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Age of onset of life-time mental disorders and treatment contact

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Early onset of mental disorders is a major social and public health concern as it affects individuals in their most formative years. The impact is more pronounced when early onset is also associated with treatment delay. Little is known about the age of onset (AOO) for mental disorders and its predictors in Singapore.

Method

A national mental health survey was conducted among adult residents aged 18 years and above in Singapore. The composite international diagnostic interview (CIDI 3.0) was used to establish the life-time diagnosis of major depressive disorder (MDD), dysthymia, bipolar disorder, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD) and alcohol abuse and dependence, and the age of onset as well as any subsequent treatment contact.

Results

A total of 6,616 respondents (mean age of 43.9 years) participated in the survey giving a response rate of 75.9 %. The median AOO for having any one of the mental disorders was 22 years with variation among the different disorders. Predictors for AOO varied across the mental disorders. Only 8 % had sought any treatment in the first year after onset. Males, those belonging to Malay and Indian ethnicities and 50+ age cohorts were less likely to have made treatment contact in the year of onset.

Conclusion

Nearly half of the respondents with any life-time mental disorder would have its onset by age of 22 years, and very few had sought treatment within the first year from onset. The study also identified socio-demographic predictors associated with AOO for mental disorders and delayed treatment contact, thus highlighting a vulnerable subpopulation that can be targeted for outreach and early interventions.

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References

  1. World Health Report (2001) Burden of mental and behavioural disorders. http://www.who.int/whr/2001/en/whr01_ch2_en.pdf. Accessed 20 Dec 2011

  2. Kessler RC, Angermeyer M, Anthony et al (2007) Life-time prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s world mental health survey initiative (research report). World Psychiatry 6:168–176

    PubMed  Google Scholar 

  3. Jayakodya R, Danzigerb S, Kessler RC (1998) Early-onset psychiatric disorders and male socioeconomic status. Soc Sci Res 27(Issue 4):371–387

    Article  Google Scholar 

  4. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:593–602

    Article  PubMed  Google Scholar 

  5. Biffin F, Tahtalian S, Filia K et al (2009) The impact of age at onset of bipolar I disorder on functioning and clinical presentation. Acta Neuropsychiatrica 21:191–196

    Article  Google Scholar 

  6. Zisook S, Lesser I, Stewart JW et al (2007) Effect of age at onset on the course of major depressive disorder. Am J Psychiatry 164:1539–1546

    Article  PubMed  Google Scholar 

  7. McGorry PD, Purcell R, Goldstone S, Amminger GP (2011) Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Curr Opin Psychiatry 24:301–306

    Google Scholar 

  8. Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Failure and delay in initial treatment contact after first onset of mental disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:603–613

    Article  PubMed  Google Scholar 

  9. Wang PS, Angermeyer M, Borges G et al (2007) Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s world mental health survey initiative. World Psychiatry 6:177–185

    PubMed  Google Scholar 

  10. Stengler K, Olbrich S, Heider D, Dietrich S, Riedel-Heller S, Jahn I (2012) Mental health treatment seeking among patients with OCD: impact of age of onset. Soc Psychiatry Psychiatr Epidemiol (Epub ahead of print)

  11. Green AC, Hunt C, Stain HJ (2012) The delay between symptom onset and seeking professional treatment for anxiety and depressive disorders in a rural Australian sample. Soc Psychiatry Psychiatr Epidemiol 47:1475–1487

    Article  PubMed  Google Scholar 

  12. Janicke DM, Finney JW, Riley AW (2001) Children’s health care use: a prospective investigation of factors related to care-seeking. Med Care 39:990–1001

    Article  PubMed  CAS  Google Scholar 

  13. Lee S, Fung SC, Tsang A et al (2007) Delay in initial treatment contact after first onset of mental disorders in Metropolitan China. Acta Psyiatr Scand 116:10–16

    Article  CAS  Google Scholar 

  14. Borges G, Wang P, Medina Mora ME et al (2007) Delay of first treatment of mental and substance use disorders in Mexico. Am J Public Health 97:9

    Article  Google Scholar 

  15. Wang PS, Patricia AB, Olfson M, Kessler RC (2004) Delays in initial treatment contact after first onset of a mental disorder (methods). Health Serv Res 39:2

    Article  Google Scholar 

  16. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustun TB (2007) Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 20:359–364

    Article  PubMed  Google Scholar 

  17. Lee S, Tsang A, Zhang M-Y et al (2007) Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China. Psychol Med 37:61–73

