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Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, Il Shin J, Kirkbride JB, Jones P, Kim JH, Kim JY, Carvalho AF, Seeman MV, Correll CU, Fusar-Poli P. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 2022; 27:281-295. [PMID: 34079068 PMCID: PMC8960395 DOI: 10.1038/s41380-021-01161-7] [Citation(s) in RCA: 861] [Impact Index Per Article: 430.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 02/06/2023]
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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Affiliation(s)
- Marco Solmi
- grid.5608.b0000 0004 1757 3470Neurosciences Department, University of Padua, Padua, Italy ,grid.5608.b0000 0004 1757 3470Neuroscience Centre, University of Padua, Padua, Italy ,grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Joaquim Radua
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.10403.360000000091771775Imaging Mood- and Anxiety-Related Disorders (IMARD) group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Mental Health Research Networking Center (CIBERSAM), Barcelona, Spain ,grid.465198.7Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Solna, Sweden
| | - Miriam Olivola
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Enrico Croce
- grid.8484.00000 0004 1757 2064Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Livia Soardo
- grid.8982.b0000 0004 1762 5736Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gonzalo Salazar de Pablo
- grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.4795.f0000 0001 2157 7667Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Jae Il Shin
- grid.15444.300000 0004 0470 5454Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - James B. Kirkbride
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Peter Jones
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, England ,CAMEO Early Intervention Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, England
| | - Jae Han Kim
- grid.15444.300000 0004 0470 5454Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Yeob Kim
- grid.15444.300000 0004 0470 5454Yonsei University College of Medicine, Seoul, South Korea
| | - Andrè F. Carvalho
- grid.414257.10000 0004 0540 0062IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Mary V. Seeman
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Christoph U. Correll
- grid.440243.50000 0004 0453 5950Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY USA ,grid.512756.20000 0004 0370 4759Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA ,grid.250903.d0000 0000 9566 0634Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY USA ,grid.6363.00000 0001 2218 4662Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. .,OASIS service, South London and Maudsley NHS Foundation Trust, London, UK. .,National Institute for Health Research, Maudsley Biomedical Research Centre, London, UK.
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Toyoshima K, Ichiki M, Inoue T, Shimura A, Masuya J, Fujimura Y, Higashi S, Kusumi I. Subjective cognitive impairment and presenteeism mediate the associations of rumination with subjective well-being and ill-being in Japanese adult workers from the community. Biopsychosoc Med 2021; 15:15. [PMID: 34600577 PMCID: PMC8487485 DOI: 10.1186/s13030-021-00218-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background In recent years, the roles of rumination, subjective cognitive impairment (SCI), and presenteeism have been emphasized in occupational mental health. However, associations between rumination, SCI, presenteeism, and psychological well-being are not fully understood. We hypothesized that SCI and presenteeism mediate the associations between rumination and subjective well-being (SWB) and subjective ill-being (SIB). Hence, we investigated the mediating roles of SCI and presenteeism in this study. Methods A total of 458 adult workers (mean age, 40.8±11.9 years; 44.1% male), who were recruited in Tokyo using convenience sampling, were analyzed in this study. The Ruminative Responses Scale, Cognitive Complaints in Bipolar Disorder Rating Assessment, Work Limitations Questionnaire 8, and Subjective Well-being Inventory were used to evaluate rumination, SCI, presenteeism, and psychological well-being (SWB and SIB), respectively. Path analyses were performed to evaluate the relations between these parameters. Results The path analysis indicated that rumination, SCI, and presenteeism were directly and negatively associated with SWB and SIB. Regarding indirect effects, rumination was negatively associated with SWB and SIB via SCI, presenteeism, and both SCI and presenteeism. Furthermore, SCI was negatively associated with SWB and SIB via presenteeism. Conclusions The results suggest that SCI and presenteeism mediate the associations of rumination with SWB and SIB in Japanese adult workers. To address the psychological well-being associated with rumination, evaluating SCI and presenteeism simultaneously may be useful in occupational mental health. This study provides key insights into the development of comprehensive intervention strategy based on the biopsychosocial perspective for worker’s psychological well-being. Supplementary Information The online version contains supplementary material available at 10.1186/s13030-021-00218-x.
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Affiliation(s)
- Kuniyoshi Toyoshima
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Masahiko Ichiki
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Akiyoshi Shimura
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Jiro Masuya
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yota Fujimura
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Department of Psychiatry, Tokyo Medical University Hachioji Medical Center, 1163, Tate-machi, Hachioji, Tokyo, 193-0998, Japan
| | - Shinji Higashi
- Department of Psychiatry, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Department of Psychiatry, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami-machi, Inashiki-gun, Ibaraki, 300-0395, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
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Fusar-Poli P, Oliver D, Spada G, Estrade A, McGuire P. The case for improved transdiagnostic detection of first-episode psychosis: Electronic health record cohort study. Schizophr Res 2021; 228:547-554. [PMID: 33234425 DOI: 10.1016/j.schres.2020.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/30/2020] [Accepted: 11/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Improving outcomes of a First Episode of Psychosis (FEP) relies on the ability to detect most individuals with emerging psychosis and treat them in specialised Early Intervention (EI) services. Efficacy of current detection strategies is undetermined. METHODS RECORD-compliant clinical, 6-year, retrospective, transdiagnostic, lifespan-inclusive, Electronic Health Record (EHR) cohort study, representing real-world secondary mental healthcare in South London and Maudsley (SLaM) NHS. All individuals accessing SLaM in the period 2007-2017 and receiving any ICD-10 diagnosis other than persistent psychosis were included. Descriptive statistics, Kaplan-Meier curves, logistic regression, epidemiological incidence of psychosis in the general population were used to address pathways to care and detection power of EI services for FEP. RESULTS A total of 106,706 individuals underwent the 6-year follow-up: they were mostly single (72.57%) males (50.51%) of white ethnicity (60.01%), aged on average 32.96 years, with an average Health Of the Nation Outcome Scale score of 11.12 and mostly affected with F40-48 Neurotic/stress-related/somatoform disorders (27.46%). Their transdiagnostic risk of developing a FEP cumulated to 0.072 (95%CI 0.067-0.077) at 6 years. Those individuals who developed a FEP (n = 1841) entered healthcare mostly (79.02%) through inpatient mental health services (29.76%), community mental health services (29.54%) or accident and emergency departments (19.50%); at the time of FEP onset, most of them (46.43%) were under the acute care pathway. Individuals contacting accident and emergency departments had an increased risk of FEP (OR 2.301, 95%CI 2.095-2.534, P < 0.001). The proportion of SLaM FEP cases that were eligible and under the care of EI services was 0.456 at any time. The epidemiological proportion of FEP cases in the sociodemographically-matched general population that was detected by EI service was 0.373. CONCLUSIONS More than half of individuals who develop a FEP remain undetected by current pathways to care and EI services. Improving detection strategies should become a mainstream area in the future generation of early psychosis research.
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Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Giulia Spada
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Andres Estrade
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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