Work and Dignity   /   Fall 2012   /    Interviews

An Interview with Julie Magno Zito

Sandra Zito

Your research indicates that there has been a dramatic increase in the diagnosis and medi- cating of  youth for so-called emotional and behavioral problems over the past twenty years. Are a lot more children mentally ill today than in the past?


Based on numerous population surveys compar- ing the prevalence of mental disorders from the early 1990s to 2004–7, there is no evidence of an increase in these illnesses. But there have been substantial increases in physician reports of such diagnoses in youth. for a concrete example, take the estimates of physician-reported diagnoses of Pediatric Bipolar Disorder (PBD). These far exceed the expected (research-based) prevalence of the disorder. One study of community practic- es showed a forty-fold increase over just ten years, from 1994 to 2003. Such a large increase in so few years raises skepticism as to whether the prev- alence of this serious disorder is truly increasing.

This difference in research prevalence estimates and diagnostic rates from community-based clinical practice (treated prevalence) is important and reinforces the fact that research and practice stan- dards are not equivalent. Research on the preva- lence of a psychiatric condition has assessment standards of high internal validity in well-defined but limited samples. In contrast, physician diagnoses represent decisions in the practice setting about each individual who comes to treatment. That’s a much wider population. Thus, physicians in the community typically assess individ- uals who are likely to differ from volunteers in clinical trials in many ways: these patients have different symptom and functioning patterns, and different social determinants of health.

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