Commentary: Physical health outcomes and health care have improved so much, so why is child mental health getting worse? Or is it? A commentary on Collishaw (2015)

The frequency of problems in children and adolescents varies between times within populations in the same geographical area. It has often been suggested that problems in children and adolescents have increased and that present-day youth fare less well than youth in the past. These concerns are fed by the assumed negative impact of societal change on individual development. It has been 20years since (Rutter and Smith, 1995. Psychosocial disorders in young people: Time trends and their causes. Chicester: Wiley) published their findings on child and adolescent problem behaviors that occur at different points in time in western societies in the latter part of the 20th century. They concluded that, despite a lack of rigorous epidemiological data, there was some evidence for a secular increase in adolescents' conduct problems, substance abuse, depression and suicide. Fergusson argued that factors implied by Rutter and Smith as risks for adjustment problems, such as changes in social, economic, educational, family and other structures associated with child rearing and child development, may equally well lead to positive developments. He argued that increasing social diversity may lead to increasing variability in adolescent adjustment patterns with on the one end increasing numbers of young people showing psychopathology (as was shown by Rutter and Smith) and on the other end increasing numbers of young people who show responsible prosocial behaviors. However, there were no data available to test the possibility that social change has had both positive and detrimental effects for adolescents. Rutter and Smith's review also made clear that there were numerous methodological obstacles hampering firm conclusions about secular changes in rates of disorder that may well reflect changes in diagnostic criteria, use of mental health services, or record keeping such as police or suicide records. Twenty years ago, few epidemiological comparisons were available in which changes in problems in representative samples of children and adolescents from western societies at different points in time were assessed with similar standardized procedures. This situation has changed drastically over the last couple of years. In the current Annual Research Review, Collishaw gives an impressively thorough overview of studies published over the last two decades on secular trends in child and adolescent mental health with an emphasis on studies that compare rates of child and adolescent problems over time in one geographically defined population. The review also raises a number of issues related to existing time-trend research worth mentioning... Read the full article at doi: