During the past year, we have continued to actively pursue analyses of topics of relevance to our research in the NIMH Intramural Research Program including anxiety disorders, mood disorders, fatigue, sleep patterns and problems, service patterns including treatment sector and psychotropic medication use, and contextual risk factors for mental disorders. The chief findings include: -Mania symptoms and disorder are common in adolescents and associated with substantial impairment and functional severity. -Using NCS-A geo-coded data, we found a strong association between neighborhood disadvantage and emotional disorder. -The majority of adolescents in the general population of the U.S. who had received mental health treatment met criteria for one or more psychiatric disorders, and there was a strong match between specific disorders and classes of medications with evidence for efficacy. -Adolescent suicidality is often untreated in the U.S. This gap in mental health services calls for increased outreach efforts to improve treatment access to youths with suicidal ideation and attempts. -Even in the absence of comorbid mental disorders, prolonged fatigue in adolescents is associated with disability and poor mental and physical health. -Phobias in adolescents are an index of substantial impairment, particularly when there are multiple fears and early age at onset. -The Strength and Difficulties Questionnaire (SDQ) scale based on parent reports is a valid index of psychopathology in youth across sociodemographic subgroups. The SDQ screen may be of greatest value for disadvantaged youths in whom unmet treatment needs are greatest. Public Health Impact: Aside from providing the first prevalence data on a wide range of psychiatric disorders in a nationally representative sample of U.S. adolescents, we believe that these analyses provide beneficial information to inform future research and treatment interventions. As mental health treatment research is moving into the translation of lab-based findings to treatment interventions, service level data provides us with an avenue to put our previous translational research into context and further enhance subsequent interventions. While the development of interventions is important, the ultimate success of intervention is predicated on the way this intervention is integrated into the existing medical system. Service utilization studies conducted within this group provide some insight into the populations and service sectors that could benefit from targeted interventions. Future Plans: Several manuscripts are either under review or ready for submission: prevalence and correlates of major depressive disorder;comorbidity pattern among adolescents with substance use disorders;prevalence, clinical characteristics, age of onset, and treatment patterns of Attention Deficit and Hyperactivity Disorder (ADHD);prevalence and correlates of Disruptive Mood Dysregulation Disorder (DMDD), sleep patterns and disorders and their correlates;salivary cortisol as in index of neighborhood stress in adolescents;structure of psychopathology in U.S. adolescents;and risk factors and correlates of neurodevelopmental disorders. We are also pursuing additional analyses on the following topics: 1) effects of sleep and exercise patterns on mental health;2) temporal associations of psychiatric disorders;3) irritability as an index of depression;4) comorbidity of medical and mental disorders;and 5) the association between race/ethnicity and immigration with the prevalence and treatment of mental disorders.
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