulthood."
Copeland said the findings reinforce the need to attack
problems early with effective therapies. He said only about 40 percent of
children get the treatment they need for psychiatric disorders, and even fewer
who have borderline problems are treated.
"A big problem with mental health in the United
States is that most children don't get treatment and those who do don't get
what we would consider optimal care," Copeland said. "So the problems
go on much longer than they need to and cost much more than they should in both
money and damaged lives."