This cross-sectional study investigated distribution, sociodemographic correlates, and health outcomes in early versus late age of onset (AOO) of mood, anxiety, and alcohol use disorders in Singapore.
The Composite International Diagnostic Interview established lifetime diagnoses of major depressive, bipolar, generalized anxiety, obsessive compulsive and alcohol use disorders in a representative sample of residents aged 18 years and over (n = 6126). The AOO of the individual and any mental disorders were classified into early and late onset using median values as cut-offs. Data included socio-demographic and health background, health utility score, and productivity losses. Multivariable logistic regression analysis was conducted to assess sociodemographic correlates of early versus late AOO of any mental disorder while linear regression analysis investigated the associations between AOO of individual disorders with health utility score and productivity loss.
Respondents’ mean (SD) age was 45.6 (16.5) years, comprising 50.5% women and majority of Chinese ethnicity (75.8%). The median AOO for any of the five studied disorders was 21 years (IQR: 15–29). Lowest AOO was observed for obsessive compulsive disorder (Median: 14, IQR: 11–26). Those aged 35 years and over (versus 18–34) were less likely to have earlier AOO [35–49 years (OR: 0.287; 95% CI: 0.154–0.534); 50–64 years (OR:0.156; 95% CI: 0.068–0.361) and 65 and over (OR:0.112; 95% CI:0.027–0.461)], while Malay ethnicity (versus Chinese) (OR: 2.319; 95% CI: 1.384–3.885) and being never married (versus married) (OR: 2.731; 95% CI: 1.493–4.993) were more likely to have early AOO for any mental disorder. Sample with early (versus late) AOO had a lower health utility score (β = − 0.06,95% CI: − 0.08 to − 0.03) and higher number of days cut down on the type of work (β = 1.61,95% CI: 0.12–3.10) in those with any mental disorders.
This study showed that half of the adults with mood, anxiety or alcohol use disorders in Singapore experienced their illness onset by 21 years of age. Early AOO is associated with sociodemographic background and poor health outcomes. Prevention, early detection, and interventions to improve health outcomes in mental disorders should consider the sociodemographic profile and age at first onset of symptoms in the population.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Study data and materials are not available due to funding guidelines. However, part of the data/aggregate data can be available upon reasonable request from the corresponding author.
These are available from the corresponding author upon reasonable request.
Jones PB (2013) Adult mental health disorders and their age at onset. Br J Psychiatry Suppl 54:s5-10. https://doi.org/10.1192/bjp.bp.112.119164
Caspi A, Houts RM, Ambler A et al (2020) Longitudinal assessment of mental health disorders and comorbidities across 4 decades among participants in the Dunedin Birth Cohort Study. JAMA Netw Open 3(4):e203221
Brakoulias V, Starcevic V, Belloch A et al (2017) Comorbidity, age of onset and suicidality in obsessive-compulsive disorder (OCD): an international collaboration. Compr Psychiatry 76:79–86
Xiao L, Zhou JJ, Feng Y et al (2019) Does early and late life depression differ in residual symptoms, functioning and quality of life among the first-episode major depressive patients. Asian J Psychiatr 47:101843. https://doi.org/10.1016/j.ajp.2019.101843
Lijster JM, Dierckx B, Utens EM et al (2017) The age of onset of anxiety disorders. Can J Psychiatry 62(4):237–246. https://doi.org/10.1177/0706743716640757
Schat A, van Noorden MS, Noom MJ et al (2016) A cluster analysis of early onset in common anxiety disorders. J Anxiety Disord 44:1–8. https://doi.org/10.1016/j.janxdis.2016.09.001
Alpert JE, Fava M, Uebelacker LA et al (1999) Patterns of axis I comorbidity in early-onset versus late-onset major depressive disorder. Biol Psychiatry 46(2):202–211
Johannessen EL, Andersson HW, Bjørngaard JH, Pape K (2017) Anxiety and depression symptoms and alcohol use among adolescents - a cross sectional study of Norwegian secondary school students. BMC Public Health 17(1):494. https://doi.org/10.1186/s12889-017-4389-2
Cho H, Hallfors DD, Iritani BJ (2007) Early initiation of substance use and subsequent risk factors related to suicide among urban high school students. Addict Behav 32(8):1628–1639
Bauer M, Glenn T, Alda M et al (2015) Influence of birth cohort on age of onset cluster analysis in bipolar I disorder. Eur Psychiatry 30(1):99–105. https://doi.org/10.1016/j.eurpsy.2014.10.005
Falk DE, Yi HY, Hilton ME (2008) Age of onset and temporal sequencing of lifetime DSM-IV alcohol use disorders relative to comorbid mood and anxiety disorders. Drug Alcohol Depend 94(1–3):234–245. https://doi.org/10.1016/j.drugalcdep.2007.11.022
