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Prevalence and Correlates of Mental Disorders Among Adolescents in Italy

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Prevalence and Correlates of Mental Disorders Among Adolescents in Italy Prevalence and correlates of mental disorders among adolescents in Italy: the PrISMA study Alessandra Frigerio, Paola Rucci, Robert Goodman, Massimo Ammaniti, Ombretta Carlet, Pina Cavolina, Giovanni Girolamo, Carlo Lenti, Loredana Lucarelli, Elisa Mani, et al. To cite this version: Alessandra Frigerio, Paola Rucci, Robert Goodman, Massimo Ammaniti, Ombretta Carlet, et al.. Prevalence and correlates of mental disorders among adolescents in Italy: the PrISMA study. Eu- ropean Child and Adolescent Psychiatry, Springer Verlag (Germany), 2009, 18 (4), pp.217-226. 10.1007/s00787-008-0720-x. hal-00478074 HAL Id: hal-00478074 https://hal.archives-ouvertes.fr/hal-00478074 Submitted on 30 Apr 2010 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Eur Child Adolesc Psychiatry (2009) 18:217–226 DOI 10.1007/s00787-008-0720-x ORIGINAL CONTRIBUTION Alessandra Frigerio, PhD Prevalence and correlates of mental Paola Rucci Robert Goodman disorders among adolescents in Italy: Massimo Ammaniti Ombretta Carlet the PrISMA study Pina Cavolina Giovanni De Girolamo Carlo Lenti Loredana Lucarelli Elisa Mani Andrea Martinuzzi Nadia Micali Annarita Milone Pierluigi Morosini Filippo Muratori Franco Nardocci Valentina Pastore Gabriella Polidori Andrea Tullini Laura Vanzin Laura Villa Mauro Walder Alessandro Zuddas Massimo Molteni j Abstract Background While in (DAWBA), a structured interview Received: 14 December 2007 Accepted: 4 August 2008 the last 5 years several studies with verbatim reports reviewed by Published online: 22 January 2009 have been conducted in Italy on clinicians. Results The prevalence the prevalence of mental disorders of CBCL caseness and DSM-IV Dr. A. Frigerio, PhD (&) Æ E. Mani, MD in adults, to date no epidemiolog- disorders was 9.8% (CI 8.8–10.8%) V. Pastore, MSc Æ L. Vanzin, MSc ical study has been targeted on L. Villa, MD Æ M. Molteni, MD and 8.2% (CI 4.2–12.3%), respec- Scientific Institute ÔE. Medea’ mental disorders in adolescents. tively. DSM-IV Emotional dis- Via Don Luigi Monza, 20 Method A two-phase study was orders were more frequently 23842 Bosisio Parini (LC), Italy conducted on 3,418 participants observed (6.5% CI 2.2–10.8%) Tel.: +39-031/877111 using the child behavior checklist/ than externalizing disorders (1.2% Fax: +39-031/877499 E-Mail: [email protected] 6–18 (CBCL) and the development CI 0.2–2.3%). In girls, prevalence and well-being assessment estimates increased significantly P. Rucci, DStat with age; furthermore, living with DPNFB University of Pisa a single parent, low level of Pisa, Italy O. Carlet, MD Æ A. Martinuzzi, MD Scientific Institute ÔE. Medea’ P. Rucci, DStat Conegliano (TV), Italy Western Psychiatric Institute and Clinic University of Pittsburgh P. Cavolina, MSc Æ A. Zuddas, MD Pittsburgh (PA), USA Department of Neuroscience A. Milone, MD Æ F. Muratori, MD University of Cagliari Scientific Institute ÔStella Maris’ R. Goodman, MD Æ N. Micali, MD Cagliari, Italy Pisa, Italy King’s College Institute of Psychiatry G. De Girolamo, MD P. Morosini, MD Æ G. Polidori, MD London, UK Department of Mental Health National Institute of Health Azienda USL Rome, Italy M. Ammaniti, MD Æ L. Lucarelli, MSc Bologna, Italy Dipartimento di Psicologia Dinamica e F. Nardocci, MD Æ A. Tullini, MD Clinica C. Lenti, MD Æ M. Walder, MD Department of Mental Health ECAP 720 University La Sapienza University of Milan Azienda ASL Rome, Italy Milan, Italy Rimini, Italy 218 European Child & Adolescent Psychiatry (2009) Vol. 18, No. 4 Ó Steinkopff Verlag 2009 maternal education, and low fam- ical problems. Teachers and clini- j Key words mental disorders – ily income were associated with a cians should focus on boys and prevalence – adolescence – higher likelihood of suffering from girls living with a single parent Italy emotional or behavioral problems. and/or in disadvantaged socio- Conclusions Approximately one economic conditions. in ten adolescents has psycholog- Introduction The Italian preadolescent mental health project (PrISMA) [24] is a two-phase survey carried out in Italy to estimate the prevalence and correlates of Findings from the recent ESEMED-WMH Study suggest mental health problems in urban preadolescents. The that the prevalence of mental disorders is lower in Italy screening instrument is the child behavior checklist compared to other European countries [15]. This (CBCL) [2], a validated checklist filled out by parents, prompted the need to clarify whether the same pattern and the diagnostic instrument is the Ôdevelopment can be observed in the developmental age. Indeed, while and well-being assessment’ (DAWBA) [29], a semi- several studies have investigated the prevalence and structured interview that combines information from correlates of mental disorders in childhood and ado- parents and adolescents. lescence in North-America and in Europe [4, 12, 14, 17, 21, 44, 46], to date no epidemiological investigation of this type has been conducted in Italy. Method The importance of early detection of mental dis- orders in preadolescence and adolescence is widely The main features of the PrISMA study are summa- acknowledged, because these years are critical for the rized below. Full details concerning its research de- onset and development of later disturbances [8, 10, sign and methods are available elsewhere [24]. 