Twelve-month prevalence of DSM-5 mental disorders and the psychosocial correlates- a child and adolescent psychiatric epidemiologic survey in Hong Kong SAR

Abstract

Background

Childhood and adolescence, as critically important developmental stages, set the premise for the lifelong trajectory of health and well-being. Epidemiologic evidence abounds in purporting that half of all lifetime mental disorders begin in adolescence. Epidemiologic data based on structured clinical diagnostic assessments are disproportionately scarce in Asian countries that host fast-growing youth population along a wide socioeconomic spectrum in the course of globalisation.

Methods

A cross-sectional school-based epidemiologic survey was conducted on a representative random sample of children and adolescents aged 6–17 years from September 2019 to June 2023 in Hong Kong Special Administrative Region (Hong Kong SAR). The main diagnostic measures were 31 DSM-5 disorders assessed with Diagnostic Interview Schedule for Children, Version 5 (DISC-5) on the whole study sample. One parent/caregiver of each participant was interviewed for cases from primary schools. Separate parent/caregiver and student interviews were conducted for cases from secondary schools where research diagnoses derived from both sources in the adolescent/caregiver pair were combined at disorder level. A host of developmental and psychosocial factors were also collected. The study sample was reconstituted according to the discrepancy between the study population and official population data (census mid-year 2022 and Education Bureau) in terms of age, sex, ethnicity, household income and school type to give weight-adjusted prevalence estimation of various disorders.

Findings

The final weighted sample consisted of 6082 participants. The 12-month prevalence of having only one DSM-5 disorder was 13.5% (95% CI: 12.6–14.3%), while the 12-month prevalence of having two or more DSM-5 disorders was 11.0% (95% CI: 10.2–11.8%). The most prevalent disorders/categories of disorders were attention-deficit/hyperactivity disorder (ADHD) (10.2%, 95% CI: 9.4–11.0%); any disruptive, impulse control and conduct disorders (8.8%, CI:8.1–9.5%); any anxiety disorders (6.1%, 95% CI: 5.5–6.7%); any depressive disorders (5.4%, 95% CI: 4.8–6.0%). The 12-month prevalence rates of suicide ideation, plan, and attempt (not including the non-suicidal self-injury) were respectively 3.9% (95% CI: 3.4–4.4%), 1.9% (95% CI: 1.6–2.3%), 1.1% (95% CI: 0.8–1.3%). Parental anxiety and depressive symptoms, any clinically significant sleep disorder, and major school maladjustments (such as repeating a grade, school suspension, absenteeism) were significant factors associated positively (ORs: 1.1–3.37, p-values < 0.01–0.001) with ADHD, externalizing and internalizing disorders in multivariate logistic regressions that account for a multitude of developmental and environmental factors.

Interpretation

This study provides the first comprehensive mental health survey on children and adolescents that might inform other high-income regions in Asia and other robustly thriving economies in the coming decades. The common mental health problems present unmet needs in the school community and yet the related factors are accessible and potentially modifiable. Sustainable mental health initiatives should prioritise an integrated approach to the well-being of parent-child dyad, early detection and intervention targeting sleep disorders, and build a holistic learning support environment in school communities.

Funding

Health and Medical Research Fund, Health Bureau, Hong Kong Special Administrative Region (MHS-P1(Part 1)-CUHK).