Scott KM, Von Korff M, Angermeyer MC et al (2011) Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen Psychiatry 68(8):838–844. https://doi.org/10.1001/archgenpsychiatry.2011.77
Kessler RC, Angermeyer M, Anthony JC et al (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6(3):168–176
Vaingankar JA, Rekhi G, Subramaniam M, Abdin E, Chong SA (2013) Age of onset of life-time mental disorders and treatment contact. Soc Psychiatry Psychiatr Epidemiol 48(5):835–843. https://doi.org/10.1007/s00127-012-0601-y
Kraus C, Kadriu B, Lanzenberger R, Zarate CA Jr, Kasper S (2019) Prognosis and improved outcomes in major depression: a review. Transl Psychiatry 9(1):127. https://doi.org/10.1038/s41398-019-0460-3
Jaul E (2017) Age-related diseases and clinical and public health implications for the 85 years old and over population. Front Public Health 5:335. https://doi.org/10.3389/fpubh.2017.00335.eCollection
Scott KM, Wells JE, Angermeyer M et al (2010) Gender and the relationship between marital status and first onset of mood, anxiety and substance use disorders. Psychol Med 40(9):1495–1505. https://doi.org/10.1017/S0033291709991942
Hakulinen C, Musliner KL, Agerbo E (2019) Bipolar disorder and depression in early adulthood and long-term employment, income, and educational attainment: a nationwide cohort study of 2,390,127 individuals. Depress Anxiety 36(11):1080–1088. https://doi.org/10.1002/da.22956
Lê Cook B, Carson N, Alegria M (2010) Assessing racial/ethnic differences in the social consequences of early-onset psychiatric disorder. J Health Care Poor Underserved 21(2 Suppl):49–66. https://doi.org/10.1353/hpu.0.0289
Verdura Vizcaíno EJ, Fernández-Navarro P, Petry N, Rubio G, Blanco C (2014) Differences between early-onset pathological gambling and later-onset pathological gambling: data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Addiction 109(5):807–813
Weinberger AH, Gbedemah M, Martinez AM, Nash D, Galea S, Goodwin RD (2018) Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychol Med 48(8):1308–1315
Fu TS, Lee CS, Gunnell D, Lee WC, Cheng AT (2013) Changing trends in the prevalence of common mental disorders in Taiwan: a 20-year repeated cross-sectional survey. Lancet 381(9862):235–241
Silva M, Loureiro A, Cardoso G (2016) Social determinants of mental health: a review of the evidence. Eur J Psychiatry 30(4):259–292
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(6):593–602
Almeida OP, Fenner S (2002) Bipolar disorder: similarities and differences between patients with illness onset before and after 65 years of age. Int Psychogeriatr 14(3):311–322
Taylor S (2011) Early versus late onset obsessive-compulsive disorder: evidence for distinct subtypes. Clin Psychol Rev 31(7):1083–1100. https://doi.org/10.1016/j.cpr.2011.06.007
Berndt ER, Koran LM, Finkelstein SN et al (2000) Lost human capital from early-onset chronic depression. Am J Psychiatry 157(6):940–947
Korten NC, Comijs HC, Lamers F, Penninx BW (2012) Early and late onset depression in young and middle aged adults: differential symptomatology, characteristics and risk factors? J Affect Disord 138(3):259–267. https://doi.org/10.1016/j.jad.2012.01.042
https://www.singstat.gov.sg/-/media/files/publications/population/population2019.pdf (Accessed 3 Mar 2020)
Subramaniam M, Abdin E, Vaingankar JA et al (2019) Tracking the mental health of a nation: prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiol Psychiatr Sci 29:e29. https://doi.org/10.1017/S2045796019000179
Kessler RC, Ustün 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 13(2):93–121
Wee HL, Cheung YB, Fong KY, Luo N, Machin D, Thumboo J (2004) Are english- and chinese-language versions of the SF-6D equivalent? A comparison from a population-based study. Clin Ther 26(7):1137–1148
Abdin E, Chong SA, Seow E et al (2019) A comparison of the reliability and validity of SF-6D, EQ-5D and HUI3 utility measures in patients with schizophrenia and patients with depression in Singapore. Psychiatry Res 274:400–408. https://doi.org/10.1016/j.psychres.2019.02.077
de Girolamo G, Dagani J, Purcell R, Cocchi A, McGorry PD (2012) Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiol Psychiatr Sci 21(1):47–57
Kovacs M, Gatsonis C (1994) Secular trends in age at onset of major depressive disorder in a clinical sample of children. J Psychiatr Res 28(3):319–329
Subramaniam M, Abdin E, Vaingankar JA, Chong SA (2012) Obsessive–compulsive disorder: prevalence, correlates, help-seeking and quality of life in a multiracial Asian population. Soc Psychiatry Psychiatr Epidemiol 47(12):2035–2043
