Centre for Mental Health & Safety, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, M13 9PL, UK.
NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK.
BMC Psychiatry. 2021 May 3;21(1):229. doi: 10.1186/s12888-021-03235-w.
There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited.
Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1-20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1-5, 6-9, 10-12, 13-16, 17-19), depression, anxiety disorders (6-9, 10-12, 13-16, 17-19), eating disorders and self-harm (10-12, 13-16, 17-19) during 2003-2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence.
The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18-3.89), depression (2.37; 2.03-2.77), ASD (2.36; 1.72-3.26), ADHD (2.3; 1.73-3.25), and self-harm (2.25; 1.82-2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06-1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders.
The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.
近年来，英国越来越关注儿童和青少年中存在的心理健康危机，但已发表的流行病学证据有限。
在临床实践研究数据链（CPRD）的 Aurum 和 GOLD 数据集中，确定了两个基于人群的英国初级保健队列。我们纳入了年龄在 1-20 岁之间的 9133246 名个体的数据，他们共提供了 117682651 人年的观察时间。估计了注意力缺陷/多动障碍（ADHD）和自闭症谱系障碍（ASD）（年龄组：1-5 岁、6-9 岁、10-12 岁、13-16 岁、17-19 岁）、抑郁症、焦虑障碍（6-9 岁、10-12 岁、13-16 岁、17-19 岁）、饮食障碍和自伤（10-12 岁、13-16 岁、17-19 岁）在 2003-2018 年间的年度发病率。我们使用负二项回归来估计发病率比（IRR），以检查观察期第一年（2003 年）和最后一年（2018 年）之间的发病率变化，并检查性别特异性发病率。
结果表明，2003 年至 2018 年间，男孩和女孩的焦虑障碍（IRR 3.51 95%CI 3.18-3.89）、抑郁症（2.37；2.03-2.77）、ASD（2.36；1.72-3.26）、ADHD（2.3；1.73-3.25）和自伤（2.25；1.82-2.79）的总体发病率均显著增加。饮食障碍的发病率也有所增加（IRR 1.3 95%CI 1.06-1.61），但增幅较小。焦虑障碍、抑郁症、自伤和饮食障碍的发病率在女孩中绝对值较高，而 ADHD 和 ASD 的发病率则相反，男孩中发病率较高。发病率相对增加最大的是神经发育障碍，特别是女孩被诊断为 ADHD 或 ASD。然而，就绝对发病率而言，抑郁症和焦虑障碍的发病率要高得多。
近年来，寻求心理困扰帮助的年轻人数量似乎有所增加。诊断标准的改变、耻辱感的减少和意识的提高可能部分解释了我们的结果，但我们不能排除人群中发病率实际增加的可能性。无论原因是什么，对医疗保健服务的需求明显增加意味着，受影响的年轻人可能更难及时获得他们所需的护理和支持。
