ARTICLES
The British Child and Adolescent Mental Health Survey 1999: The Prevalence of DSM-IV Disorders

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Objective

To describe the prevalence of DSM-IV disorders and comorbidity in a large population-based sample of British children and adolescents.

Method

Using a one-phase design, 10,438 children were assessed using the Development and Well-Being Assessment (DAWBA), a structured interview with verbatim reports reviewed by clinicians so that information from parents, teachers, and children was combined in a manner that emulated the clinical process. The authors’ analysis examined comorbidity and the influence of teacher reports.

Results

The overall prevalence of DSM-IV disorders was 9.5% (95% confidence interval 8.8–10.1%), but 2.1% of children were assigned “not otherwise specified” rather than operationalized diagnoses. After adjusting for the presence of a third disorder, there was no longer significant comorbidity between anxiety and conduct disorder or attention-deficit/hyperactivity disorder (ADHD), or between depression and oppositional defiant disorder. A comparison of the disorders in children with and without teacher reports suggested that the prevalence of conduct disorders and ADHD would be underestimated in the absence of teacher information.

Conclusions

Roughly 1 in 10 children have at least one DSM-IV disorder, involving a level of distress or social impairment likely to warrant treatment. Comorbidity reported between some childhood diagnoses may be due to the association of both disorders with a third. Diagnoses of conduct disorder and ADHD may be missed if information is not sought from teachers about children's functioning in school.

Section snippets

Participants

In Great Britain (England, Wales, and Scotland, but not Northern Ireland), “child benefit” is a universal state benefit payable for each child in the family, and it has an extremely high uptake. The child benefit register was used to develop a sampling frame of postal sectors from England, Wales, and Scotland that, after excluding families with no recorded ZIP code or subject to current revision of their record, was estimated to represent 90% of all British children (Meltzer et al., 2000). Four

Prevalence of Childhood Psychiatric Disorder

At least one DSM-IV diagnosis was present in 983 children, representing a weighted prevalence of 9.5% (95% confidence interval [CI] 8.8–10.1%). A fifth of these children (2.1%) had nonoperationalized or “not otherwise specified” diagnoses (anxiety NOS, depression NOS, or disruptive disorder NOS) that failed to meet current DSM-IV criteria but were causing the child significant impairment or distress.

Table 1 presents the prevalence of individual diagnoses and diagnostic groupings by age and

Prevalence of Childhood Psychiatric Disorders

The British Child and Mental Health Survey in 1999 (BCAMHS 99) was completed in one phase, so that all parents, most teachers, and the great majority of 11- to 15-year-olds contributed information that was used to decide whether the child had a disorder. This approach avoided the loss of precision that may occur with a two-phase design deploying a screening measure before a more in-depth diagnostic assessment. The advantages of a highly structured interview that can be administered by

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