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

IRCCS Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy.
Epidemiology and Psychiatric Sciences (Impact Factor: 3.36). 03/2012; 21(1):47-57. DOI: 10.1017/S2045796011000746
Source: PubMed

ABSTRACT 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.
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.
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.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: For mental health professionals to provide personalized early interventions, young people need to disclose sensitive information to a clinician they are unlikely to have yet formed a relationship with. We conducted in-depth qualitative interviews with 129 young people aged 12–25 years from several sites across Australia to gauge views on whether young people thought that an electronic psychosocial assessment tool could help them initially disclose personal information. Additionally, we were interested in whether young people from different demographic groups held similar views around using the e-tool. Results provided support for the use of an e-tool, with most young people stating that it could help in the disclosure of particularly embarrassing problems. The main advantages reported were that the e-tool would support disclosure without fear of judgment by health professionals, and would enable young people greater input in deciding what to focus on. Young people who held a preference to simply talk were most concerned about the clinician missing non-verbal cues. These findings highlight the value of incorporating electronic options within clinical practice, but also the need for health professionals to work within a flexible framework guided by the individual preferences of each of their clients.
    Journal of Child and Family Studies 01/2014; DOI:10.1007/s10826-014-9929-0 · 1.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study elicited multiple perspectives on attitudes towards help-seeking behaviors associated with mental health problems of college students in Ukraine. It employed a sequential mixed method design. First, focus groups were conducted with students and psychologists. These data were analyzed and used to develop a survey. The survey was subsequently administered to psychiatrists, the primary providers of services to people with psychiatric problems in Ukraine. Findings from the focus groups revealed four help-seeking behaviors: 1) friends and partners, (2) alcohol use, (3) family support, and (4) conventional and alternative mental health services. Students and psychiatrists differed in their beliefs about help-seeking behaviors. Although psychiatrists believed students sought help from mental health and/or addictions professionals, students reported using self-medication and social network support. Implications include a troubling gap in perceptions between the students impacted and the professional communities that should be serving them.
    International Journal of Mental Health and Addiction 10/2014; 12(5):549-560. DOI:10.1007/s11469-014-9483-4 · 0.95 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 03/2015; 30:405-416. DOI:10.1016/j.eurpsy.2015.01.010 · 3.21 Impact Factor