Abstract
We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used weighted data (N = 2317) from NCS-A participants (age: 13–18 years) who did not meet DSM-IV criteria for any lifetime mental disorder. Adolescent mental disorders were assessed with the WHO CIDI. Maternal psychopathology was obtained by self-report. Adolescent mental health service use was assessed with the Service Assessment for Children and Adolescents. Substantial associations between maternal psychopathology and mental health service use in offspring without mental disorders were found between affective disorders and the mental health/medical specialty (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.60–3.90) and any service sector (HR = 2.14, CI = 1.45–3.16), anxiety disorders and any service sector (HR = 1.63, CI = 1.13–2.35), behavior disorders and the school (HR = 3.69, CI = 1.39–9.77) and any service sector (HR = 2.81, CI = 1.12–7.07), substance use disorders and the mental health/medical specialty (HR = 3.75, CI = 1.75–8.03), the school (HR = 3.17, CI = 1.43–7.02), and any service sector (HR = 3.66, CI = 2.00–6.70), and any mental disorder and the mental health/medical specialty (HR = 2.10, CI = 1.34–3.30) and any service sector (HR = 2.03, CI = 1.40–2.92). Results were comparable when restricting analyses to offspring with no indication of suicidality and no more than three life events during the past 12 months. The likelihood of service use was higher among offspring of mothers with mental disorders, compared to mothers without mental disorders. Considering maternal mental disorder status may help to identify subjects at risk of overtreatment.
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Weisz JR, Jensen-Doss A, Hawley KM (2006) Evidence-based youth psychotherapies versus usual clinical care: a meta-analysis of direct comparisons. Am Psychol 61(7):671–689. https://doi.org/10.1037/0003-066X.61.7.671
Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS (2010) Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics 125(1):75–81. https://doi.org/10.1542/peds.2008-2598
Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B, Georgiades K, Heaton L, Swanson S, Olfson M (2011) Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 50(1):32–45. https://doi.org/10.1016/j.jaac.2010.10.006
Bruffaerts R, Posada-Villa J, Al-Hamzawi AO, Gureje O, Huang Y, Hu C, Bromet EJ, Viana MC, Hinkov HR, Karam EG, Borges G, Florescu SE, Williams DR, Demyttenaere K, Kovess-Masfety V, Matschinger H, Levinson D, de Girolamo G, Ono Y, de Graaf R, Browne MO, Bunting B, Xavier M, Haro JM, Kessler RC (2015) Proportion of patients without mental disorders being treated in mental health services worldwide. Br J Psychiatry 206(2):101–109. https://doi.org/10.1192/bjp.bp.113.141424
Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP, Angermeyer MC, Bernert S, de Girolamo G, Morosini P, Polidori G, Kikkawa T, Kawakami N, Ono Y, Takeshima T, Uda H, Karam EG, Fayyad JA, Karam AN, Mneimneh ZN, Medina-Mora ME, Borges G, Lara C, de Graaf R, Ormel J, Gureje O, Shen Y, Huang Y, Zhang M, Alonso J, Haro JM, Vilagut G, Bromet EJ, Gluzman S, Webb C, Kessler RC, Merikangas KR, Anthony JC, Von Korff MR, Wang PS, Brugha TS, Aguilar-Gaxiola S, Lee S, Heeringa S, Pennell BE, Zaslavsky AM, Ustun TB, Chatterji S, Consortium WHOWMHS (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291(21):2581–2590. https://doi.org/10.1001/jama.291.21.2581
Jorg F, Visser E, Ormel J, Reijneveld SA, Hartman CA, Oldehinkel AJ (2015) Mental health care use in adolescents with and without mental disorders. Eur Child Adolesc Psychiatry. https://doi.org/10.1007/s00787-015-0754-9
Merten EC, Cwik JC, Margraf J, Schneider S (2017) Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child Adolesc Psychiatry Ment Health 11:5. https://doi.org/10.1186/s13034-016-0140-5
