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Prevalence of Serious Emotional Disturbance Among U.S. Children: A Meta-Analysis.

OBJECTIVE
Prevalence estimates of child psychiatric disorders with severe impairment vary widely, and there is a critical need for precise estimates to inform clinical practice and policy in the United States. This study presents a systematic review and meta-analysis of population-based U.S. studies estimating the prevalence of youths with serious emotional disturbance (SED), as defined by the Substance Abuse and Mental Health Services Administration.


METHODS
Studies were identified through searches of the MEDLINE and PsycINFO databases and nine prior reviews. Two raters evaluated 423 full-text articles, and studies were included if they assessed psychopathology and functional impairment among community samples of youths (age ≤18) in the United States via structured interviews or standardized, nationally normed rating scales and if they reported point to 12-month prevalence estimates. Prevalence estimates of SED with domain-specific and global impairment were extracted, along with study characteristics and case definitions. Random-effects meta-analysis was used to calculate pooled prevalence estimates; metaregression analyses tested predictors of heterogeneity.


RESULTS
Twelve studies met inclusion criteria. The pooled prevalence of SED with domain-specific impairment was 10.06% (95% confidence interval [CI]=8.60%-11.51%, N=32,015); prevalence of SED with global impairment was 6.36% (CI=5.78%-6.93%, N=38,939). Prevalence estimates did not differ by study or sample characteristic, including representativeness of the sample (national versus regional), assessment method (taxonomic versus quantitative), or time frame (12 versus <12 months).


CONCLUSIONS
These estimates of SED are sufficiently precise to meaningfully guide clinical decision making, mental health policy, and consideration of child psychiatry workforce needs in the United States.