Costello E J, Angold A, Burns B J, Erkanli A, Stangl D K, Tweed D L
Developmental Epidemiology Program, Duke University Medical Center, Durham, NC, USA.
Arch Gen Psychiatry. 1996 Dec;53(12):1137-43. doi: 10.1001/archpsyc.1996.01830120077013.
Federal regulations require states to estimate the prevalence and incidence of serious emotional disturbance (SED) in children, defined as a DSM-III-R diagnosis in the presence of impaired functioning in 1 or more areas. We reviewed the published data on SED and examined rates and correlates of SED in an ongoing epidemiologic study of children.
Rates of DSM-III-R disorders, functional impairment, and their co-occurrence (SED) were examined in a representative population sample of 9-, 11-, and 13-year-olds from a predominantly rural area of North Carolina. Three measures of functional impairment were used, and their interrelationship and impact on rates of SED were examined.
Serious emotional disturbance was identified in 4% to 8% of the study population, depending on the measure of impairment; the rate of DSM-III-R disorder ignoring impairment was 20.3%. One quarter of children identified as having SED on any measure were identified by all 3, and one half by 2 or more. Behavioral disorders, emotional disorders, and comorbidity were associated with a significant increase in the likelihood of SED; enuresis and tic disorders in the absence of comorbidity were not. Diagnosis and impairment made independent contributions to the increase in service use seen in children with SED. Poverty greatly increased the likelihood of SED.
Specific areas of functional impairment should be examined when SED is assessed and treatment is planned. Plans to target mental health care resources to children with SED need to be accompanied by efforts to ensure access to those resources.
联邦法规要求各州估计儿童严重情绪障碍（SED）的患病率和发病率，SED被定义为存在《精神疾病诊断与统计手册第三版修订版》（DSM - III - R）诊断且在一个或多个领域功能受损。我们回顾了关于SED的已发表数据，并在一项正在进行的儿童流行病学研究中检查了SED的发生率及其相关因素。
在来自北卡罗来纳州一个主要为农村地区的具有代表性的9岁、11岁和13岁儿童人群样本中，检查了DSM - III - R障碍、功能受损及其共现情况（SED）。使用了三种功能受损测量方法，并检查了它们之间的相互关系以及对SED发生率的影响。
根据受损测量方法的不同，在4%至8%的研究人群中发现了严重情绪障碍；忽略功能受损情况的DSM - III - R障碍发生率为20.3%。在任何一种测量方法中被确定为患有SED的儿童中，四分之一是通过所有三种测量方法确定的，二分之一是通过两种或更多测量方法确定的。行为障碍、情绪障碍和共病与SED发生可能性的显著增加相关；不存在共病时的遗尿症和抽动障碍则不然。诊断和功能受损对SED儿童服务使用增加均有独立影响。贫困极大地增加了SED的发生可能性。
在评估SED并制定治疗计划时，应检查功能受损的具体领域。针对患有SED儿童的心理健康护理资源计划需要伴随着确保这些资源可及的努力。
