Young people with early-onset mental illnesses-such as depression, anxiety disorders, and conduct disorders-are more likely to have children in their teenage years, according to a new study by a team of researchers at Harvard Medical School and other institutions. The rise in teenage parenthood, which occurs in both males and females, appears to be due to greater sexual activity and not a decrease in contraception. The findings are reported in the October issue of the American Journal of Psychiatry.
As policymakers debate the costs and benefits of our health care system, the findings suggest that a move to expand mental health coverage may be an economical step to take.
"For many of these psychiatric disorders, society pays a cost-all of us pay everyday when we get a percentage of our income taken out for taxes," says Ronald C. Kessler, professor of health care policy and lead author of the study. "It turns out the profile of consequences of psychiatric disorders-dropping out of school, having a baby early, not being married, not having good educational skills-is the profile of being a welfare mother."
Kessler estimates that people on welfare have a very high incidence of psychiatric disease. He and his colleagues are currently looking at whether these people have a harder time getting off welfare than those without psychiatric disorders. "The common suggestion nowadays is to get these people to finish high school. But finishing is going to be difficult if they have depression or a drug problem," Kessler says. In a previous study, the researchers showed that people with early onset psychiatric disorders are significantly less likely than unaffected youths to finish high school and college.
The new findings grow out of data from the National Comorbidity Survey, which Kessler began in 1990 to investigate the interaction between drug and alcohol use and early-onset mental illness. To assess the causes and consequences of psychiatric comorbidity, he and his colleagues conducted face- to-face interviews with 8,098 people between the ages of 15 and 54. Respondents were asked questions to assess whether they had ever suffered from anxiety, mood, conduct, or substance use disorders.
A subsample of 5,877 respondents-including all those who screened positive for lifetime psychiatric disease, all others in the age range 15 to 24, and a random subsample of other respondents-were then asked a second set of questions to assess risk factors and social consequences of psychiatric disorders. Included were questions about parents' drug use, violence, mental illness, marital history, childbearing, and education and about their own educational attainment, marital status, parenting, employment, and income.
Those with early-onset psychiatric disorders had a significantly higher chance of having a child before the age of 19 than the general population. "We also found young people in the sample were more likely to report they were sexually active if they had emotional problems. They were not less likely to use contraception," says Kessler.
It is not clear why teens with psychiatric disorders are more likely to engage in sexual activity. "We don't really have any data on that," Kessler says, though he and his coauthors suggest that it might be due to the acting out and lack of inhibition associated with conduct disorders and substance use. In those suffering from affective disorders, it could be a product of low self- esteem - "needing to be needed, having a hard time saying no," says Kessler.
He believes teens suffering from affective disorders are at greater risk of chronic psychiatric illness than those with conduct disorders, such as juvenile delinquents. "For juvenile delinquents, it's often a phase of life-they grow ponytails, do drugs. Then miraculously something happens-they graduate, get mortgages. They grow out of it somehow. But the ones who are using drugs because every time they get sad they have to take a drink, will have that problem for the rest of their life," says Kessler.
Funding for outreach programs to children and teens with affective disorders could help reduce the adverse social consequences of psychiatric disorders, he says. Such programs could also help in the war on drugs. "It's clear a substantial part of the drug problem, and the more severe and prolonged drug problem, is in people starting out with emotional problems. And the drinking and drug problems are just a kind of manifestation of that," says Kessler.
He and his colleagues have embarked on a pilot study with funding from the MacArthur Foundation to do school-based screening and interventions with young people at risk for affective and anxiety disorders. Kessler has a hunch that such programs may be more successful than the many that already exist for juvenile delinquents. "Delinquents don't want to hear they have a problem because they're too busy having fun. The anxious, depressed kids are not having fun," he says.
Funding for this study came from the National Institute of Mental Health and the National Institute of Drug Abuse.