Druss BG, Wang PS, Sampson NA, Olfson M, Pincus HA, Wells KB, Kessler RC (2007) Understanding mental health treatment in persons without mental diagnoses: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry 64(10):1196–1203. https://doi.org/10.1001/archpsyc.64.10.1196
Angold A, Costello EJ, Farmer EM, Burns BJ, Erkanli A (1999) Impaired but undiagnosed. J Am Acad Child Adolesc Psychiatry 38(2):129–137. https://doi.org/10.1097/00004583-199902000-00011
Regier DA, Kaelber CT, Rae DS, Farmer ME, Knauper B, Kessler RC, Norquist GS (1998) Limitations of diagnostic criteria and assessment instruments for mental disorders. Implications for research and policy. Arch Gen Psychiatry 55(2):109–115
Sareen J, Stein MB, Campbell DW, Hassard T, Menec V (2005) The relation between perceived need for mental health treatment, DSM diagnosis, and quality of life: a Canadian population-based survey. Can J Psychiatry 50(2):87–94
Spitzer RL (1998) Diagnosis and need for treatment are not the same. Arch Gen Psychiatry 55(2):120
Batstra L, Frances A (2012) Holding the line against diagnostic inflation in psychiatry. Psychother Psychosom 81(1):5–10. https://doi.org/10.1159/000331565
Batstra L, Hadders-Algra M, Nieweg E, Van Tol D, Pijl SJ, Frances A (2012) Childhood emotional and behavioral problems: reducing overdiagnosis without risking undertreatment. Dev Med Child Neurol 54(6):492–494. https://doi.org/10.1111/j.1469-8749.2011.04176.x
Editors PM (2013) The paradox of mental health: over-treatment and under-recognition. PLoS Med 10(5):e1001456. https://doi.org/10.1371/journal.pmed.1001456
Gornall J (2013) DSM-5: a fatal diagnosis? BMJ 346:f3256. https://doi.org/10.1136/bmj.f3256
Coon ER, Quinonez RA, Moyer VA, Schroeder AR (2014) Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 134(5):1013–1023. https://doi.org/10.1542/peds.2014-1778
Glasziou P, Moynihan R, Richards T, Godlee F (2013) Too much medicine; too little care. BMJ 347:f4247. https://doi.org/10.1136/bmj.f4247
Lieb R, Isensee B, Hofler M, Pfister H, Wittchen HU (2002) Parental major depression and the risk of depression and other mental disorders in offspring: a prospective-longitudinal community study. Arch Gen Psychiatry 59(4):365–374
McLaughlin KA, Gadermann AM, Hwang I, Sampson NA, Al-Hamzawi A, Andrade LH, Angermeyer MC, Benjet C, Bromet EJ, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hinkov HR, Horiguchi I, Hu C, Karam AN, Kovess-Masfety V, Lee S, Murphy SD, Nizamie SH, Posada-Villa J, Williams DR, Kessler RC (2012) Parent psychopathology and offspring mental disorders: results from the WHO World Mental Health Surveys. Br J Psychiatry 200(4):290–299. https://doi.org/10.1192/bjp.bp.111.101253
Cornelius JR, Pringle J, Jernigan J, Kirisci L, Clark DB (2001) Correlates of mental health service utilization and unmet need among a sample of male adolescents. Addict Behav 26(1):11–19
Farmer EM, Stangl DK, Burns BJ, Costello EJ, Angold A (1999) Use, persistence, and intensity: patterns of care for children's mental health across one year. Community Ment Health J 35(1):31–46
Flisher AJ, Kramer RA, Grosser RC, Alegria M, Bird HR, Bourdon KH, Goodman SH, Greenwald S, Horwitz SM, Moore RE, Narrow WE, Hoven CW (1997) Correlates of unmet need for mental health services by children and adolescents. Psychol Med 27(5):1145–1154
Mojtabai R, Olfson M, Mechanic D (2002) Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry 59(1):77–84
Olfson M, Marcus SC, Druss B, Alan Pincus H, Weissman MM (2003) Parental depression, child mental health problems, and health care utilization. Med Care 41(6):716–721. https://doi.org/10.1097/01.MLR.0000064642.41278.48
Teagle SE (2002) Parental problem recognition and child mental health service use. Ment Health Serv Res 4(4):257–266
