title: Severity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement.
abstract: BACKGROUND
  Estimates of DSM-IV disorder prevalence are high; stringent criteria to define need for services are desired.
  
  
  OBJECTIVE
  To present US national data on the prevalence and sociodemographic correlates of 12-month serious emotional disturbance (SED), defined by the US Substance Abuse and Mental Health Services Administration, from the National Comorbidity Survey Replication Adolescent Supplement.
  
  
  METHODS
  The National Comorbidity Survey Replication Adolescent Supplement is a national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents.
  
  
  METHODS
  Dual-frame household and school samples of US adolescents.
  
  
  METHODS
  Total of 6483 pairs of adolescents aged 13 to 17 (interviews) and parents (questionnaires).
  
  
  METHODS
  The DSM-IV disorders were assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Serious emotional disturbance was operationalized as a DSM-IV/Composite International Diagnostic Interview disorder with a score of 50 or less on the Children's Global Assessment Scale (ie, moderate impairment in most areas of functioning or severe impairment in at least 1 area). Concordance of Composite International Diagnostic Interview SED diagnoses with blinded Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses was good.
  
  
  RESULTS
  The estimated prevalence of SED was 8.0%. Most SEDs were due to behavior (54.5%) or mood (31.4%) disorders. Although respondents with 3 or more disorders made up only 29.0% of those with 12-month DSM-IV/Composite International Diagnostic Interview disorders, they constituted 63.5% of SEDs. Predictive effects of high comorbidity were significantly greater than the product of their disorder-specific odds ratios and consistent across disorder types. Associations of sociodemographic variables with SED were generally nonsignificant after controlling for disorder type and number.
  
  
  CONCLUSIONS
  The high estimated 12-month prevalence of DSM-IV disorders among US adolescents is largely due to mild cases. The significant between-disorder differences in risk of SED and the significant effect of high comorbidity have important public health implications for targeting interventions.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. ncs@hcp.med.harvard.edu
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Shelli
authors.initials: S
authors.lastname: Avenevoli
authors.forename: Jane
authors.initials: J
authors.lastname: Costello
authors.forename: Jennifer Greif
authors.initials: JG
authors.lastname: Green
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gruber
authors.forename: Katie A
authors.initials: KA
authors.lastname: McLaughlin
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Kathleen Ries
authors.initials: KR
authors.lastname: Merikangas
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000328:Adult; D000342:Affective Symptoms / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D010290:Parents / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology