Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-24T19:50:04.711Z Has data issue: false hasContentIssue false
  • English
  • Français

Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles

Published online by Cambridge University Press:  13 December 2011

G. de Girolamo ,
J. Dagani ,
R. Purcell ,
A. Cocchi  and
P. D. McGorry
G. de Girolamo*
Affiliation:
IRCCS Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy
J. Dagani
Affiliation:
IRCCS Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy
R. Purcell
Affiliation:
Department of Psychiatry, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
A. Cocchi
Affiliation:
A.O. Ospedale Niguarda Ca' Granda, Programma 2000, Via Livigno, 3, 20128 Milan, Italy
P. D. McGorry
Affiliation:
Department of Psychiatry, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia
*
*Address for correspondence: Giovanni de Girolamo, M.D., IRCCS Fatebenefratelli, Via Pilastroni 4, Brescia, Italy. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose of review.

In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention.

Recent findings.

The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes.

Summary.

Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.

Keywords

Age of onset (AOO)early interventionpreventionDUPtreatment delay
Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 21 , Issue 1 , March 2012 , pp. 47 - 57
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amaddeo, F, Jones, J (2007). What is the impact of socio-economic inequalities on the use of mental health services? Epidemiologia e Psichiatria Sociale 16, 16–19.CrossRefGoogle ScholarPubMed
Amminger, GP, Henry, LP, Harrigan, SM, Harris, MG, Alvarez-Jimenez, M, Herrman, H, Jackson, HJ, McGorry, PD (2011). Outcome in early-onset schizophrenia revisited: findings from the Early Psychosis Prevention and Intervention Centre long-term follow-up study. Schizophrenia Research 131, 112–119.CrossRefGoogle ScholarPubMed
Amone-P'Olak, K, Ormel, J, Huisman, M, Verhulst, FC, Oldehinkel, AJ, Burger, H (2009). Life stressors as mediators of the relation between socioeconomic position and mental health problems in early adolescence: the TRAILS study. Journal of the American Academy of Child and Adolescent Psychiatry 48, 1031–1038.Google ScholarPubMed
Amone-P'Olak, K, Ormel, J, Oldehinkel, AJ, Reijneveld, SA, Verhulst, FC, Burger, H (2010). Socioeconomic position predicts specialty mental health service use independent of clinical severity: the TRAILS study. Journal of the American Academy of Child and Adolescent Psychiatry 49, 647–655.CrossRefGoogle ScholarPubMed
Angold, A, Erkanli, A, Costello, EJ, Rutter, M (1996). Precision, reliability and accuracy in the dating of symptom onsets in child and adolescent psychopathology. Journal of Child Psychology and Psychiatry 37, 57–64.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Rossler, W, Ajdacic, V, Klein, DN (2009). Long-term depression versus episodic major depression: results from the prospective Zurich study of a community sample. Journal of Affective Disorders 115, 112–121.CrossRefGoogle ScholarPubMed
Baldessarini, RJ, Bolzani, L, Cruz, N, Jones, PB, Lai, M, Lepri, B, Perez, J, Salvatore, P, Tohen, M, Tondo, L, Vieta, E (2010). Onset-age of bipolar disorders at six international sites. Journal of Affective Disorders 121, 143–146.CrossRefGoogle ScholarPubMed
Beesdo, K, Pine, DS, Lieb, R, Wittchen, HU (2010). Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Archives of General Psychiatry 67, 47–57.CrossRefGoogle ScholarPubMed
Behrendt, S, Wittchen, HU, Höfler, M, Lieb, R, Beesdo, K (2009). Transitions from first substance use to substance use disorders in adolescence: is early onset associated with a rapid escalation? Drug and Alcohol Dependence 99, 68–78.CrossRefGoogle ScholarPubMed
Bignami, R, Fioritti, A, Lanciotti, G, Pazzi, L, Piazza, A, Verdini, E(eds) ( 2008). Rapporto 2008: Dati del Sistema Informativo dei Servizi di Salute Mentale dell'Emilia-Romagna Anno 2007. Regione Emilia-Romagna: Bologna.Google Scholar
Bromet, E, Andrade, LH, Hwang, I, Sampson, NA, Alonso, J, de Girolamo, G, de Graaf, R, Demyttenaere, K, Hu, C, Iwata, N, Karam, AN, Kaur, J, Kostyuchenko, S, Lépine, JP, Levinson, D, Matschinger, H, Mora, ME, Browne, MO, Posada-Villa, J, Viana, MC, Williams, DR, Kessler, RC (2011). Cross-national epidemiology of DSM-IV major depressive episode. BCM Medicine 9, 90.Google ScholarPubMed
Burgess, PM, Pirkis, JE, Slade, TN, Johnston, AK, Meadows, GN, Gunn, JM (2009). Service use for mental health problems: findings from the 2007 National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry 43, 615–623.CrossRefGoogle ScholarPubMed
Carpenter, J (2002). Mental health recovery paradigm: implications for social work. Health and Social Work 27, 86–94.CrossRefGoogle ScholarPubMed
Christiana, JM, Gilman, SE, Guardino, M, Mickelson, K, Morselli, PL, Olfson, M, Kessler, RC (2000). Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: an international survey of members of mental health patient advocate groups. Psychological Medicine 30, 693–703.CrossRefGoogle ScholarPubMed
Costello, EJ, Mustillo, S, Erkanli, A, Keeler, G, Angold, A (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry 60, 837–844.CrossRefGoogle ScholarPubMed
Costello, EJ, Egger, H, Angold, A (2005). 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child and Adolescent Psychiatry 44, 972–986.CrossRefGoogle ScholarPubMed
Dadds, MR, Spence, SH, Holland, DE, Barrett, PM, Laurens, KR (1997). Prevention and early intervention for anxiety disorders: a controlled trial. Journal of Consulting and Clinical Psychology 65, 627–635.CrossRefGoogle ScholarPubMed
Degenhardt, L, Chiu, WT, Sampson, N, Kessler, RC, Anthony, JC, Angermeyer, M, Bruffaerts, R, de Girolamo, G, Gureje, O, Huang, Y, Karam, A, Kostyuchenko, S, Lepine, JP, Mora, ME, Neumark, Y, Ormel, JH, Pinto-Meza, A, Posada-Villa, J, Stein, DJ, Takeshima, T, Wells, JE (2008). Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys. PLoS Medicine 5, e141.Google Scholar
Essau, CA, Lewinsohn, PM, Seeley, JR, Sasagawa, S (2010). Gender differences in the developmental course of depression. Journal of Affective Disorders 127, 185–190.CrossRefGoogle ScholarPubMed
Esterberg, ML, Trotman, HD, Holtzman, C, Compton, MT, Walker, EF (2010). The impact of a family history of psychosis on age-at-onset and positive and negative symptoms of schizophrenia: a meta-analysis. Schizophrenia Research 120, 121–130.CrossRefGoogle ScholarPubMed
Frangou, S (2010). Cognitive function in early onset schizophrenia: a selective review. Frontiers in Human Neuroscience 3, 79.Google ScholarPubMed
Fryers, T, Melzer, D, Jenkins, R (2003). Social inequalities and the common mental disorders: a systematic review of the evidence. Social Psychiatry and Psychiatric Epidemiology 38, 229–237.CrossRefGoogle ScholarPubMed
Garber, J, Clarke, GN, Weersing, VR, Beardslee, WR, Brent, DA, Gladstone, TR, DeBar, LL, Lynch, FL, D'Angelo, E, Hollon, SD, Shamseddeen, W, Iyengar, S (2009). Prevention of depression in at-risk adolescents: a randomized controlled trial. Journal of the American Medical Association 301, 2215–2224.CrossRefGoogle ScholarPubMed
Goodman, A (2010). Substance use and common child mental health problems: examining longitudinal associations in a British sample. Addiction 105, 1484–1496.CrossRefGoogle Scholar
Gore, FM, Bloem, PJ, Patton, GC, Ferguson, J, Joseph, V, Coffey, C, Sawyer, SM, Mathers, CD (2011). Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 377, 2093–2102.CrossRefGoogle ScholarPubMed
Häfner, H (2003). Gender differences in schizophrenia. Psychoneuroendocrinology 28, 17–54.CrossRefGoogle ScholarPubMed
Häfner, H, Maurer, K, Löffler, W, an der Heiden, W, Munk-Jørgensen, P, Hambrecht, M, Riecher-Rössler, A (1998). The ABC Schizophrenia Study: a preliminary overview of the results. Social Psychiatry and Psychiatric Epidemiology 33, 380–386.Google ScholarPubMed
Hamshere, ML, Gordon-Smith, K, Forty, L, Jones, L, Caesar, S, Fraser, C, Hyde, S, Tredget, J, Kirov, G, Jones, I, Craddock, N, Smith, DJ (2009). Age-at-onset in bipolar-I disorder: mixture analysis of 1369 cases identifies three distinct clinical sub-groups. Journal of Affective Disorders 116, 23–29.Google ScholarPubMed
Hetrick, SE, Parker, AG, Hickie, IB, Purcell, R, Yung, AR, McGorry, PD (2008). Early identification and intervention in depressive disorders: towards a clinical staging model. Psychotherapy and Psychosomatics 77, 263–270.Google ScholarPubMed
Insel, TR, Fenton, WS (2005). Psychiatric epidemiology: it's not just about counting anymore. Archives of General Psychiatry 62, 590–592.CrossRefGoogle Scholar
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A (1992). Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine. Monograph Supplement 20, 1–97.CrossRefGoogle ScholarPubMed
Joa, I, Johannessen, JO, Auestad, B, Friis, S, McGlashan, T, Melle, I, Opjordsmoen, S, Simonsen, E, Vaglum, P, Larsen, TK (2008). The key to reducing duration of untreated first psychosis: information campaigns. Schizophrenia Bulletin 34, 466–472.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google ScholarPubMed
Kessler, RC, Angermeyer, M, Anthony, JC, DE Graaf, R, Demyttenaere, K, Gasquet, I, DE Girolamo, G, Gluzman, S, Gureje, O, Haro, JM, Kawakami, N, Karam, A, Levinson, D, Medina Mora, ME, Oakley Browne, MA, Posada-Villa, J, Stein, DJ, Adley Tsang, CH, Aguilar-Gaxiola, S, Alonso, J, Lee, S, Heeringa, S, Pennell, BE, Berglund, P, Gruber, MJ, Petukhova, M, Chatterji, S, Ustün, TB (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6, 168–176.Google ScholarPubMed
Kim-Cohen, J, Caspi, A, Moffitt, TE, Harrington, H, Milne, BJ, Poulton, R (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry 60, 709–717.CrossRefGoogle ScholarPubMed
Korczak, DJ, Goldstein, BI (2009). Childhood onset major depressive disorder: course of illness and psychiatric comorbidity in a community sample. Journal of Pediatrics 155, 118–123.CrossRefGoogle Scholar
Krausz, M, Muller-Thomsen, T (1993). Schizophrenia with onset in adolescence: an 11-year follow up. Schizophrenia Bulletin 19, 831–841.CrossRefGoogle Scholar
Kuepper, R, van Os, J, Lieb, R, Wittchen, HU, Höfler, M, Henquet, C (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. British Medical Journal 342, d738.CrossRefGoogle ScholarPubMed
Kyriakopoulos, M, Frangou, S (2007). Pathophysiology of early onset schizophrenia. International Review of Psychiatry 19, 315–324.CrossRefGoogle ScholarPubMed
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and Earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555–561.CrossRefGoogle ScholarPubMed
Lora, A (2008). Il Sistema di Salute Mentale della Regione Lombardia. Regione Lombardia: Milano.Google Scholar
Luthar, SS, Sawyer, JA, Brown, PJ (2006). Conceptual issues in studies of resilience: past, present, and future research. Annals of the New York Academy of Sciences 1094, 105–115.CrossRefGoogle ScholarPubMed
Marmot, M (2005). Social determinants of health inequalities. Lancet 365, 1099–104.CrossRefGoogle ScholarPubMed
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975–983.CrossRefGoogle ScholarPubMed