32, 34]. Therefore, accurate estimates of the preva- lence of psychopathology for these age groups are essential for setting up adequate services, with the aim j Sample of diminishing the consequences of mental disorders on later development and functioning in adulthood. The study population consisted of Italian preadolescents, Moreover, valid and reliable screening and diagnostic aged 10–14 years, attending secondary school (6th–8th measures based ideally on multiple informants can grade) and living in seven urban areas, including two contribute to more precise prevalence estimates. metropolitan areas (the cities of Rome and Milan) and Individual and family characteristics may play a five small- to average-sized urban areas, which were se- significant role in the onset of psychopathology in this lected according to willingness to participate in the developmental age [22]. In fact, although mental dis- study. Participant selection was conducted through orders are more common in boys than in girls during schools, rather than by public register, due to the Italian childhood and preadolescence—especially in terms of personal data privacy law, which does not allow public externalizing behaviors [12]—a trend in the opposite registers to be viewed [26]. The PrISMA project was direction can be observed for adolescence, in that girls approved by the Italian Ministry of Health and by the show high rates of internalizing behaviors [27]. Diffi- ethics committee of each participating site. According to culties in school progression (defined by having re- Italian law (DL 30 July 1999, n. 281 and 282), informed peated a grade) have been found to be more strongly consent was not required because the primary aim of the associated with externalizing disorders than with study was to assess the health status of the population. internalizing disorders [6, 37, 45]. Moreover many Two–stage sampling was conducted separately at each studies have focused on the socioeconomic factor as a site by randomly selecting a sample of schools and then key correlate of psychopathology, but the relationship by obtaining a random sample of individuals at each between socioeconomic level (defined in different ways selected school. Secondary schools at each site were as socioeconomic status, parental education level, and sampled with stratification by funding source (public/ family income) and mental disorder is controversial. private) and mean family income of adolescents attend- Most studies have found that children with low socio- ing each school (banded into high, medium and low). A economic level are at increased risk of mental (espe- minimum of four schools were selected for each stratum, cially behavioral) disorders, but other researchers have to reflect the public/private ratio and the neighborhood not reached the same conclusion [12, 27, 35]. Lastly, the affluence of the different urban areas. Figure 1 illustrates variable of single-parent family has been found to be the subject flow in the two study phases. Of a total of 5,627 associated with externalizing disorders [36, 45]. students potentially eligible for the screening phase, A. Frigerio et al. 219 Prevalence and correlates of mental disorders among adolescents in Italy Fig. 1 Subject flowchart 5627 Subjects potentially eligible for screening phase 2190 drop-outs (38.9%): • 1,213 (55.4%) form not returned • 737 (33.7%) form not filled in • 43 (2%) form not delivered • 197 (9%) unknown 19 excluded: • 3 age out of range • 6 severe handicap • Percentage of drop-outs: 10 CBCL missing data 33.2% Lecco 22.8% Conegliano 3418 35.2% Rimini Subjects who completed the screening phase 27.8% Pisa 63.7% Cagliari 41.9% Milano 31.1% Roma STRATIFICATION 661 311 100% screen positive 10% random sample (90th percentile of CBCL Internalizing and of screen negative /or Externalizing scales) 451 180 participants in the diagnostic phase participants in the diagnostic phase Drop-outs = 341 (35.1%) 631 Percentage of drop-outs by site: Subjects who completed the diagnostic assessment 23.5% Lecco (SDQ, DAWBA, HoNOSCA, C-GAS) 10.2% Conegliano 15.8% Rimini 71.0% Pisa 45.5% Cagliari 51.3% Milano 31.0% Roma 2,190 (38.9%) did not participate. Non–participation for severe handicap and a further ten participants were rates varied by site (v2(6) = 350.3, P < 0.001), with excluded from the analyses, due to missing data on the increasing age (v2(3) = 84.4, P < 0.001), and were sig- child behavior checklist/6–18 (CBCL).
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