Stalujanis E, Meinlschmidt G, Belardi A, Tegethoff M (2019) Maternal psychopathology and mental health treatment delay in adolescents from a national cohort. Health Serv Res 54(1):149–157. https://doi.org/10.1111/1475-6773.13097
Milne BJ, Caspi A, Harrington H, Poulton R, Rutter M, Moffitt TE (2009) Predictive value of family history on severity of illness: the case for depression, anxiety, alcohol dependence, and drug dependence. Arch Gen Psychiatry 66(7):738–747. https://doi.org/10.1001/archgenpsychiatry.2009.55
Seiffge-Krenke I, Kollmar F (1998) Discrepancies between mothers' and fathers' perceptions of sons' and daughters' problem behaviour: a longitudinal analysis of parent-adolescent agreement on internalising and externalising problem behaviour. J Child Psychol Psychiatry 39(5):687–697
Zwaanswijk M, Van der Ende J, Verhaak PF, Bensing JM, Verhulst FC (2007) The different stages and actors involved in the process leading to the use of adolescent mental health services. Clin Child Psychol Psychiatry 12(4):567–582
Kessler RC, Avenevoli S, Costello EJ, Green JG, Gruber MJ, Heeringa S, Merikangas KR, Pennell BE, Sampson NA, Zaslavsky AM (2009) National Comorbidity Survey Replication Adolescent Supplement (NCS-A): II. Overview and design. J Am Acad Child Adolesc Psychiatry 48(4):380–385. https://doi.org/10.1097/CHI.0b013e3181999705
Kessler RC, Avenevoli S, Costello EJ, Green JG, Gruber MJ, Heeringa S, Merikangas KR, Pennell BE, Sampson NA, Zaslavsky AM (2009) Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Int J Methods Psychiatr Res 18(2):69–83. https://doi.org/10.1002/mpr.279
Merikangas K, Avenevoli S, Costello J, Koretz D, Kessler RC (2009) National Comorbidity Survey Replication Adolescent Supplement (NCS-A): I. Background and measures. J Am Acad Child Adolesc Psychiatry 48(4):367–369. https://doi.org/10.1097/CHI.0b013e31819996f1
Kessler RC, Avenevoli S, Green J, Gruber MJ, Guyer M, He Y, Jin R, Kaufman J, Sampson NA, Zaslavsky AM (2009) National Comorbidity Survey Replication Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI diagnoses with clinical reassessments. J Am Acad Child Adolesc Psychiatry 48(4):386–399. https://doi.org/10.1097/CHI.0b013e31819a1cbc
Andreasen NC, Endicott J, Spitzer RL, Winokur G (1977) The family history method using diagnostic criteria. Reliability and validity. Arch Gen Psychiatry 34(10):1229–1235
Kendler KS, Davis CG, Kessler RC (1997) The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: a family history study. Br J Psychiatry 170:541–548
Stiffman AR, Horwitz SM, Hoagwood K, Compton W 3rd, Cottler L, Bean DL, Narrow WE, Weisz JR (2000) The Service Assessment for Children and Adolescents (SACA): adult and child reports. J Am Acad Child Adolesc Psychiatry 39(8):1032–1039. https://doi.org/10.1097/00004583-200008000-00019
Tegethoff M, Stalujanis E, Belardi A, Meinlschmidt G (2014) School mental health services: signpost for out-of-school service utilization in adolescents with mental disorders? A nationally representative United States cohort. PLoS ONE 9(6):e99675. https://doi.org/10.1371/journal.pone.0099675
Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, Kessler RC (2013) Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 70(3):300–310. https://doi.org/10.1001/2013.jamapsychiatry.55
Singer JD, Willett JB (2003) Applied longitudinal data analysis: modeling change and event occurrence. Oxford University Press, New York
Williams RL (2008) Taylor Series Linearization (TSL). In: Lavrakas P (ed) Encyclopedia of survey research methods. SAGE Publications, Thousand Oaks, pp 877–878
Zahner GE, Daskalakis C (1997) Factors associated with mental health, general health, and school-based service use for child psychopathology. Am J Public Health 87(9):1440–1448
Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165(6):710–718. https://doi.org/10.1093/aje/kwk052
Benjamini Y, Hochberg Y (1995) Controlling the False Discovery Rate: a practical and powerful approach to multiple testing. J Roy Stat Soc B 57(1):289–300
McLaughlin KA, Conron KJ, Koenen KC, Gilman SE (2010) Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults. Psychol Med 40(10):1647–1658. https://doi.org/10.1017/S0033291709992121
Cunningham PJ, Freiman MP (1996) Determinants of ambulatory mental health services use for school-age children and adolescents. Health Serv Res 31(4):409–427
Owens PL, Hoagwood K, Horwitz SM, Leaf PJ, Poduska JM, Kellam SG, Ialongo NS (2002) Barriers to children's mental health services. J Am Acad Child Adolesc Psychiatry 41(6):731–738. https://doi.org/10.1097/00004583-200206000-00013
Sourander A, Santalahti P, Haavisto A, Piha J, IkAheimo K, Helenius H (2004) Have there been changes in children's psychiatric symptoms and mental health service use? A 10-year comparison from Finland. J Am Acad Child Adolesc Psychiatry 43(9):1134–1145. https://doi.org/10.1097/01.chi.0000133261.75795.1a
Lewinsohn PM, Olino TM, Klein DN (2005) Psychosocial impairment in offspring of depressed parents. Psychol Med 35(10):1493–1503. https://doi.org/10.1017/S0033291705005350
Bijl RV, de Graaf R, Hiripi E, Kessler RC, Kohn R, Offord DR, Ustun TB, Vicente B, Vollebergh WA, Walters EE, Wittchen HU (2003) The prevalence of treated and untreated mental disorders in five countries. Health Aff (Millwood) 22(3):122–133
Kessler RC, Merikangas KR, Berglund P, Eaton WW, Koretz DS, Walters EE (2003) Mild disorders should not be eliminated from the DSM-V. Arch Gen Psychiatry 60(11):1117–1122. https://doi.org/10.1001/archpsyc.60.11.1117
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850. https://doi.org/10.1016/S0140-6736(07)61414-7
Grills AE, Ollendick TH (2002) Issues in parent-child agreement: the case of structured diagnostic interviews. Clin Child Fam Psychol Rev 5(1):57–83
First MB, Spitzer RL, Gibbon M, Williams JB (2002) Structured clinical interview for DSM-IV-TR Axis I disorders, research version, non-patient edition (SCID-I/NP). Biometrics research, New York State Psychiatric Institute, New York
Kessler RC, Abelson J, Demler O, Escobar JI, Gibbon M, Guyer ME, Howes MJ, Jin R, Vega WA, Walters EE, Wang P, Zaslavsky A, Zheng H (2004) Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMH-CIDI). Int J Methods Psychiatr Res 13(2):122–139
Rumpf HJ, Meyer C, Hapke U, John U (2001) Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res 105(3):243–253
Bromet E, Sonnega A, Kessler RC (1998) Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 147(4):353–361
Wamboldt MZ, Weintraub P, Krafchick D, Wamboldt FS (1996) Psychiatric family history in adolescents with severe asthma. J Am Acad Child Adolesc Psychiatry 35(8):1042–1049. https://doi.org/10.1097/00004583-199608000-00015
Kessler RC, Andrews G, Mroczek D, Ustun B, Wittchen HU (1998) The World Health Organization Composite International Diagnostic Interview short form (CIDI-SF). Int J Methods Psychiatr Res 7(4):171–185
Jacobi F, Wittchen HU, Holting C, Hofler M, Pfister H, Muller N, Lieb R (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34(4):597–611. https://doi.org/10.1017/S0033291703001399
Kessler RC, Angermeyer M, Anthony JC, De Graaf R, Demyttenaere K, Gasquet I, De Girolamo G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustun TB (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6(3):168–176
Hill AB (1965) The environment and disease: association or causation? Proc R Soc Med 58:295–300
Farmer EMZ, Angold A, Burn BJ, Costello EJ (1994) Reliability of self-reported service use: test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA). J Child Fam Stud 3(3):307–325