McGorry, P (2009). Should youth mental health become a specialty in its own right? Yes. British Medical Journal 339, b3373.CrossRefGoogle ScholarPubMed
McGorry, P, Purcell, R (2009). Youth mental health reform and early intervention: encouraging early signs. Early Intervention in Psychiatry 3, 161–162.CrossRefGoogle ScholarPubMed
McGorry, P, Hazell, P, Hickie, I, Yung, A, Chanen, A, Moran, J, Fraser, R (2008). The ‘youth model’ in mental health services. Australasian Psychiatry 16, 136–137.CrossRefGoogle ScholarPubMed
McGorry, PD, Purcell, R, Hickie, IB, Jorm, AF (2007 a). Investing in youth mental health is a best buy. Medical Journal of Australia 187 (Suppl. 7), S5.Google Scholar
McGorry, PD, Purcell, R, Hickie, IB, Yung, AR, Pantelis, C, Jackson, HJ (2007 b). Clinical staging: a heuristic model for psychiatry and youth mental health. Medical Journal of Australia 187 (Suppl. 7), S40–S42.Google ScholarPubMed
McGue, M, Iacono, WG, Krueger, R (2006). The association of early adolescent problem behavior and adult Psychopathology: multivariate behavioral genetic perspective. Behavior Genetics 36, 591–602.CrossRefGoogle ScholarPubMed
Moffitt, TE, Caspi, A, Taylor, A, Kokaua, J, Milne, BJ, Polanczyk, G, Poulton, R (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine 40, 899–909.Google ScholarPubMed
Murray, CJ, Lopez, AD (1996). The Global Burden of Disease. World Health Organization: Geneva.Google ScholarPubMed
Patton, GC, Hetrick, SE, McGorry, P (2007). Service responses for youth onset mental disorders. Current Opinion in Psychiatry 20, 319–324.CrossRefGoogle ScholarPubMed
Paus, T, Keshavan, M, Giedd, JN (2008). Why do many psychiatric disorders emerge during adolescence? Nature Reviews Neuroscience 9, 947–957.CrossRefGoogle ScholarPubMed
Perlis, RH, Dennehy, EB, Miklowitz, DJ, Delbello, MP, Ostacher, M, Calabrese, JR, Ametrano, RM, Wisniewski, SR, Bowden, CL, Thase, ME, Nierenberg, AA, Sachs, G (2009). Retrospective age at onset of bipolar disorder and outcome during two-year follow-up: results from the STEP-BD study. Bipolar Disorders 11, 391–400.Google ScholarPubMed
Pine, DS (2009). Anxiety disorders in childhood and adolescence. New Oxford Textbook of Psychiatry 2, 1664–1669.Google Scholar
Pottick, KJ, Bilder, S, Vander Stoep, A, Warner, LA, Alvarez, MF (2008). US patterns of mental health service utilization for transition-age youth and young adults. Journal of Behavioral Health Services and Research 35, 373–389.CrossRefGoogle ScholarPubMed
Rajji, TK, Ismail, Z, Mulsant, BH (2009). Age at onset and cognition in schizophrenia: meta-analysis. British Journal of Psychiatry 195, 286–293.CrossRefGoogle ScholarPubMed
Rapee, RM, Kennedy, SJ, Ingram, M, Edwards, SL, Sweeney, L (2010). Altering the trajectory of anxiety in at-risk young children. American Journal of Psychiatry 167, 1518–1525.CrossRefGoogle ScholarPubMed
Reef, J, Diamantopoulou, S, Van Meurs, I, Verhulst, F, Van Der Ende, J (2009). Child to adult continuities of psychopathology: a 24-year follow- up. Acta Psychiatrica Scandinavica 120, 230–238.Google ScholarPubMed
Rickwood, DJ, Deane, FP, Wilson, CJ (2007). When and how do young people seek professional help for mental health problems? Medical Journal of Australia 187, S35–S39.Google Scholar
Rockhill, C, Kodish, I, DiBattisto, C, Macias, M, Varley, C, Ryan, S (2010). Anxiety disorders in children and adolescents. Current Problems in Pediatric and Adolescent Health Care 40, 66–99.Google ScholarPubMed
Rosen, A (2006). The community psychiatrist of the future. Current Opinion in Psychiatry 19, 380–388.CrossRefGoogle ScholarPubMed
Roza, SJ, Hofstra, MB, Van Der Ende, J, Verhulst, FC (2003). Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: A 14 year follow-up during childhood, adolescence and young adulthood. American Journal of Psychiatry 160, 2116–2121.CrossRefGoogle ScholarPubMed