    Article  PubMed  Google Scholar 

  18. Medina-Mora ME, Borges G, Benjet C, Lara C, Berglund P (2007) Psychiatric disorders in Mexico: lifetime prevalence in a nationally representative sample. Br J Psychiatry 190:521–528

    Article  PubMed  Google Scholar 

  19. Subramaniam M, Vaingankar J, Heng D, Kwok KW, Lim YW, Yap M, Chong SA (2012) The Singapore mental health study: an overview of the methodology. Int J Methods Psychiatr Res 21(2):149–157

    Article  PubMed  Google Scholar 

  20. Kessler RC, Ustun TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–121

    Article  PubMed  Google Scholar 

  21. Karam EG, Mneimneh ZN, Dimassi H, Fayyad JA, Karam AN et al (2008) Lifetime prevalence of mental disorders in lebanon: first onset, treatment, and exposure to war. PLoS Med 5(4):e61. doi:10.1371/journal.pmed.0050061

    Article  PubMed  Google Scholar 

  22. De Girolamo G, Morosini P, Gigantesco A, Delmonte S, Kessler RC (2008) The prevalence of mental disorders and service use in Italy: results from national health survey 2001–2003. In: Kessler RC, Ustun TB (eds) The world mental health surveys: global perspectives on the epidemiology of mental disorders. University press, Cambridge, pp 364–387

    Google Scholar 

  23. Herman AA, Williams D, Stein DJ et al (2008) The n stress and health study (SASH): a foundation for improving mental health care in South Africa. In: Kessler RC, Ustun TB (eds) The world mental health surveys: global perspectives on the epidemiology of mental disorders. University press, Cambridge, p 245

    Google Scholar 

  24. Bruffaerts R, Bonnewyn A, Demyttenaere K (2008) Mental health in Belgium: current situation and future perspectives. In: Kessler RC, Ustun TB (eds) The world mental health surveys: global perspectives on the epidemiology of mental disorders. University press, Cambridge, pp 279–304

    Google Scholar 

  25. De Graaf R, Ormel J, Have MT, Burger H, Buist-Bouwman M (2008) Mental disorders and service use in the Netherlands: results from the european study of the epidemiology of mental disorders (ESEMed). In: Kessler RC, Ustun TB (eds) The world mental health surveys: global perspectives on the epidemiology of mental disorders. University press, Cambridge, pp 388–405

    Google Scholar 

  26. Alonso J, Pinto-Meza A, Saiz V et al (2008) The epidemiology of mental disorders in the general population of Spain. In: Kessler RC, Ustun TB (eds) The world mental health surveys: global perspectives on the epidemiology of mental disorders. University Press, Cambridge, p 416

  27. Oakley Browne MA, Wells JE, Scott KM, McGee MA (2006) New Zealand mental health survey research team. Lifetime prevalence and projected lifetime risk of DSM-IV disorders in Te Rau Hinengaro: the New Zealand mental health survey. Aust N Z J Psychiatry 40:865–874

    Article  PubMed  Google Scholar 

  28. Levinson D, Zilber N, Lerner Y et al (2007) Prevalence of mood and anxiety disorders in the community: results from the Israel national health survey. Israel J Psychiatry Relat Sci 44(2):94–103

    Google Scholar 

  29. Cho MJ, Chang SM, Hahm BJ et al (2012) Lifetime risk and age of onset distributions of psychiatric disorders: analysis of national sample survey in South Korea. Soc Psychiatry Psychiatr Epidemiol 47:671–681

    Article  PubMed  Google Scholar 

  30. Jacobi F, Wittchen H-U, Holting C et al (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German health interview and examination survey (GHS). Psychol Med 34:1–15

    Article  Google Scholar 

  31. Le Roux H, Gatz M, Wetherell JL (2005) Age at onset of generalized anxiety disorder in older adults. Am J Geriatr Psychiatry 13:23–30

    PubMed  Google Scholar 

  32. Chou KL (2009) Age at onset of generalized anxiety disorder in older adults. Am J Geriatr Psychiatry 17:455–464

    Article  PubMed  Google Scholar 

  33. Simon GE, VonKorff M, Ustun TB, Gater R, Gureje O, Sartorius N (1995) Is the life-time risk of depression actually increasing? J Clin Epidemiol 48(9):1109–1118

    Article  PubMed  CAS  Google Scholar 

  34. Yang F, Li Y, Xie D et al (2011) Age at onset of major depressive disorder in Han Chinese women: relationship with clinical features and family history. J Affect Disord 135:89–94

    Article  PubMed  Google Scholar 

  35. Kessler RC (2000) Gender differences in major depression: epidemiologic findings. In: Frank E (ed) Gender and its effect on psychopathology. American Psychiatric Press, Washington, pp 61–84

    Google Scholar 

  36. Cook BL, Carson N, Alegria M (2010) Assessing racial/ethnic differences in the social consequences of early-onset psychiatric disorder. J Health Care Poor Underserv 21(2 Suppl):49–66

    Google Scholar 

  37. Javaid N, Kennedy JL, De Luca V (2011) Ethnicity and age at onset in bipolar spectrum disorders. CNS Spectr (Epub ahead of print)

  38. Breslau J, Borges G, Tancredi D et al (2011) Migration from Mexico to the United States and subsequent risk for depressive and anxiety disorders: a cross-national study. Arch Gen Psychiatry 68:428–433

    Article  PubMed  Google Scholar 

  39. Tang J, Xiao L, Shu C et al (2008) Association of the brain-derived neurotrophic factor gene and bipolar disorder with early age of onset in mainland China. Neurosci Lett 433:98–102

    Article  PubMed  CAS  Google Scholar 

  40. Sureshkumar R, Bharath S, Jain S et al (2012) ApoE4 and late onset depression in Indian population. J Affect Disord 136:244–248

    Article  PubMed  CAS  Google Scholar 

  41. Nurnberger JI Jr, McInnis M, Reich W et al (2011) A high-risk study of bipolar disorder. Childhood clinical phenotypes as precursors of major mood disorders. Arch Gen Psychiatry 68:1012–1020

    Article  PubMed  Google Scholar 

  42. Kramer EJ, Kwong K, Lee E, Chung H (2002) Cultural factors influencing the mental health of Asian Americans. West J Med 176:227–231

    PubMed  Google Scholar 

  43. Chong S, Verma S, Vaingankar J, Chan Y, Wong L, Heng B (2007) Perception of the public towards the mentally ill in developed Asian country. Soc Psychiatry Psychiatr Epidemiol 42:734–739

    Article  PubMed  Google Scholar 

  44. Kessler RC, Brown RL, Brown CL (1981) Sex differences in psychiatric help–seeking: evidence from four large-scale surveys. J Health Soc Behav 22:49–64

    Article  PubMed  CAS  Google Scholar 

  45. Danielsson UE, Bengs C, Samuelsson E, Johansson EE (2011) “My greatest dream is to be normal”: the impact of gender on the depression narratives of young Swedish men and women. Qual Health Res 21:612–624

    Article  PubMed  Google Scholar 

  46. Padgett DK, Patrick C, Burns BJ, Schlesinger HJ (1994) Ethnicity and the use of outpatient mental health services in a national insured population. Am J public Health 84(2):222–226. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615002/pdf/amjph00453-0064.pdf. Accessed on 20 Dec 2011

  47. Trudy AN, Velma AK (1992) Attributions of mental illness and judgments about help seeking among Japanese-American and White American students. J Couns Psychol 39:363–369

    Article  Google Scholar 

  48. Sellwood W, Tarrier N (1994) Demographic factors associated with extreme non-compliance in schizophrenia. Soc Psychiatry Psychiatr Epidemiol 29:172–177

    PubMed  CAS  Google Scholar 

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Acknowledgments

The study was funded by the Singapore Millennium Foundation and the Ministry of Health, Singapore.

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Authors and Affiliations

  1. Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747, Singapore

    Janhavi Ajit Vaingankar, Gurpreet Rekhi, Mythily Subramaniam, Edimansyah Abdin & Siow Ann Chong

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  1. Janhavi Ajit Vaingankar
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  2. Gurpreet Rekhi
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  3. Mythily Subramaniam
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  4. Edimansyah Abdin
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  5. Siow Ann Chong
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Correspondence to Janhavi Ajit Vaingankar.

Additional information

J. A. Vaingankar, G. Rekhi Joint first authors.

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Vaingankar, J.A., Rekhi, G., Subramaniam, M. et al. Age of onset of life-time mental disorders and treatment contact. Soc Psychiatry Psychiatr Epidemiol 48, 835–843 (2013). https://doi.org/10.1007/s00127-012-0601-y

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  • DOI: https://doi.org/10.1007/s00127-012-0601-y

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