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Influences of Age, Sex, and Impairment on Rates of Disorder

Emily Simonoff, MD; Andrew Pickles, PhD; Joanne M. Meyer, PhD; Judy L. Silberg, PhD; Hermine H. Maes, PhD; Rolf Loeber, PhD; Michael Rutter, MD, FRS; John K. Hewitt, PhD; Lindon J. Eaves, Dsc

Arch Gen Psychiatry. 1997;54(9):801-808.

Abstract
Background
The Virginia Twin Study of Adolescent Behavioral Development is a cohort-longitudinal epidemiological study that uses the genetic twin design to study the development and maintenance of child psychiatric disorders. We determined the rates of DSM-III-R disorders, disorders with impairment, and age, sex, and co-morbidity effects.

Methods
Families of 2762 white twins aged 8 to 16 years participated. Twins and their parents were asked systematically about risk factors and current psychiatric symptoms by means of investigator-based psychiatric interviews and questionnaires. The DSM-III-R diagnoses were made for major depressive disorder, separation anxiety, overanxious disorder, simple phobia, social phobia, agoraphobia, oppositional defiant disorder, conduct disorder, and attention deficit hyperactivity disorder.

Results
The 3-month point prevalence for any DSM-III-R disorders was 413 per 1000, and that for disorders with associated impairment was 142 per 1000. Emotionnal disorders with impairment occurred in 89 per 1000, with girls being more commonly affected; behavioral disorders had a prevalence of 71 per 1000, with boys being more frequently affected. The proportion with disorder who also had functional impairment varied across disorders; anxiety and phobic disorders were particularly likely not to be accompanied by impairment. Rates of emotional and behavioral disorders increased over the age range. There was extensive comorbidity among disorders.

Conclusions
The prevalence rates and patterns of findings from this study of twins are consistent with those of other epidemiological studies, supporting previous findings of few differences in rates of psychiatric disorder between twins and singletons. The importance of including measures of functional impairment is evident by its effect on rates of disorder and patterns of comorbidity.

Author Affiliations
From the Medical Research Council Child Psychiatry Unit and the Social, Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry, London, England (Drs Simonoff, Pickles, and Rutter); Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond (Drs Meyer, Silberg, Maes, and Eaves); Western Psychiatric Institute, Pittsburgh, Pa (Dr Loeber); and Institute of Behavioral Genetics, University of Colorado, Boulder (Dr Hewitt).

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