www.ncss.gov.sg/Our-Initiatives/Beyond-The-Label (Accessed 3 Mar 2020)
Grant BF, Goldstein RB, Saha TD et al (2015) Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry 72(8):757–766
Manthey J, Gual A, Jakubczyk A et al (2016) Alcohol use disorders in Europe: a comparison of general population and primary health care prevalence rates. J Subst Use 21(5):478–484
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
Subramaniam M, Abdin E, Seow E et al (2020) Prevalence, socio-demographic correlates and associations of adverse childhood experiences with mental illnesses: results from the Singapore Mental Health Study. Child Abuse Negl 103:104447
Jamieson D, Broadhouse KM, Lagopoulos J, Hermens DF (2020) Investigating the links between adolescent sleep deprivation, fronto-limbic connectivity and the onset of mental disorders: a review of the literature. Sleep Med 66:61–67
Korczak DJ, Goldstein BI (2009) Childhood onset major depressive disorder: course of illness and psychiatric comorbidity in a community sample. J Pediatr 155(1):118–123
Lavori PW, Warshaw M, Klerman G, Mueller TI, Leon A, Rice J, Akiskal H (1993) Secular trends in lifetime onset of MDD stratified by selected sociodemographic risk factors. J Psychiatr Res 27(1):95–109
Leach LS, Butterworth P (2012) The effect of early onset common mental disorders on educational attainment in Australia. Psychiatry Res 199(1):51–57. https://doi.org/10.1016/j.psychres.2012.03.040
Ramsawh HJ, Weisberg RB, Dyck I, Stout R, Keller MB (2011) Age of onset, clinical characteristics, and 15-year course of anxiety disorders in a prospective, longitudinal, observational study. J Affect Disord 132(1–2):260–264. https://doi.org/10.1016/j.jad.2011.01.006
Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD (2011) Economic costs of excessive alcohol consumption in the US 2006. Am J Prev Med 41(5):516–524
Janszky I, Ahnve S, Lundberg I, Hemmingsson T (2010) Early-onset depression, anxiety, and risk of subsequent coronary heart disease: 37-year follow-up of 49,321 young Swedish men. J Am Coll Cardiol 56(1):31–37. https://doi.org/10.1016/j.jacc.2010.03.033
Liebenberg L (2020) Reconsidering interactive resilience processes in mental health: implications for child and youth services. J Community Psychol. https://doi.org/10.1002/jcop.22331
Enns J, Holmqvist M, Wener P, Halas G, Rothney J, Schultz A, Goertzen L, Katz A (2016) Mapping interventions that promote mental health in the general population: a scoping review of reviews. Prev Med 87:70–80. https://doi.org/10.1016/j.ypmed.2016.02.022
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(3):177–185
Rodwell L, Romaniuk H, Nilsen W, Carlin JB, Lee KJ, Patton GC (2018) Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training. Psychol Med 48(5):861–871. https://doi.org/10.1017/S0033291717002434
Manchia M, Maina G, Carpiniello B et al (2017) Clinical correlates of age at onset distribution in bipolar disorder: a comparison between diagnostic subgroups. Int J Bipolar Disorders 5(1):28
Davey CG, McGorry PD (2019) Early intervention for depression in young people: a blind spot in mental health care. Lancet Psychiatry 6(3):267–272. https://doi.org/10.1016/S2215-0366(18)30292-X
Choo CC, Chew PKH, Ho CS (2018) Quality of life in patients with a major mental disorder in Singapore. Front Psychiatry 9:727. https://doi.org/10.3389/fpsyt.2018.00727.eCollection
Van Der Gaag M, Webber M (2008) Measurement of individual social capital. In: Kawachi I, Subramanian S, Kim D (eds) Social Capital and Health. Springer
Hysenbegasi A, Hass SL, Rowland CR (2005) The impact of depression on the academic productivity of university students. J Mental Health Policy Econ 8(3):145
Ang I, Stratton J (1995) The Singapore way of multiculturalismwestern concepts/Asian Cultures. Sojourn J Soc Iss Southeast Asia 10(1):65–89
The study was funded by the Ministry of Health Singapore and Temasek Foundation.
Conflicts of interest
Authors do not have any competing or conflicts of interest to declare.
The study was approved by the National Healthcare Group’s Domain Specific Review Board and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Relevant national laws on research on human research subjects have been observed.
Written informed consent was obtained from all respondents and their parents or legal guardians for those aged under 21 years.
About this article
Cite this article
Vaingankar, J.A., Chong, S.A., Abdin, E. et al. Early age of onset of mood, anxiety and alcohol use disorders is associated with sociodemographic characteristics and health outcomes in adults: results from a cross-sectional national survey. Soc Psychiatry Psychiatr Epidemiol 56, 1835–1846 (2021). https://doi.org/10.1007/s00127-021-02070-4