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

Molecular Psychiatry, Journal Year: 2021, Volume and Issue: 27(1), P. 281 - 295

Published: June 2, 2021

Promotion of good mental health, prevention, and early intervention before/at the onset disorders improve outcomes. However, range peak ages at for are not fully established. To provide robust, global epidemiological estimates age disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis birth cohort/cross-sectional/cohort studies, representative general population, reporting any ICD/DSM-mental identified in PubMed/Web Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were proportion individuals before 14, 18, 25, onset, disorder across International Classification Diseases 11 diagnostic blocks. Median specific was additionally investigated. Across 192 studies (n = 708,561) included, 25 34.6%, 48.4%, 62.5%, 14.5 years (k median interquartile (IQR) 11-34). For blocks, as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 21, median=12, IQR 7-16), anxiety/fear-related 38.1%, 51.8%, 73.3%, 73, 17, 9-25), obsessive-compulsive/related 24.6%, 45.1%, 64.0%, 20, 19, 14-29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 11, 15-23), conditions specifically associated stress 16.9%, 27.6%, 43.1%, 16, 30, 17-48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 58, 20-41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 36, 20-34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 6, 20-33), mood 2.5%, 11.5%, 34.5%, 79, 31, 21-46). No significant difference emerged by sex, or definition onset. mapped on time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis (17-22 years), followed schizophrenia, personality, panic alcohol (25-27 finally post-traumatic/depressive/generalized anxiety/bipolar/acute transient (30-35 overlap among groups no clustering. These results inform timing health promotion/preventive/early intervention, updating current system structured around child/adult service schism 18.

Language: Английский

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Designing and scaling up integrated youth mental health care

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(1), P. 61 - 76

Published: Jan. 11, 2022

Mental ill‐health represents the main threat to health, survival and future potential of young people around world. There are indications that this is a rising tide vulnerability need for care, trend has been augmented by COVID‐19 pandemic. It global public health crisis, which not only demands deep sophisticated understanding possible targets prevention, but also urgent reform investment in provision developmentally appropriate clinical care. Despite having greatest level need, benefit, adolescents emerging adults have worst access timely quality mental How crisis be addressed? Since start century, range co‐designed youth strategies innovations emerged. These from digital platforms, through new models primary care services potentially severe illness, must locally adapted according availability resources, workforce, cultural factors financing patterns. The fulcrum progress advent broad‐spectrum, integrated services. They represent blueprint beach‐head an overdue system reform. While resources will vary across settings, needs largely universal, underpin set fundamental principles design features. include establishing accessible, “soft entry” platform with support, where valued essential partners design, operation, management evaluation service. Global achieved date implementing highlighted these being accessed genuine substantial needs, they benefiting them, both their families highly satisfied receive. However, we still at base camp platforms scaled up globe, complemented and, crucially, more specialized complex persistent conditions, aligned transitional age (from approximately 12 25 years). globally focus elevated top priority health.

Language: Английский

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The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(1), P. 133 - 145

Published: Jan. 11, 2022

Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such waiting list). We performed an umbrella review recent meta-analyses randomized controlled (RCTs) psychotherapies for the main mental adults. selected formally assessed risk bias or quality studies, excluded comparators, used effect sizes target symptoms primary outcome. searched PubMed PsycINFO individual records Cochrane Library published between January 2014 March 2021 comparing with placebo treatment-as-usual (TAU), vs. head-to-head, combination psychotherapy pharmacotherapy either monotherapy. One hundred two meta-analyses, encompassing 3,782 RCTs 650,514 patients, were included, covering depressive disorders, anxiety post-traumatic stress disorder, obsessive-compulsive somatoform eating attention-deficit/hyperactivity substance use insomnia, schizophrenia spectrum bipolar disorder. Across treatments, majority small. A random meta-analytic evaluation reported by largest per disorder yielded standardized mean difference (SMD) 0.34 (95% CI: 0.26-0.42) 0.36 0.32-0.41) compared TAU. The SMD head-to-head comparisons was 0.11 -0.05 0.26). combined treatment monotherapy 0.31 0.19-0.44). Risk often high. After more than half century research, thousands millions invested funds, limited, suggesting ceiling research presently conducted. paradigm shift seems required achieve further progress.

Language: Английский

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The social determinants of mental health and disorder: evidence, prevention and recommendations

World Psychiatry, Journal Year: 2024, Volume and Issue: 23(1), P. 58 - 90

Published: Jan. 12, 2024

People exposed to more unfavourable social circumstances are vulnerable poor mental health over their life course, in ways that often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage health. Addressing these challenges is an imperative matter justice. In this paper we provide a roadmap address the determinants cause ill Relying as far possible on high-quality evidence, first map out literature supports causal link between later outcomes. Given breadth topic, focus most pervasive across those common major disorders. We draw primarily available evidence from Global North, acknowledging other global contexts will face both similar unique sets require equitable attention. Much our focuses groups who marginalized, thus multitude intersecting risk factors. These include refugees, asylum seekers displaced persons, well ethnoracial minoritized groups; lesbian, gay, bisexual, transgender queer (LGBTQ+) living poverty. then introduce preventive framework for conceptualizing disorder, can guide much needed primary prevention strategies capable reducing inequalities improving population Following this, review concerning candidate intervene interventions fall broadly within scope universal, selected indicated strategies, but also briefly important secondary tertiary promote recovery with existing Finally, seven key recommendations, framed around justice, constitute action research, policy public Adoption recommendations would opportunity advance efforts modifiable affect

Language: Английский

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Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(3), P. 393 - 414

