Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

Abstract

Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11–34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7–16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9–25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14–29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15–23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17–48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20–41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20–34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20–33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21–46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18.

Study of Early Onset Schizophrenia: Associations of GRIN2A and GRIN2B Polymorphisms

“…Earlier onset is often associated with a poorer outcome [37]. Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes [38]. We could speculate that our findings could be potentially useful for families with psychiatric burden when they pass prenatal genetic counseling for psychiatric disorders, although our data need to be confirmed on a larger sample.…”

ITAlian Partnership for Psychosis Prevention (ITAPP): improving the mental health of young people

“…All ITAPP centers were targeting a transitional age (12-39 years), with minor variations across sites. This is relevant, because a large-scale meta-analysis found that 12.3% of psychotic disorders occur before the age of 18 and 47.8% before 25, with a peak onset at 20.5 years [28]. These findings do not support the current pediatric-adult bifurcation of mental health services (cut at the age of 15 or 18) in Italy, where young people may fall into institutional gaps when they are most liable to mental disorders [29].…”

COVID-19-related changes in adolescents' daily-life social interactions and psychopathology symptoms

“…Previous early-pandemic studies have reported high levels of adolescent psychopathology and anxiety symptoms (e.g., Luijten et al, 2021;Waite et al, 2021). However, since many of these studies have no pre-COVID-19 data, their results may reflect the moderate to high levels of adolescent psychopathology already present in adolescent populations before the pandemic (e.g., Kessler et al, 2005;Solmi et al, 2021). Where studies have been able to combine pre-and early-pandemic data on psychopathology symptoms, results are limited and conflicting.…”