title: Estimating the burden of psychiatric disorders in adolescence: the impact of subthreshold disorders.
abstract: OBJECTIVE
  We examine the impact of including subthreshold disorders on estimating psychiatric morbidity burden in adolescents. To more fully understand this burden it is important to focus on both full syndrome and subthreshold disorders and the impairment associated with each, since evidence suggests prevalence of subthreshold disorders is substantial as is impairment.
  
  
  METHODS
  Data were analyzed from a probability sample of 4,175 youths 11-17 years of age. We examine the prevalence of DSM-IV disorders (FS) and subthreshold (SUB) disorders, with and without impairment. Diagnostic categories examined were anxiety, mood, attention deficit hyperactivity disorder, disruptive, and substance use disorders in the past year.
  
  
  RESULTS
  The prevalence of any FS disorders was 16.1 and 42.3 % for SUB. The combined prevalence was 58.4 %. By requiring impairment, the prevalence of any FS in the past year dropped to 8 % and for SUB to 15.7 %, with a combined overall rate of 23.7 %. For FS disorders, 49.6 % met criteria for moderate to severe impairment, compared to 37.8 % for SUB. One in four adolescents had either an FS or SUB disorder with impairment.
  
  
  CONCLUSIONS
  The results indicate that SUB disorders constitute a major public health burden in terms of psychiatric morbidity among adolescents. Given their substantial impairment and their high prevalence, consideration should be given to including SUB disorders in estimates of the public health burden psychiatric morbidity. Doing so would provide a more accurate estimate of psychiatric morbidity.
authors.affiliation: UTHealth School of Public Health, University of Texas Health Science Center, San Antonio Regional Campus, 7411 John Smith Drive, Suite 1100, San Antonio, TX, 78229, USA, Robert.E.Roberts@uth.tmc.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roberts
authors.forename: Prudence W
authors.initials: PW
authors.lastname: Fisher
authors.forename: J Blake
authors.initials: JB
authors.lastname: Turner
authors.forename: Min
authors.initials: M
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D002648:Child; D017281:Cost of Illness; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D012720:Severity of Illness Index