Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Research Center on Neurodevelopment and Mental Health, University of São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.
J Child Psychol Psychiatry. 2015 Mar;56(3):345-65. doi: 10.1111/jcpp.12381. Epub 2015 Feb 3.
The literature on the prevalence of mental disorders affecting children and adolescents has expanded significantly over the last three decades around the world. Despite the field having matured significantly, there has been no meta-analysis to calculate a worldwide-pooled prevalence and to empirically assess the sources of heterogeneity of estimates.
We conducted a systematic review of the literature searching in PubMed, PsycINFO, and EMBASE for prevalence studies of mental disorders investigating probabilistic community samples of children and adolescents with standardized assessments methods that derive diagnoses according to the DSM or ICD. Meta-analytical techniques were used to estimate the prevalence rates of any mental disorder and individual diagnostic groups. A meta-regression analysis was performed to estimate the effect of population and sample characteristics, study methods, assessment procedures, and case definition in determining the heterogeneity of estimates.
We included 41 studies conducted in 27 countries from every world region. The worldwide-pooled prevalence of mental disorders was 13.4% (CI 95% 11.3-15.9). The worldwide prevalence of any anxiety disorder was 6.5% (CI 95% 4.7-9.1), any depressive disorder was 2.6% (CI 95% 1.7-3.9), attention-deficit hyperactivity disorder was 3.4% (CI 95% 2.6-4.5), and any disruptive disorder was 5.7% (CI 95% 4.0-8.1). Significant heterogeneity was detected for all pooled estimates. The multivariate metaregression analyses indicated that sample representativeness, sample frame, and diagnostic interview were significant moderators of prevalence estimates. Estimates did not vary as a function of geographic location of studies and year of data collection. The multivariate model explained 88.89% of prevalence heterogeneity, but residual heterogeneity was still significant. Additional meta-analysis detected significant pooled difference in prevalence rates according to requirement of funcional impairment for the diagnosis of mental disorders.
Our findings suggest that mental disorders affect a significant number of children and adolescents worldwide. The pooled prevalence estimates and the identification of sources of heterogeneity have important implications to service, training, and research planning around the world.
过去三十年来，全球范围内有关影响儿童和青少年的精神障碍患病率的文献大量增加。尽管该领域已经有了很大的发展，但仍没有进行荟萃分析来计算全球范围内的患病率，并从实证角度评估估计值的异质性来源。
我们系统地检索了 PubMed、PsycINFO 和 EMBASE 中的文献，以寻找使用标准化评估方法调查儿童和青少年概率性社区样本的精神障碍患病率研究，这些方法根据 DSM 或 ICD 得出诊断。使用荟萃分析技术来估计任何精神障碍和个别诊断组的患病率。进行了元回归分析，以估计人口和样本特征、研究方法、评估程序和病例定义在确定估计值的异质性方面的影响。
我们纳入了来自世界各地 27 个国家的 41 项研究。全球范围内精神障碍的总患病率为 13.4%（95%置信区间为 11.3-15.9）。任何焦虑障碍的全球患病率为 6.5%（95%置信区间为 4.7-9.1），任何抑郁障碍为 2.6%（95%置信区间为 1.7-3.9），注意力缺陷多动障碍为 3.4%（95%置信区间为 2.6-4.5），任何破坏性行为障碍为 5.7%（95%置信区间为 4.0-8.1）。所有汇总估计均存在显著的异质性。多元荟萃回归分析表明，样本代表性、样本框架和诊断访谈是患病率估计的重要调节因素。估计值的变化与研究地点和数据收集年份无关。多元模型解释了 88.89%的患病率异质性，但仍存在显著的剩余异质性。进一步的荟萃分析显示，根据精神障碍诊断是否需要功能障碍的要求，患病率的差异具有统计学意义。
我们的研究结果表明，精神障碍在全球范围内影响着相当数量的儿童和青少年。汇总的患病率估计值以及异质性来源的确定，对全球范围内的服务、培训和研究规划具有重要意义。
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