Prevalence of childhood mental disorders in high-income countries: a systematic review and meta-analysis to inform policymaking

Abstract

Question: Mental disorders typically start in childhood and persist, causing high individual and collective burdens. To inform policymaking to address children's mental health in high-income countries we aimed to identify updated data on disorder prevalence.

Methods: We identified epidemiological studies reporting mental disorder prevalence in representative samples of children aged 18 years or younger-including a range of disorders and ages and assessing impairment (searching January 1990 through February 2021). We extracted associated service-use data where studies assessed this. We conducted meta-analyses using a random effects logistic model (using R metafor package).

Findings: Fourteen studies in 11 countries met inclusion criteria, published from 2003 to 2020 with a pooled sample of 61 545 children aged 4-18 years, including eight reporting service use. (All data were collected pre-COVID-19.) Overall prevalence of any childhood mental disorder was 12.7% (95% CI 10.1% to 15.9%; I²=99.1%). Significant heterogeneity pertained to diagnostic measurement and study location. Anxiety (5.2%), attention-deficit/hyperactivity (3.7%), oppositional defiant (3.3%), substance use (2.3%), conduct (1.3%) and depressive (1.3%) disorders were the most common. Among children with mental disorders, only 44.2% (95% CI 37.6% to 50.9%) received any services for these conditions.

Conclusions: An estimated one in eight children have mental disorders at any given time, causing symptoms and impairment, therefore requiring treatment. Yet even in high-income countries, most children with mental disorders are not receiving services for these conditions. We discuss the implications, particularly the need to substantially increase public investments in effective interventions. We also discuss the policy urgency, given the emerging increases in childhood mental health problems since the onset of the COVID-19 pandemic (PROSPERO CRD42020157262).

Keywords: child & adolescent psychiatry.

Figure 1

Search process. DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD, International Classification of Diseases.

Figure 2

Forest plot for overall prevalence of any childhood mental disorder. Georgiades 2019^s8 reported 18.2% of 4- to 11-year-olds (parent report) and 21.8% of 12- to 17-year-olds (child report) with any mental disorders. Vicente 2012^s15 reported 27.8% of 4- to 11-year-olds (parent report) and 16.5% of 12- to 18-year-olds (child report) with any mental disorders. We report the weighted averages for these two studies in our meta-analysis.

Figure 3

Forest plot for prevalence of service use. Service use data for Costello 2003,^s4 Farbstein 2010,^s6 Kessler 2012^s10 and Lawrence 2016^s11 were obtained from the separate articles by Burns 1995, Mansbach-Kleinfeld 2010, Costello 2014 and Johnson 2016, respectively. Costello 2003^s4 and Merikangas et al 2010^s13 reported that 40.3% and 50.6%, respectively, of children with mental disorders received any services for their mental health problems; we report slight variations in our meta-analysis due to rounding. Georgiades 2019^s8 reported that 61.5% of 4- to 11-year-olds (parent report) and 43.7% of 12- to 17-year-olds (child report) with mental disorders received any services for their mental health problems; we report the weighted average in our meta-analysis.