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Empirically derived subtypes of serious emotional disturbance in a large adolescent sample

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Abstract

Purpose

The heterogeneity of serious emotional disturbance has been thoroughly documented among adolescents with nationally representative data derived from structured interviews, although use of these interviews may not be feasible within the context of brief and self-administered school surveys. This study seeks to identify distinct subtypes of serious emotional disturbance in a large school-based sample.

Methods

A total of 108,736 students fully completed the K6 scale that was included on the 2012 Kentucky Incentives for Prevention Survey. Latent class analysis was used to derive subtypes of serious emotional disturbance among students receiving a positive screen (n = 15,147). To determine significant predictors of class membership, adjusted rate ratios and 95 % confidence intervals were calculated using multinomial logistic regression.

Results

A four-class model was the most parsimonious, with four distinct subtypes emerging that varied by both symptom type and severity: comorbid moderate severity, comorbid high severity, anxious moderate severity, and depressed high severity. Age, gender, race/ethnicity, family structure, substance use, antisocial behavior, role impairments, and peer victimization were significant predictors of class membership, although the magnitude of these effects was stronger for the two high severity groups.

Conclusions

Our results suggest heterogeneity of serious emotional disturbance by both symptom type and severity. Prevention programs may benefit by shifting focus from specific disorders to the core features of serious emotional disturbance, including psychological distress, high comorbidity, and role impairments.

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Acknowledgments

Data collection for this study was made possible through the Substance Abuse Prevention Program in the Kentucky Cabinet for Health and Family Services. This research was supported by Grant SP019436-01-2 funded by the Center for Substance Abuse Prevention at the United States Substance Abuse and Mental Health Services Administration. We thank Connie Smith and Steve Cambron for their leadership on the initiative as well as the members of the Kentucky State Epidemiological Outcomes Workgroup for their ongoing contributions.

Conflict of interest

No authors declare a conflict of interest. The terms of the grants assure that the sponsors are unaware of this study, and thus had no scientific input or other influence with respect to its design, analysis, interpretation or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Epidemiology and Population Health, University of Louisville, Louisville, KY, USA

    Nicholas Peiper, Elizabeth O’Brien, Richard Kerber & Richard Baumgartner

  2. REACH Evaluation, 501 Park Avenue, Louisville, KY, 40208, USA

    Nicholas Peiper & Robert Illback

  3. Department of Health Behavior, University of Kentucky, Lexington, KY, USA

    Richard Clayton

  4. Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA

    Richard Wilson

  5. Department of Medicine, University of Louisville, Louisville, KY, USA

    Carlton Hornung

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  1. Nicholas Peiper
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  2. Richard Clayton
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  3. Richard Wilson
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  8. Carlton Hornung
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Correspondence to Nicholas Peiper.

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Peiper, N., Clayton, R., Wilson, R. et al. Empirically derived subtypes of serious emotional disturbance in a large adolescent sample. Soc Psychiatry Psychiatr Epidemiol 50, 983–994 (2015). https://doi.org/10.1007/s00127-015-1017-2

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