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: 3.91). 03/2012; 21(1):47-57. DOI: 10.1017/S2045796011000746
Source: PubMed


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.

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Available from: Angelo Cocchi, Apr 17, 2015
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    • "Emerging adults (EAs), also known as transition-age youth, are at heightened risk for an array of problems that can have a lifetime of impact. The onset of mental illness occurs primarily during this age range, with three quarters of all serious mental illnesses (SMIs; e.g., schizophrenia, major depressive disorder, posttraumatic stress disorder) having onset before the age of 25 (de Girolamo, Dagani, Purcell, Cocchi, & McGorry, 2012; Kessler et al., 2007). Prevalence rates of SMIs (excluding substance abuse disorders) are nearly 10% among EAs and are higher during this time than at any other developmental period (Substance Abuse and Mental Health Services Administration [SAMHSA], 2012). "
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    ABSTRACT: Most serious mental illnesses (SMI) have onset by emerging adulthood and SMI can impair adolescents' transitions into healthy, productive adults. Emerging adults (EAs) with SMI are at high risk for justice involvement, and rates of recidivism are greater for offenders with SMI than without. These EAs are frequently multi-system involved (e.g., aging out of foster care; both juvenile and adult arrests; prison reentry). Few interventions, however, have focused specifically on EAs, and no interventions have focused on reducing recidivism in EAs with or without SMI. Multisystemic Therapy for Emerging Adults (MST-EA) is an adaptation of standard MST (for adolescent antisocial behavior) that was specifically designed for EAs with SMI and justice involvement. This paper provides the first description of MST-EA, including clinical outcome data on pilot cases and an extensive case example. To date, 57 cases have been treated with MST-EA. Success at discharge was demonstrated on main outcomes (rearrest and mental health) and other functional outcomes. Clinical data on pilot cases is promising and supports further research to assess long-term outcomes and effectiveness.
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    • "The lifetime prevalence of psychoses is estimated between 0.2 and 3.5% [83] [125], their annual incidence between 0.01 and 0.035%, with growing numbers reported in Europe where, within 12 months, approximately 3.7 million adults (0.8%) had been affected in 2005 and as much as 5 million (1.2%) in 2011 [46] [125]. The gender related incidence of affective and non-affective psychotic disorders depends on type of psychosis and age with a higher incidence of schizophrenia in men and a similar cumulative incidence of all psychoses at age 60 [19] [34] [35] [38] [47] [65] [114]. Approximately 10–15% of all psychoses are early-onset psychoses (EOP) manifesting before the age of 18, and approximately 1–3% are very-early-onset psychoses (VEOP) with an onset before the age of 13 [98] [125]. "
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    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.
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    • "The majority of mental disorders emerge in adolescence and young adulthood (Belfer 2008; de Girolamo et al. 2012), with three-quarters of all lifetime cases occurring before 24 years of age (Kessler et al. 2005). Mental health problems in young people significantly impact on their social, emotional, physical, and educational development (Kazdin 1993; Strauss et al. 1987), and are likely to continue well into adulthood if left untreated (Catania et al. 2011; de Girolamo et al. 2012). Fortunately, early intervention and prevention strategies can substantially improve the outlook (McGorry et al. 2011) but, in order for mental health professionals to provide appropriate intervention, assessments that give an accurate and holistic picture of the young person and their life are required (Leavey et al. 2008). "
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