Change in the severity and impact of child psychiatric disorders over 3 years: an analysis of trends using the national child mental health surveys of England from 1999, 2004, and 2017

Abstract

Background Child and adolescent psychiatric disorders are common, now affecting at least one in eight children. Evidence points towards an increase in prevalence over time, but very few studies have tested whether longitudinal outcomes for children with mental health problems have changed. This study is the first to test whether mental health and functional outcomes for children with a diagnosed psychiatric disorder have improved or worsened across time in England. Methods Three national probability surveys were undertaken in England in 1999, 2004, and 2017, each with respective 3‐year follow‐ups in 2002, 2007, and 2020. We include children at baseline aged 5–13 years and compare outcomes for those with baseline psychiatric diagnosis (mental health disorder or ADHD). Three‐year mental health symptom severity and functional impairment were assessed using the parent‐ and self‐rated total difficulties score and impact supplement from the Strengths and Difficulties Questionnaire. Results Across all surveys, having a psychiatric disorder at baseline predicted greater difficulty and impact scores at follow‐up. The magnitude of these associations increased sequentially over time, such that having a disorder at baseline was more strongly associated with parent‐ and self‐rated difficulties in the 2017 survey compared with the 1999 and 2004 surveys. Children in the 2017 survey were also more likely to report a greater impact of problems. Patterns of individual change also showed a temporal gradient. For children with a psychiatric disorder in 1999, 34% experienced deterioration in mental health at the three‐year follow‐up, compared to 52% of those with a disorder in 2017. The proportion of those who improved decreased correspondingly. Conclusions Children with a psychiatric condition are experiencing increased difficulties in their daily lives compared to previous generations. Understanding why children are now more likely to experience impaired functioning is a major public concern.