title: Adult Functional Outcomes of Common Childhood Psychiatric Problems: A Prospective, Longitudinal Study.
abstract: OBJECTIVE
  Psychiatric problems are among the most common health problems of childhood.
  
  
  OBJECTIVE
  To test whether these health problems adversely affect adult functioning even if the problems themselves do not persist.
  
  
  METHODS
  Prospective, population-based study of 1420 participants from 11 predominantly rural counties of North Carolina who were assessed with structured interviews up to 6 times during childhood (9-16 years of age, for a total 6674 observations) for common psychiatric diagnoses and subthreshold psychiatric problems. The period for this study was from 1993 to 2010.
  
  
  METHODS
  A total of 1273 participants were assessed 3 times during young adulthood (19, 21, and 24-26 years of age, for a total of 3215 observations) for adverse outcomes related to health, the legal system, personal finances, and social functioning.
  
  
  RESULTS
  Participants with a childhood disorder had 6 times higher odds (odds ratio [OR], 5.9 [95% CI, 3.6-9.7]) of at least 1 adverse adult outcome (ie, indicator) compared with those with no history of psychiatric problems and 9 times higher odds (OR, 8.7 [95% CI, 4.3-17.8]) of 2 or more such indicators (1 indicator: 59.5% vs 19.9% [P < .001]; ≥ 2 indicators: 34.2% vs 5.6% [P < .001]). These associations persisted after statistically controlling for childhood psychosocial hardships and adult psychiatric problems. Risk was not limited to those who received a diagnosis; participants with subthreshold psychiatric problems had 3 times higher odds (OR, 2.9 [95% CI, 1.8-4.8]) of adult adverse outcomes and 5 times higher odds (OR, 5.1 [95% CI, 2.4-10.7]) of 2 or more outcomes (1 indicator: 41.9% vs 19.9% [P < .001]; ≥ 2 indicators: 23.2% vs 5.6% [P < .001]). The best diagnostic predictor of adverse outcomes was cumulative childhood exposure to psychiatric disorders.
  
  
  CONCLUSIONS
  Common, typically moderately impairing, childhood psychiatric problems are associated with a disrupted transition to adulthood even if the problems do not persist into adulthood and even if the problems are subthreshold. Such problems provide a potential target for public health efforts to ameliorate adult suffering and morbidity.
authors.affiliation: Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: William E
authors.initials: WE
authors.lastname: Copeland
authors.affiliation: Department of Psychology and Division of Mental Health and Wellbeing, University of Warwick, Coventry, Warwickshire, England.
authors.forename: Dieter
authors.initials: D
authors.lastname: Wolke
authors.affiliation: Department of Psychology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lilly
authors.initials: L
authors.lastname: Shanahan
authors.affiliation: Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Costello
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000453:epidemiology / Q000523:psychology; D002648:Child; D015331:Cohort Studies; D019955:Conduct Disorder / Q000453:epidemiology / Q000523:psychology; D003415:Crime / Q000706:statistics & numerical data*; D018450:Disease Progression; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D019964:Mood Disorders / Q000453:epidemiology / Q000523:psychology; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D010290:Parents; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D012917:Social Adjustment; D012944:Social Support; D055815:Young Adult