High risk cohort study for psychiatric disorders in childhood: rationale, design, methods and preliminary results

Abstract

The objective of this study is to present the rationale, methods, design and preliminary results from the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders. We describe the sample selection and the components of each phases of the study, its instruments, tasks and procedures. Preliminary results are limited to the baseline phase and encompass: (i) the efficacy of the oversampling procedure used to increase the frequency of both child and family psychopathology; (ii) interrater reliability and (iii) the role of differential participation rate. A total of 9937 children from 57 schools participated in the screening procedures. From those 2512 (random = 958; high risk = 1554) were further evaluated with diagnostic instruments. The prevalence of any child mental disorder in the random strata and high-risk strata was 19.9% and 29.7%. The oversampling procedure was successful in selecting a sample with higher family rates of any mental disorders according to diagnostic instruments. Interrater reliability (kappa) for the main diagnostic instrument range from 0.72 (hyperkinetic disorders) to 0.84 (emotional disorders). The screening instrument was successful in selecting a sub-sample with "high risk" for developing mental disorders. This study may help advance the field of child psychiatry and ultimately provide useful clinical information.

Obsessive–compulsive symptoms are associated with psychiatric comorbidities, behavioral and clinical problems: a population-based study of Brazilian school children

“…This study examined data from the cross-sectional phase of a large community school-based cohort from the National Institute of Developmental Psychiatry (INPD) in Brazil http://www.inpd.org [24]. A total of 57 public schools from two large Brazilian cities (22 in Porto Alegre and 35 in São Paulo) were included and 12,500 families were approached.…”

Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias

“…6 Further details are available elsewhere. 6 Briefly, after a screening phase, 2,512 subjects were selected for further assessment by a simple randomization procedure that selects a high risk sample (n=1,554), using a risk prioritization procedure that consists of selecting individuals with high family loading of symptoms and ongoing psychiatric symptoms, as well as a random-selection subgroup (n=958). The study was previously approved by the Ethics Committee at Universidade de São Paulo, and written informed consent was obtained from the parents of all participants.…”

“…26 The DAWBA is reliable and well suited for epidemiological research. The Brazilian Portuguese version shows appropriate psychometric proprieties and high interrater reliability, 6 as well as good reliability for diagnosis of emotional disorders (kappa = 0.84). 6 …”

“…1,5 The prevalence of specific and social phobia in children and adolescents is 2.9 and 0.3% respectively. 6 In short, the presence of fears is typically normative, and only a minority of children is significantly impaired by fears requiring clinical attention.…”

The future of psychiatric research

“…That is why emphasis on these studies is growing both globally, 29 and in Brazilian research too. 30 It will also be important to maintain a translational focus, in order to both prioritize research that can eventually impact the health of individuals and populations and also to accelerate the process of translation of the findings of research to patient care. In view of the limitations of our diagnostic systems, I also believe that it will be necessary to carry out research that is not based on current diagnostic categories.…”