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. 2004 Jul-Aug;119(4):409–417. doi: 10.1016/j.phr.2004.05.005

Mental health disorders among individuals with mental retardation: challenges to accurate prevalence estimates.

Bonnie D Kerker 1, Pamela L Owens 1, Edward Zigler 1, Sarah M Horwitz 1
PMCID: PMC1497647  PMID: 15219798

Abstract

OBJECTIVES: The objectives of this literature review were to assess current challenges to estimating the prevalence of mental health disorders among individuals with mental retardation (MR) and to develop recommendations to improve such estimates for this population. METHODS: The authors identified 200 peer-reviewed articles, book chapters, government documents, or reports from national and international organizations on the mental health status of people with MR. Based on the study's inclusion criteria, 52 articles were included in the review. RESULTS: Available data reveal inconsistent estimates of the prevalence of mental health disorders among those with MR, but suggest that some mental health conditions are more common among these individuals than in the general population. Two main challenges to identifying accurate prevalence estimates were found: (1) health care providers have difficulty diagnosing mental health conditions among individuals with MR; and (2) methodological limitations of previous research inhibit confidence in study results. CONCLUSIONS: Accurate prevalence estimates are necessary to ensure the availability of appropriate treatment services. To this end, health care providers should receive more training regarding the mental health treatment of individuals with MR. Further, government officials should discuss mechanisms of collecting nationally representative data, and the research community should utilize consistent methods with representative samples when studying mental health conditions in this population.

