Diagnostic Prevalence Rates From Early to Mid-Adolescence Among Indigenous Adolescents: First Results From a Longitudinal Study

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Abstract

Objective

Investigate change in prevalence rates for mental and substance abuse disorders between early and midadolescence among a cohort of indigenous adolescents.

Method

The data are from a lagged, sequential study of 651 indigenous adolescents from a single culture in the northern Midwest UOnited States and Canada. At waves 1 (ages 10-12 years) and 4 (ages 13-15 years), one adult caretaker and one tribally enrolled adolescent completed a computer-assisted personal interview that included Diagnostic Interview Schedule for Children-Revised assessment for 11 diagnoses. Multivariate analyses investigate effects of wave 1 adolescent diagnosis and wave 1 biological mother diagnosis (University of Michigan Composite International Diagnostic Interview) on wave 4 diagnostic outcomes.

Results

The findings show a increase in prevalence rates for substance abuse disorders and conduct disorders between ages 10 and 12 years and 13 and 15 years among indigenous adolescents, with these disorders affecting more than one fourth of the children. The rate of lifetime conduct disorder is about twice that expected in general population studies (23.4% versus 5%-10%), and the rate of lifetime substance abuse disorder (27.2%) is three times that reported in the 2004 National Survey on Drug Use and Health (9.4%) for individuals 12 years or older. Prevalence rates for any single mental or substance use disorder (44.8 lifetime) for the 13- to 15-year-olds are similar to the lifetime prevalence rates reported in the National Comorbidity Survey-Replication (46.4%) for individuals 18 years and older.

Conclusions

A mental health crisis exists on the indigenous reservations and reserves that participated in this study. Current service systems are overwhelmed and unable to meet the demands placed upon them. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(8):890-900.

Section snippets

Procedures

These data were collected as part of a lagged sequential study under way on four reservations in the northern Midwest and four Canadian reserves that involves yearly interviews with the adolescent and at least one primary caretaker. The data are from waves 1 (ages 10-12 years) and 4 (ages 13-15 years) of the study. Wave 1 data were collected on two U.S. reservations and one Canadian reserve from February through October 2002, and from a closely related study on two U.S. reservations and three

Results

The prevalence of meeting criteria for a single lifetime disorder increased from 25.6% (combined caretaker and child report) at wave 1 when the children were ages 10 to 12 years to 44.8% at wave 4 when the children had reached 12 to 15 years (Table 2). The prevalence of meeting criteria for any single 12-month disorder increased from 23.4% at wave 1 to 41.2% at wave 4. Rates of lifetime comorbidity among the 13 disorders increased from 9.2% to 26.6%.

Discussion

Although we have no indigenous comparison groups in this age range (13-15 years), we can compare the adolescents to current prevalence rates in the general population. In the National Comorbidity Survey Replication, the lifetime prevalence for psychiatric disorder (ages 18 and older) was 46.4% for one disorder and 27.7% for two or more disorders.16 The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project reported a lifetime prevalence rate of one

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