December 1996

The Great Smoky Mountains Study of YouthGoals, Design, Methods, and the Prevalence of DSM-III-R Disorders

Author Affiliations

From the Developmental Epidemiology Program, Duke University Medical Center, Durham, NC (Drs Costello, Angold, Burns, Stangl, Tweed, and Erkanli); and the Department of Anthropology, Emory University, Atlanta, Ga (Dr Worthman).

Arch Gen Psychiatry. 1996;53(12):1129-1136. doi:10.1001/archpsyc.1996.01830120067012

Background:  The Great Smoky Mountains Study of youth focuses on the relationship between the development of psychiatric disorder and the need for and use of mental health services.

Methods:  A multistage, overlapping cohorts design was used, in which 4500 of the 11 758 children aged 9, 11, and 13 years in an 11-country area of the southeastern United States were randomly selected for screening for psychiatric symptoms. Children who scored in the top 25% on the screening questionnaire, together with a 1 in 10 random sample of the rest, were recruited for 4 waves of intensive, annual interviews (n=1015 at wave 1). In a parallel study, all American Indian children aged 9, 11, and 13 years were recruited (N=323 at wave 1).

Results:  The 3-month prevalence (±SE) of any DSMIII-R axis I disorder in the main sample, weighted to reflect population prevalence rates, was 20.3%±1.7%. The most common diagnoses were anxiety disorders (5.7%±1.0%), enuresis (5.1%±1.0%), tic disorders (4.2%±0.9%), conduct disorder (3.3%±0.6%), oppositional defiant disorder (2.7%±0.4%), and hyperactivity (1.9%±0.4%).

Conclusions:  The prevalence of psychiatric disorder in this rural sample was similar to rates reported in other recent studies. Poverty was the strongest demographic correlate of diagnosis, in both urban and rural children.