Published: Sept. 8, 2022

Psychiatry has always been characterized by a range of different models and approaches to mental disorder, which have sometimes brought progress in clinical practice, but often also accompanied critique from within without the field. Psychiatric nosology particular focus debate recent decades; successive editions DSM ICD strongly influenced both psychiatric practice research, led assertions that psychiatry is crisis, advocacy for entirely new paradigms diagnosis assessment. When thinking about etiology, many researchers currently refer biopsychosocial model, this approach received significant critique, being considered some observers overly eclectic vague. Despite development evidence-based pharmacotherapies psychotherapies, current evidence points treatment gap research-practice health. In paper, after considering we discuss proposed novel perspectives recently achieved prominence may significantly impact research future: neuroscience personalized pharmacotherapy; statistical nosology, assessment research; deinstitutionalization community health care; scale-up psychotherapy; digital phenotyping therapies; global task-sharing approaches. We consider extent transitions practices reflect hype or hope. Our review indicates each contributes important insights allow hope future, provides only partial view, any promise paradigm shift field not well grounded. conclude there crucial advances that, despite progress, considerable need further improvements intervention; such will likely be specific shifts rather incremental iterative integration.

Language: Английский

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Incidence, prevalence, and global burden of schizophrenia - data, with critical appraisal, from the Global Burden of Disease (GBD) 2019

Molecular Psychiatry, Journal Year: 2023, Volume and Issue: 28(12), P. 5319 - 5327

Published: July 27, 2023

Language: Английский

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The lived experience of psychosis: a bottom‐up review co‐written by experts by experience and academics

World Psychiatry, Journal Year: 2022, Volume and Issue: 21(2), P. 168 - 188

Published: May 7, 2022

Psychosis is the most ineffable experience of mental disorder. We provide here first co-written bottom-up review lived psychosis, whereby experts by primarily selected subjective themes, that were subsequently enriched phenomenologically-informed perspectives. First-person accounts within and outside medical field screened discussed in collaborative workshops involving numerous individuals with psychosis as well family members carers, representing a global network organizations. The material was complemented semantic analyses shared across all collaborators cloud-based system. early phases (i.e., premorbid prodromal stages) found to be characterized core existential themes including loss common sense, perplexity lack immersion world compromised vital contact reality, heightened salience feeling something important about happen, perturbation sense self, need hide tumultuous inner experiences. episode stage denoted some transitory relief associated onset delusions, intense self-referentiality permeated self-world boundaries, internal noise, dissolution self social withdrawal. Core experiences later stages relapsing chronic) involved grieving personal losses, split, struggling accept constant chaos, new diagnosis an uncertain future. receiving psychiatric treatments, such inpatient outpatient care, interventions, psychological treatments medications, included both positive negative aspects, determined hope achieving recovery, understood enduring journey reconstructing personhood re-establishing lost bonds others towards meaningful goals. These findings can inform clinical practice, research education. one painful upsetting experiences, so dizzyingly alien our usual patterns life unspeakably enigmatic human.

Language: Английский

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Towards a youth mental health paradigm: a perspective and roadmap

Molecular Psychiatry, Journal Year: 2023, Volume and Issue: 28(8), P. 3171 - 3181

Published: Aug. 1, 2023

Abstract Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance this period for pathogenesis, diagnosis, treatment ill-health. This perspective addresses interactions risk protective factors brain development as key pillars accounting emergence psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis interventions are required reflect evolution emerging psychopathology, service models, knowledge exchange science practitioners. Taken together, transformative intervention paradigm research clinical care could significantly enhance health young people initiate shift prevention severe disorders.

Language: Английский

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Climate Change and Children’s Mental Health: A Developmental Perspective

Clinical Psychological Science, Journal Year: 2021, Volume and Issue: 10(4), P. 767 - 785

Published: Sept. 14, 2021

Climate change is a major global public-health challenge that will have wide-ranging impacts on human psychological health and well-being. Children adolescents are at particular risk because of their rapidly developing brain, vulnerability to disease, limited capacity avoid or adapt threats impacts. They also more likely worry about climate than any other age group. Drawing developmental life-course perspective, we show climate-change-related can additively, interactively, cumulatively increase psychopathology from conception onward; these effects already occurring; they constitute an important threat healthy development worldwide. We then argue monitoring, measuring, mitigating risks matter social justice crucial long-term investment in mental sciences. conclude with discussion conceptual measurement challenges outline research priorities going forward.

Language: Английский

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Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

World Psychiatry, Journal Year: 2023, Volume and Issue: 22(3), P. 366 - 387

Published: Sept. 15, 2023

Populations with common physical diseases – such as cardiovascular diseases, cancer and neurodegenerative disorders experience substantially higher rates of major depressive disorder (MDD) than the general population. On other hand, people living MDD have a greater risk for many diseases. This high level comorbidity is associated worse outcomes, reduced adherence to treatment, increased mortality, health care utilization costs. Comorbidity can also result in range clinical challenges, more complicated therapeutic alliance, issues pertaining adaptive behaviors, drug‐drug interactions adverse events induced by medications used mental disorders. Potential explanations prevalence above involve shared genetic biological pathways. These latter include inflammation, gut microbiome, mitochondrial function energy metabolism, hypothalamic‐pituitary‐adrenal axis dysregulation, brain structure function. Furthermore, several antecedents related social factors (e.g., socioeconomic status), lifestyle variables activity, diet, sleep), stressful live childhood trauma). Pharmacotherapies psychotherapies are effective treatments comorbid MDD, introduction interventions well collaborative models digital technologies provide promising strategies improving management. paper aims detailed overview epidemiology specific including bidirectional risk; pathways potentially implicated pathogenesis diseases; socio‐environmental that serve both protective factors; management prevention treatment. We conclude future directions emerging research optimal

Language: Английский

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