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Selected References

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  1. Anderson L. L., Lakin K. C., Mangan T. W., Prouty R. W. State institutions: thirty years of depopulation and closure. Ment Retard. 1998 Dec;36(6):431–443. doi: 10.1352/0047-6765(1998)036<0431:SITYOD>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  2. Bergeron L., Valla J. P., Breton J. J. Pilot study for the Quebec Child Mental Health survey: Part I. Measurement of prevalence estimates among six to 14 year olds. Can J Psychiatry. 1992 Aug;37(6):374–380. doi: 10.1177/070674379203700605. [DOI] [PubMed] [Google Scholar]
  3. Borthwick-Duffy S. A. Epidemiology and prevalence of psychopathology in people with mental retardation. J Consult Clin Psychol. 1994 Feb;62(1):17–27. doi: 10.1037//0022-006x.62.1.17. [DOI] [PubMed] [Google Scholar]
  4. Borthwick-Duffy S. A., Eyman R. K. Who are the dually diagnosed? Am J Ment Retard. 1990 May;94(6):586–595. [PubMed] [Google Scholar]
  5. Brown R. T., Freeman W. S., Perrin J. M., Stein M. T., Amler R. W., Feldman H. M., Pierce K., Wolraich M. L. Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics. 2001 Mar;107(3):E43–E43. doi: 10.1542/peds.107.3.e43. [DOI] [PubMed] [Google Scholar]
  6. Clarke A. D. A brief history of the International Association for the Scientific Study of Mental Deficiency (IASSMD) J Ment Defic Res. 1991 Feb;35(Pt 1):1–12. doi: 10.1111/j.1365-2788.1991.tb01026.x. [DOI] [PubMed] [Google Scholar]
  7. Crews W. D., Jr, Bonaventura S., Rowe F. Dual diagnosis: prevalence of psychiatric disorders in a large state residential facility for individuals with mental retardation. Am J Ment Retard. 1994 May;98(6):724–731. [PubMed] [Google Scholar]
  8. Day K. A. Mental health services for people with mental retardation: a framework for the future. J Intellect Disabil Res. 1993 Oct;37 (Suppl 1):7–16. doi: 10.1111/j.1365-2788.1993.tb00888.x. [DOI] [PubMed] [Google Scholar]
  9. Dekker Marielle C., Koot Hans M. DSM-IV disorders in children with borderline to moderate intellectual disability. I: prevalence and impact. J Am Acad Child Adolesc Psychiatry. 2003 Aug;42(8):915–922. doi: 10.1097/01.CHI.0000046892.27264.1A. [DOI] [PubMed] [Google Scholar]
  10. Eaton L. F., Menolascino F. J. Psychiatric disorders in the mentally retarded: types, problems, and challenges. Am J Psychiatry. 1982 Oct;139(10):1297–1303. doi: 10.1176/ajp.139.10.1297. [DOI] [PubMed] [Google Scholar]
  11. Edgerton R. B. Alcohol and drug use by mentally retarded adults. Am J Ment Defic. 1986 May;90(6):602–609. [PubMed] [Google Scholar]
  12. Embregts P. J. Reliability of the Child Behavior Checklist for the assessment of behavioral problems of children and youth with mild mental retardation. Res Dev Disabil. 2000 Jan-Feb;21(1):31–41. doi: 10.1016/s0891-4222(99)00028-1. [DOI] [PubMed] [Google Scholar]
  13. Gabriel S. R. The developmentally disabled, psychiatrically impaired client. Proper treatment of dual diagnosis. J Psychosoc Nurs Ment Health Serv. 1994 Sep;32(9):35–39. doi: 10.3928/0279-3695-19940901-12. [DOI] [PubMed] [Google Scholar]
  14. Gillberg C., Persson E., Grufman M., Themner U. Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: epidemiological aspects. Br J Psychiatry. 1986 Jul;149:68–74. doi: 10.1192/bjp.149.1.68. [DOI] [PubMed] [Google Scholar]
  15. Glick M., Zigler E. Developmental differences in the symptomatology of psychiatric inpatients with and without mild mental retardation. Am J Ment Retard. 1995 Jan;99(4):407–417. [PubMed] [Google Scholar]
  16. Holbrook S. M. Psychopathology and behavioral problems in mental retardation. J Psychosoc Nurs Ment Health Serv. 2000 Mar;38(3):23–26. doi: 10.3928/0279-3695-20000301-11. [DOI] [PubMed] [Google Scholar]
  17. Ineichen B. Prevalence of mental illness among mentally handicapped people: discussion paper. J R Soc Med. 1984 Sep;77(9):761–765. doi: 10.1177/014107688407700911. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Iverson J. C., Fox R. A. Prevalence of psychopathology among mentally retarded adults. Res Dev Disabil. 1989;10(1):77–83. doi: 10.1016/0891-4222(89)90030-9. [DOI] [PubMed] [Google Scholar]
  19. Jacobson J. W. Problem behavior and psychiatric impairment within a developmentally disabled population I: behavior frequency. Appl Res Ment Retard. 1982;3(2):121–139. doi: 10.1016/0270-3092(82)90002-9. [DOI] [PubMed] [Google Scholar]
  20. King B. H., State M. W., Shah B., Davanzo P., Dykens E. Mental retardation: a review of the past 10 years. Part I. J Am Acad Child Adolesc Psychiatry. 1997 Dec;36(12):1656–1663. doi: 10.1097/00004583-199712000-00013. [DOI] [PubMed] [Google Scholar]
