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We present prevalence data for adolescents in a large metropolitan area in the US and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates. We sampled 4175 youths aged 11-17 years from households enrolled in large health maintenance organizations. Data were collected using questionnaires and the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Impairment was measured using the Child Global Assessment Scale and diagnostic specific impairment in the DISC-IV. 17.1% of the sample met DSM-IV criteria for one or more disorders in the past year; 11% when only DISC impairment was considered and 5.3% only using the CGAS. The most prevalent disorders were anxiety (6.9%), disruptive (6.5%), and substance use (5.3%) disorders. The most prevalent specific disorders were agoraphobia, conduct and marijuana abuse/dependence, then alcohol use and oppositional defiant disorder. Younger youths and females had lower odds for any disorder, as did youths from two parent homes. There was increased odds associated with lower family income. Females had greater odds of mood and anxiety disorders, males of disruptive and substance use disorders. There were greater odds of mood and disruptive disorders for older youths. Prevalences were highly comparable to recent studies using similar methods in diverse non-metropolitan populations. We found associations with age, gender, and to a lesser extent, socioeconomic status reported in previous studies. The inclusion of both diagnosis-specific impairment and global impairment reduced prevalence rates significantly. Our results suggest commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.

Objective: To examine the impact of insomnia among adolescents on somatic, interpersonal, and psychological functioning using data from a two-wave, prospective study., Methods: Subjects were adolescents 11-17 years of age sampled from managed care enrollment rosters in the United States. The baseline sample was 4175 and the follow-up sample a year later was 3136. Data were collected using computer-assisted personal interviews and self-administered questionnaires. Insomnia was measured using DSM-IV symptom criteria, scored as a summated scale and as separate symptoms. Indicators of somatic functioning were perceived health, limitations due to health problems, and impact of illness on family activities. Indicators of interpersonal functioning were social support, relations with parents, relations with peers and relations at school. Indicators of psychological functioning were self-esteem, perceived mental health, life satisfaction, and depression., Results: Symptoms of insomnia were common, with 17% reporting nonrestorative sleep, 6% difficulty initiating sleep, 7% daytime fatigue, and 5% daytime sleepiness almost every day. Without adjustment for insomnia at follow-up, the odds of dysfunction at follow-up for those with insomnia averaged 2.5 across 11 indicators of functioning. For 9 of 11 indicators, there was a clear dose-response relation such that moderate levels of insomnia increased risk and this risk increased with greater insomnia. Adjusting for insomnia at follow-up eliminated the association with somatic functioning and attenuated associations with interpersonal and psychological functioning., Discussion: These prospective data provide additional evidence that insomnia can have adverse consequences for the functioning of adolescents. Given the growing evidence for a relation between disturbed sleep and impaired adolescent functioning, more attention needs to be directed to identifying causal pathways and possible strategies for intervention.