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

M Solmi, J Radua, M Olivola, E Croce, L Soardo…�- Molecular�…, 2022 - nature.com
M Solmi, J Radua, M Olivola, E Croce, L Soardo, G Salazar de Pablo, J Il Shin, JB Kirkbride
Molecular psychiatry, 2022nature.com
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�…
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.
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