Having psychiatric problems in childhood is challenging enough, but new evidence suggests that these problems can lead to issues as an adult—even if the problems do not persist into adulthood.
A new study published in JAMA Psychiatry used data from a survey of 1,420 children from 11 counties in rural North Carolina. The children were followed over time and assessed annually between ages 9 and 16 for common psychiatric problems, like depression, anxiety and behavioral issues. The researchers found that 26% of children in the group suffered some form of behavioral or emotional disorder; another 31% displayed "subthreshold" psychiatric problems, or a few symptoms of psychiatric problems without being diagnosed with the condition.
"In terms of most types of health problems, kids are the healthiest," says lead author Dr. William Copeland of Duke University Medical Center. Most chronic health diseases take hold during middle age, but "one exception is mental health problems, which occur at the onset of childhood and adolescence," he says. These can include ADHD, behavioral or conduct problems, anxiety and depression.
Out of the initial survey group, 1,273 people were later re-evaluated three times at the outset of adulthood—ages 19, 21 and 25—to see how the now-young adults had fared in four areas: health, the legal system, personal finances and social functioning. These included negative life events like being incarcerated, dropping out of high school, having trouble keeping a job and having a serious health problem or addiction, Copeland says. "Nineteen and 21 are a peak period in terms of criminal behavior, substance problems, and transitioning from the home," he says, and age 25 is when things typically start to stabilize.
Of the young adults who had suffered from a subthreshold psychiatric problem in childhood, 42% suffered an adverse outcome in adulthood. Of the kids who had behavioral or emotional issues as kids, 60% of them reported having trouble as adults. By comparison, just 20% of the young adults who had no psychiatric issues reported adult problems.
In other words, having a diagnosed psychiatric issue as a child made him or her six times more likely to experience at least one adverse effect as an adult and nine times more likely to suffer from two or more adverse outcomes. Children who had subthreshold symptoms without an official diagnosis faced three times the risk of having one adverse outcome and five times the risk of having two or more adverse outcomes.
Copeland thinks this is proof that mental health needs to be addressed early on and without stigma. "We need to focus on prevention and intervention," he says. "If we want to reduce the cost and distress associated with many social problems, we really need to address them earlier."