title: The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders.
abstract: 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.
authors.affiliation: Developmental Epidemiology Program, Duke University Medical Center, Durham, NC, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Costello
authors.forename: A
authors.initials: A
authors.lastname: Angold
authors.forename: B J
authors.initials: BJ
authors.lastname: Burns
authors.forename: D K
authors.initials: DK
authors.lastname: Stangl
authors.forename: D L
authors.initials: DL
authors.lastname: Tweed
authors.forename: A
authors.initials: A
authors.lastname: Erkanli
authors.forename: C M
authors.initials: CM
authors.lastname: Worthman
mesh_terms: D000293:Adolescent; D001061:Appalachian Region / Q000453:epidemiology; D002648:Child; D002657:Child Development; D015331:Cohort Studies; D015897:Comorbidity; D005190:Family; D005192:Family Health; D006304:Health Status; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution*; D011203:Poverty; D015995:Prevalence; D011897:Random Allocation; D012424:Rural Population / Q000706:statistics & numerical data; D012494:Sampling Studies; D015144:Southeastern United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data