Rutter, M (2006). Implications of resilience concepts for scientific understanding. Annals of the New York Academy of Sciences 1094, 1–12.CrossRefGoogle ScholarPubMed
Rutter, M, Kim-Cohen, J, Maughan, B (2006). Continuities and discontinuities in psychopathology between childhood and adult life. Journal of Child Psychology and Psychiatry 47, 276–295.CrossRefGoogle ScholarPubMed
Sanders, MR (2008). Triple P-positive parenting program as a public health approach to strengthening parenting. Journal of Family Psychology 22, 506–517.CrossRefGoogle ScholarPubMed
Saxena, S, Jané-Llopis, E, Hosman, C (2006). Prevention of mental and behavioural disorders: implications for policy and practice. World Psychiatry 5, 5–14.Google ScholarPubMed
Shatkin, JP, Belfer, ML (2004). The global absence of child and adolescent mental health policy. Child and Adolescent Mental Health 9, 104–108.CrossRefGoogle ScholarPubMed
Singh, SP (2009). Transition of care from child to adult mental health services: the great divide. Current Opinion in Psychiatry 22, 386–390.CrossRefGoogle ScholarPubMed
Slade, EP, Stuart, EA, Salkever, DS, Karakus, M, Green, KM, Ialongo, N (2008). Impacts of age of onset of substance use disorders on risk of adult incarceration among disadvantaged urban youth: a propensity score matching approach. Drug and Alcohol Dependence 95, 1–13.Google ScholarPubMed
Thorup, A, Waltoft, BL, Pedersen, CB, Mortensen, PB, Nordentoft, M (2007). Young males have a higher risk of developing schizophrenia: a Danish register study. Psychological Medicine 37, 479–484.CrossRefGoogle ScholarPubMed
Tijssen, MJ, van Os, J, Wittchen, HU, Lieb, R, Beesdo, K, Mengelers, R, Wichers, M (2010). Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study. British Journal of Psychiatry 196, 102–108.CrossRefGoogle Scholar
Vanheusden, K, Mulder, CL, van der Ende, J, van Lenthe, FJ, Mackenbach, JP, Verhulst, FC (2008). Young adults face major barriers to seeking help from mental health services. Patient Education and Counseling 73, 97–104.CrossRefGoogle ScholarPubMed
van Oort, FV, van der Ende, J, Wadsworth, ME, Verhulst, FC, Achenbach, TM (2011). Cross-national comparison of the link between socioeconomic status and emotional and behavioral problems in youths. Social Psychiatry and Psychiatric Epidemiology 46, 167–172.CrossRefGoogle ScholarPubMed
van Os, J, Kenis, G, Rutten, BP (2010). The environment and schizophrenia. Nature 468, 203–212.CrossRefGoogle ScholarPubMed
Vega, WA, Aguilar-Gaxiola, S, Andrade, L, Bijl, R, Borges, G, Caraveo-Anduaga, JJ, DeWit, DJ, Heeringa, SG, Kessler, RC, Kolody, B, Merikangas, KR, Molnar, BE, Walters, EE, Warner, LA, Wittchen, HU (2002). Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology. Drug and Alcohol Dependence 68, 285–297.CrossRefGoogle Scholar
Vyas, NS, Patel, NH, Puri, BK (2011). Neurobiology and phenotypic expression in early onset schizophrenia. Early Intervention in Psychiatry 5, 3–14.CrossRefGoogle ScholarPubMed
Walker, EF, Sabuwalla, Z, Huot, R (2004). Pubertal neuromaturation, stress sensivity and psychopathology. Development and Psychopathology 16, 807–824.CrossRefGoogle Scholar
Wang, PS, Berglund, P, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Archives of General Psychiatry 62, 603–613.CrossRefGoogle ScholarPubMed
Wilson, CJ, Bushnell, JA, Caputi, P (2011). Early access and help seeking: practice implications and new initiatives. Early Intervention in Psychiatry 5, 34–39.CrossRefGoogle ScholarPubMed
Wright, A, McGorry, PD, Harris, MG, Jorm, AF, Pennell, K (2006). Development and evaluation of a youth mental health community awareness campaign – The Compass Strategy. BMC Public Health 6, 215.CrossRefGoogle ScholarPubMed