The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark.
National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.
JAMA Psychiatry. 2020 Feb 1;77(2):155-164. doi: 10.1001/jamapsychiatry.2019.3523.
Knowledge about the epidemiology of mental disorders in children and adolescents is essential for research and planning of health services. Surveys can provide prevalence rates, whereas population-based registers are instrumental to obtain precise estimates of incidence rates and risks.
To estimate age- and sex-specific incidence rates and risks of being diagnosed with any mental disorder during childhood and adolescence.
This cohort study included all individuals born in Denmark from January 1, 1995, through December 31, 2016 (1.3 million), and followed up from birth until December 31, 2016, or the date of death, emigration, disappearance, or diagnosis of 1 of the mental disorders examined (14.4 million person-years of follow-up). Data were analyzed from September 14, 2018, through June 11, 2019.
Age and sex.
Incidence rates and cumulative incidences of all mental disorders according to the ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research, diagnosed before 18 years of age during the study period.
A total of 99 926 individuals (15.01%; 95% CI, 14.98%-15.17%), including 41 350 girls (14.63%; 95% CI, 14.48%-14.77%) and 58 576 boys (15.51%; 95% CI, 15.18%-15.84%), were diagnosed with a mental disorder before 18 years of age. Anxiety disorder was the most common diagnosis in girls (7.85%; 95% CI, 7.74%-7.97%); attention-deficit/hyperactivity disorder (ADHD) was the most common in boys (5.90%; 95% CI, 5.76%-6.03%). Girls had a higher risk than boys of schizophrenia (0.76% [95% CI, 0.72%-0.80%] vs 0.48% [95% CI, 0.39%-0.59%]), obsessive-compulsive disorder (0.96% [95% CI, 0.92%-1.00%] vs 0.63% [95% CI, 0.56%-0.72%]), and mood disorders (2.54% [95% CI, 2.47%-2.61%] vs 1.10% [95% CI, 0.84%-1.21%]). Incidence peaked earlier in boys than girls in ADHD (8 vs 17 years of age), intellectual disability (5 vs 14 years of age), and other developmental disorders (5 vs 16 years of age). The overall risk of being diagnosed with a mental disorder before 6 years of age was 2.13% (95% CI, 2.11%-2.16%) and was higher in boys (2.78% [95% CI, 2.44%-3.15%]) than in girls (1.45% [95% CI, 1.42%-1.49%]).
This nationwide population-based cohort study provides a first comprehensive assessment of the incidence and risks of mental disorders in childhood and adolescence. By 18 years of age, 15.01% of children and adolescents in this study were diagnosed with a mental disorder. The incidence of several neurodevelopmental disorders peaked in late adolescence in girls, suggesting possible delayed detection. The distinct signatures of the different mental disorders with respect to sex and age may have important implications for service planning and etiological research.
了解儿童和青少年精神障碍的流行病学知识对于研究和规划卫生服务至关重要。调查可以提供患病率，而基于人群的登记册则有助于准确估计发病率和风险。
估计儿童和青少年期任何精神障碍的年龄和性别特异性发病率和发病风险。
这项队列研究包括 1995 年 1 月 1 日至 2016 年 12 月 31 日期间在丹麦出生的所有个体（130 万），并从出生开始随访至 2016 年 12 月 31 日，或随访至死亡、移民、失踪或研究中检查的任何精神障碍诊断日期（1440 万人年）。数据于 2018 年 9 月 14 日至 2019 年 6 月 11 日进行分析。
年龄和性别。
根据国际疾病分类第 10 版精神和行为障碍诊断标准研究，在研究期间 18 岁之前诊断为所有精神障碍的发病率和累积发病率。
共有 99926 人（15.01%；95%CI，14.98%-15.17%），包括 41350 名女孩（14.63%；95%CI，14.48%-14.77%）和 58576 名男孩（15.51%；95%CI，15.18%-15.84%）被诊断患有精神障碍。在女孩中，焦虑症是最常见的诊断（7.85%；95%CI，7.74%-7.97%）；注意缺陷/多动障碍（ADHD）在男孩中最常见（5.90%；95%CI，5.76%-6.03%）。与男孩相比，女孩患精神分裂症的风险更高（0.76%[95%CI，0.72%-0.80%]比 0.48%[95%CI，0.39%-0.59%]）、强迫症（0.96%[95%CI，0.92%-1.00%]比 0.63%[95%CI，0.56%-0.72%]）和心境障碍（2.54%[95%CI，2.47%-2.61%]比 1.10%[95%CI，0.84%-1.21%]）。ADHD（8 岁与 17 岁）、智力障碍（5 岁与 14 岁）和其他发育障碍（5 岁与 16 岁）男孩的发病率早于女孩。6 岁前被诊断患有精神障碍的总体风险为 2.13%（95%CI，2.11%-2.16%），男孩（2.78%[95%CI，2.44%-3.15%]）高于女孩（1.45%[95%CI，1.42%-1.49%]）。
这项全国性基于人群的队列研究首次全面评估了儿童和青少年精神障碍的发病率和发病风险。在这项研究中，18 岁以下的儿童和青少年中有 15.01%被诊断患有精神障碍。几种神经发育障碍的发病率在女孩青春期晚期达到高峰，这表明可能存在延迟发现。不同精神障碍的性别和年龄特征可能对服务规划和病因学研究具有重要意义。
