During the past year we have done extensive analyses of the data from both the child and adult components of the NHANES surveys. Two papers have been published or are in press and four others have been submitted. Below we describe the substantive issues addressed in this work. ? 1) We have completed the analyses of the prevalence estimates of GAD, panic, eating disorder, major depressive disorder/dysthymic disorder, ADHD and conduct disorders for the overall sample, by informant (child or parent), gender, race/ethnicity, and age group. In order to assess the severity of these conditions, we have also calculated prevalence by four alternative impairment algorithms. These data will provide the first population prevalence data on these seven major mental disorders in children ages 8 through 19 in a national probability sample of the US. ? 2) A separate project set out to describe the prevalence, demographic correlates, comorbidities, and service patterns for nocturnal enuresis. There are no published nationally representative prevalence estimates of nocturnal enuresis among children in the United States using standardized diagnostic criteria. The overall 12-month prevalence of nocturnal enuresis was 4.45%. The prevalence in boys was significantly greater than that in girls. Nocturnal enuresis was more common at younger ages and among black youth. ADHD was strongly associated with nocturnal enuresis. Only 36% of the enuretic children had received health service for nocturnal enuresis. Nocturnal enuresis is a common condition among children in the US. Few families seek treatment for nocturnal enuresis despite the potential for adverse effects on emotional health. Child healthcare professionals should routinely screen for nocturnal enuresis and its effects on the emotional health of the child and the family. Assessment of ADHD should routinely include evaluation for nocturnal enuresis and vice versa. Research on the explanations for the association between nocturnal enuresis and ADHD is indicated.? 3) We investigated the prevalence of mental and physical comorbidity and health service utilization among 3,042 children aged 8 to 15 from the 2001 2004 NHANES. There was a strong association between mental and physical disorders. After adjusting for social and demographic characteristics, comorbidity was associated with a 2.5 times increase in healthcare utilization compared to those without comorbidity. Our findings confirm prior local population studies of comorbidity among youth and suggest that physical and mental comorbidity has a strong impact on healthcare utilization. Integrated treatment of mental and physical disorders is clearly indicated. Future studies should examine the explanations for systematic patterns of comorbidity in youth.? 4) To determine the prevalence, sociodemographic correlates and comorbid medical conditions of recurrent headache in U.S. children, we investigated 10198 children aged 4 to 18 years old who participated in the 1999 to 2004 National Health and Nutrition Examination Surveys. We found that frequent or severe headaches including migraine in the past 12 months were reported in 17.1% of children, with greater rates among girls and older adolescents. Children with headache had more school absences and health care utilization. Asthma, hay fever, and frequent ear infections were more common in children with headache, with at least one of these occurring in 41.6% of children with headache vs. 25.0% of children free of headache (p<.0001). Children with headache were 13.6 times more likely to have all three of these conditions. We conclude that recurrent headache in childhood is extremely common and is associated with a variety of other medical conditions, particularly those with immunologic and inflammatory bases. The high frequency of recurrent headaches and their association with school absences suggest that headaches in U.S. youth have major public health significance. These results are a significant first step towards research to understand biologic mechanisms, identify more homogeneous subgroups in clinical and genetic studies, and develop better clinical management.? 5) Our analytic team investigated patterns of mental and physical comorbidity among adults with severe headaches and migraine using merged data from the 1999-2004 survey years. The analyses include a comparison of the sociodemographic characteristics of individuals with versus without headaches as well as a description of the rates of comorbidity of both mental and physical disorders within both headache groups. In order to assess the relative impact of these comorbid conditions, we compared the responses to a series of questions on health care utilization and health perception across five groups (no headache, headache only, headache plus any physical condition, headache plus any mental condition, headache plus a physical and mental condition). ? 6) To understand the association between severe/recurrent headache and a range of cardiovascular and immunologic measures in the adult U.S. population, we used NHANES 1999-2004 surveys data including 14,503 adults and found that the major laboratory correlates of cardiovascular disease assessed in the NHANES including C-reactive protein, folate, homocysteine and HDL cholesterol differed among those with severe headaches/migraine compared to their non-headache counterparts. Moreover, people with severe headaches or migraine were more likely to have high BMI and diastolic blood pressure. These findings suggest that inflammatory mechanisms may play an important role in the pathophysiology of migraine as a risk factor for stroke and cardiovascular disease.? 7) A parallel study to investigate the association of childhood headache with biomarkers for cardiovascular and cerebrovascular disease was also conducted among 11,770 children aged 4 19 years old in NHANES 1999 2004 data. We found mean values for homocysteine, C reactive protein, and body mass index were higher in children with than without headaches, and more children with headaches were in the highest quintile for these factors. Serum and red cell folate were lower in children with headache. More children with headache (32% in children < 12 years) thanMore children with headache (32% in children < 12 years) than without headache (18%) were in the highest quintile of risk for 3 or more of these factors. The findings indicate that these important risk factors for long-term vascular morbidity cluster with severe or recurrent headache in childhood or adolescence. Recognition of the subgroup among children with headache in whom these risk factors concentrate may permit improved preventive management. ? ? 8) These data provide new information on the significant role of comorbid disorders, specifically comorbid mood and anxiety disorders, on the impact of severe headaches or migraine, on health care utilization and health perception. Future analyses will then examine the risk factors and biological correlates of these conditions in the general population. We will prioritize our analyses to address the key study questions that are the focus of our own research.
| Nelson, Karin B; Richardson, Amanda Kalaydjian; He, Jianping et al. (2010) Headache and biomarkers predictive of vascular disease in a representative sample of US children. Arch Pediatr Adolesc Med 164:358-62 |
| Kalaydjian, Amanda; Merikangas, Kathleen (2008) Physical and mental comorbidity of headache in a nationally representative sample of US adults. Psychosom Med 70:773-80 |
| Merikangas, Kathleen R; Kalaydjian, Amanda (2007) Magnitude and impact of comorbidity of mental disorders from epidemiologic surveys. Curr Opin Psychiatry 20:353-8 |