  21. Lennox N. G., Diggens J. N., Ugoni A. M. The general practice care of people with intellectual disability: barriers and solutions. J Intellect Disabil Res. 1997 Oct;41(Pt 5):380–390. doi: 10.1111/j.1365-2788.1997.tb00725.x. [DOI] [PubMed] [Google Scholar]
  22. Lennox N., Chaplin R. The psychiatric care of people with intellectual disabilities: the perceptions of consultant psychiatrists in Victoria. Aust N Z J Psychiatry. 1996 Dec;30(6):774–780. doi: 10.3109/00048679609065044. [DOI] [PubMed] [Google Scholar]
  23. Loeber R., Burke J. D., Lahey B. B., Winters A., Zera M. Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry. 2000 Dec;39(12):1468–1484. doi: 10.1097/00004583-200012000-00007. [DOI] [PubMed] [Google Scholar]
  24. McAlister F. A., Clark H. D., van Walraven C., Straus S. E., Lawson F. M., Moher D., Mulrow C. D. The medical review article revisited: has the science improved? Ann Intern Med. 1999 Dec 21;131(12):947–951. doi: 10.7326/0003-4819-131-12-199912210-00007. [DOI] [PubMed] [Google Scholar]
  25. Menolascino F. J., Gilson S. F., Levitas A. S. Issues in the treatment of mentally retarded patients in the community mental health system. Community Ment Health J. 1986 Winter;22(4):314–327. doi: 10.1007/BF00754386. [DOI] [PubMed] [Google Scholar]
  26. Moss S., Bouras N., Holt G. Mental health services for people with intellectual disability: a conceptual framework. J Intellect Disabil Res. 2000 Apr;44(Pt 2):97–107. doi: 10.1046/j.1365-2788.2000.00283.x. [DOI] [PubMed] [Google Scholar]
  27. Moss S., Emerson E., Bouras N., Holland A. Mental disorders and problematic behaviours in people with intellectual disability: future directions for research. J Intellect Disabil Res. 1997 Dec;41(Pt 6):440–447. doi: 10.1111/j.1365-2788.1997.tb00735.x. [DOI] [PubMed] [Google Scholar]
  28. Parmenter T. R. Intellectual disabilities and the next millennium: the role of the International Association for the Scientific Study of Intellectual Disabilities (IASSID) J Intellect Disabil Res. 1999 Jun;43(Pt 3):145–148. doi: 10.1046/j.1365-2788.1999.00205.x. [DOI] [PubMed] [Google Scholar]
  29. Prosser H., Moss S., Costello H., Simpson N., Patel P., Rowe S. Reliability and validity of the Mini PAS-ADD for assessing psychiatric disorders in adults with intellectual disability. J Intellect Disabil Res. 1998 Aug;42(Pt 4):264–272. doi: 10.1046/j.1365-2788.1998.00146.x. [DOI] [PubMed] [Google Scholar]
  30. Reid A. H. Psychiatric disorders in mentally handicapped children: a clinical and follow-up study. J Ment Defic Res. 1980 Dec;24(Pt 4):287–298. doi: 10.1111/j.1365-2788.1980.tb00082.x. [DOI] [PubMed] [Google Scholar]
  31. Reiss S., Benson B. A. Awareness of negative social conditions among mentally retarded, emotionally disturbed outpatients. Am J Psychiatry. 1984 Jan;141(1):88–90. doi: 10.1176/ajp.141.1.88. [DOI] [PubMed] [Google Scholar]
  32. Reiss S., Levitan G. W., Szyszko J. Emotional disturbance and mental retardation: diagnostic overshadowing. Am J Ment Defic. 1982 May;86(6):567–574. [PubMed] [Google Scholar]
  33. Reiss S. Prevalence of dual diagnosis in community-based day programs in the Chicago metropolitan area. Am J Ment Retard. 1990 May;94(6):578–585. [PubMed] [Google Scholar]
  34. Reiss S. Psychopathology and mental retardation: survey of a developmental disabilities mental health program. Ment Retard. 1982 Jun;20(3):128–132. [PubMed] [Google Scholar]
  35. Reiss S., Valenti-Hein D. Development of a psychopathology rating scale for children with mental retardation. J Consult Clin Psychol. 1994 Feb;62(1):28–33. doi: 10.1037//0022-006x.62.1.28. [DOI] [PubMed] [Google Scholar]
  36. Siperstein G. N., Leffert J. S., Wenz-Gross M. The quality of friendships between children with and without learning problems. Am J Ment Retard. 1997 Sep;102(2):111–125. doi: 10.1352/0895-8017(1997)102<0111:TQOFBC>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  37. Sovner R. Limiting factors in the use of DSM-III criteria with mentally ill/mentally retarded persons. Psychopharmacol Bull. 1986;22(4):1055–1059. [PubMed] [Google Scholar]
  38. Taylor A. R., Asher S. R., Williams G. A. The social adaptation of mainstreamed mildly retarded children. Child Dev. 1987 Oct;58(5):1321–1334. doi: 10.1111/j.1467-8624.1987.tb01461.x. [DOI] [PubMed] [Google Scholar]
  39. Tuinier S., Verhoeven W. M. Psychiatry and mental retardation: towards a behavioural pharmacological concept. J Intellect Disabil Res. 1993 Oct;37 (Suppl 1):16–25. doi: 10.1111/j.1365-2788.1993.tb00889.x. [DOI] [PubMed] [Google Scholar]
  40. Zigler E., Burack J. A. Personality development and the dually diagnosed person. Res Dev Disabil. 1989;10(3):225–240. doi: 10.1016/0891-4222(89)90012-7. [DOI] [PubMed] [Google Scholar]

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