Dowdy E, Furlong M, Raines TC, Bovery B, Kauffman B, Kamphaus RW, Dever BV, Price M, Murdock J (2015) Enhancing school-based mental health services with a preventive and promotive approach to universal screening for complete mental health. J Educ Psychol Consult 25(2–3):5. https://doi.org/10.1080/10474412.2014.929951
Topper M, Emmelkamp PM, Watkins E, Ehring T (2017) Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: a randomized controlled trial. Behav Res Ther 90:123–136. https://doi.org/10.1016/j.brat.2016.12.015
Cuijpers P, Beekman AT, Reynolds CF 3rd (2012) Preventing depression: a global priority. JAMA 307(10):1033–1034. https://doi.org/10.1001/jama.2012.271
Lynch FL, Hornbrook M, Clarke GN, Perrin N, Polen MR, O'Connor E, Dickerson J (2005) Cost-effectiveness of an intervention to prevent depression in at-risk teens. Arch Gen Psychiatry 62(11):1241–1248. https://doi.org/10.1001/archpsyc.62.11.1241
Dallaire DH, Ciccone A, Wilson LC (2010) Teachers' experiences with and expectations of children with incarcerated parents. J Appl Dev Psychol 31(4):281–290. https://doi.org/10.1016/j.appdev.2010.04.001
Wang PS, Angermeyer M, Borges G, Bruffaerts R, Tat Chiu W, De Girolamo G, Fayyad J, Gureje O, Haro JM, Huang Y, Kessler RC, Kovess V, Levinson D, Nakane Y, Oakley Brown MA, Ormel JH, Posada-Villa J, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Chatterji S, Ustun TB (2007) Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6(3):177–185
Henderson S, Korten A, Medway J (2001) Non-disabled cases in a national survey. Psychol Med 31(5):769–777
Funding
This project was financed by the Swiss National Science Foundation (SNSF, to MT, project no. PZ00P1_137023). Additionally, MT and GM receive funding from the Korea Research Foundation within the Global Research Network Program under project no. 2013S1A2A2035364, and GM received SNSF funding under project no. 100014_135328. Currently GM receives funding from the Stanley Thomas Johnson Stiftung & Gottfried und Julia Bangerter-Rhyner-Stiftung (project no. PC_28/17 and PC_05/18), from the Swiss Cancer League (Krebsliga Schweiz) under project no. KLS-4304-08-2017, from the Research Foundation of the International Psychoanalytic University (IPU) Berlin, and from Gesundheitsförderung Schweiz under project no. 18.191. The funding sources had no involvement in study design; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication. The National Comorbidity Survey Replication Adolescent Supplement (NCS-A) was funded by: United States Department of Health and Human Services. National Institutes of Health. National Institute of Mental Health (U01-MH60220); United States Department of Health and Human Services. National Institutes of Health. National Institute on Drug Abuse (R01-DA12058-05); United States Department of Health and Human Services. Substance Abuse and Mental Health Services Administration; Robert Wood Johnson Foundation (Grant 044780); John W. Alden Trust.
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None declared. GM has been acting as consultant for Janssen Research & Development, LLC.
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Mothers and adolescents gave written informed consent, and the Human Subjects Committees of the Harvard Medical School and the University of Michigan approved the NCS-A.
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Hereby, we acknowledge that the original collector of the data, ICPSR, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
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Stalujanis, E., Meinlschmidt, G., Belardi, A. et al. Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey. Eur Child Adolesc Psychiatry 29, 1207–1216 (2020). https://doi.org/10.1007/s00787-019-01429-y
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DOI: https://doi.org/10.1007/s00787-019-01429-y