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Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance

School of Epidemiology and Health Science, University of Manchester, Manchester, UK

RICHARD ROWE, PhD, MRC

Child Psychiatry Unit, and Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College, London, UK

EMILY SIMONOFF, MD

Department of Child and Adolescent Psychiatry, Guy's, King's and St Thomas' Medical School, London, UK

DEBRA FOLEY, PhD

Royal Children's Hospital Melbourne, Victoria, Australia

MICHAEL RUTTER, MD

Social, Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College, London, UK

JUDY SILBERG, PhD

Virginia Commonwealth University, Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Richmond, Virginia, USA

Correspondence: Professor Andrew Pickles, School of Epidemiology and Health Science, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK. E-mail: andrew.pickles{at}man.ac.uk

Declaration of interest None.

See editorial, pp. 189–190, this issue.

ABSTRACT

Background Relatively little is known about the relationships between psychiatric symptoms, diagnosis and psychosocial impairment.

Aims To examine these contemporaneous relationships and prognostic significance in a large general population sample.

Method Symptoms of major depression, conduct and oppositional defiant disorders were assessed by interview in two waves of the Virginia Twin Study of Adolescent behavioural Development (2800 children aged 8-16 years).

Results Many children below the DSM-III-R diagnostic threshold, especially for depression, had symptom-related impairment, whereas many children reaching the symptom threshold for conduct and oppositional defiant disorders were little impaired. Impairment score was linearly related to symptom count, with no evidence of any additional impairment at the diagnostic threshold. For depression, only symptoms predicted later symptoms and diagnosis. For conduct and oppositional defiant disorders, impairment was additionally predictive of later symptoms and diagnosis.

Conclusions Impairment, in addition to symptoms, is important for both nosology and prognosis.

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