Epidemiology of Mental

Disorders in Young People

George Patton Centre for Adolescent Health ,

University of Melbourne

Some facts…….

Rank Males Females TotalCause DALYs % totaCause DALYs % totaCause DALYs % tot

('00,000) ('00,000) ('00,000)10-24 years

1 Road traffic accidents 186 7.8 Unipolar depressive diso 230 9.8 Unipolar depressive diso 387 8.22 Unipolar depressive diso 156 6.6 Schizophrenia 93 4.0 Road traffic accidents 254 5.43 Violence 138 5.8 Bipolar disorder 87 3.7 Schizophrenia 193 4.14 Alcohol use disorders 125 5.3 Abortion 86 3.7 Bipolar disorder 177 3.85 Schizophrenia 100 4.2 HIV/AIDS 76 3.2 Violence 163 3.56 Bipolar disorder 90 3.8 Road traffic accidents 69 2.9 Alcohol use disorders 141 3.07 Self-inflicted injuries 70 3.0 Self-inflicted injuries 64 2.7 HIV/AIDS 140 3.08 HIV/AIDS 65 2.7 Maternal sepsis 63 2.7 Self-inflicted injuries 134 2.89 Tuberculosis 64 2.7 Lower respiratory infecti 61 2.6 Tuberculosis 121 2.6

10 Asthma 63 2.7 Panic disorder 60 2.6 Lower respiratory infect 121 2.6

Leading specific causes of DALYs in 10 to 24 year olds globally

Prevalent Disability in Young Australians

Incidence of suicide in males 20-24 across Europe and Central Asia

Variation in incidence of suicide in males 20-24 across Europe and Central Asia

Summary of Headline Epi Stats

• Huge burden of disease due to mental disorders in adolescents

• Mental disorder is almost a universal experience

• Variation geographically in mental disorder and consequences

• ? Increase in teen mental disorder over time

1.Puberty & Mental Health 2.Prognosis of Teen Mental

Disorders

Two important questions

1.Puberty & Mental Health 2.Prognosis of Teen Mental

Disorders

8 9 10 11 12 13 14 15 16 17 18 years

Pubertal Cascade

Adrenarche

8 9 10 11 12 13 14 15 16 17 18 years

Pubertal Cascade

Gonadarche

Adrenarche

8 9 10 11 12 13 14 15 16 17 18 years

Pubertal Cascade

Gonadarche

Growth spurt

Oxytocin system

Adrenarche

And what else?

I

II

III

IV

V

Early

Mid

Late

Mental disorders commoner from puberty • Depression - anxiety syndromes • Deliberate self-harm • Substance abuse • Eating disorders • Dysmorphophobia • Psychotic symptoms • Functional somatic disorders • Pain syndromes eg migraine

0

5

10

15

20

25

30

35

I/II III IV/V

12 yrs13 yrs14 yrs15 yrs

Substance abuse by pubertal stage

Mental disorders commoner from puberty • Depression - anxiety syndromes • Deliberate self-harm • Substance abuse • Eating disorders • Dysmorphophobia • Psychotic symptoms • Functional somatic disorders • Pain syndromes eg migraine

Self harm by pubertal stage

0

2

4

6

8

10

I-III IV/V I-III IV/V

%

Males Females

Depressive symptoms & pubertal stage in girls

0

5

10

15

20

25

30

35

40

I/II III IV/V

Wave 1Wave 2Wave 3

Tanner stage

%

T1 T2

Predicting New Depression at Puberty

Odds Ratio for late puberty 1.8 (1.1, 2.9) Odds Ratio for late puberty

1.3 (0.5, 3.1) Poor emotional regulation

1.8 (1.4, 2.4)

T1 T2

Predicting Persisting Depression at Puberty

Odds Ratio for late puberty 2.4 (1.2, 4.7)

Family Conflict (OR 1.6) /Bullying (OR 2.1)

Puberty: Activating or Organising? -.7

5-.5

-.25

0.2

5.5

.75

4/5 6/7 8/9 10/11 4/5 6/7 8/9 10/11

Girls Boys

No indication of puberty - mean Z score and 95% CI Barely onset Definitely onset

Psy

chos

ocia

l hea

lth s

umm

ary

Child's age in years

1.Puberty & Mental Health 2.Prognosis of Teen

Mental Disorders

Sturm und Drang

G Stanley Hall

‘An interruption of peaceful growth … a steady

equilibrium is in itself abnormal… adolescence

resembles other emotional upsets … merges almost imperceptibly into almost all the mental illnesses’

Anna Freud

“Adolescent turmoil is a fact, not a fiction, but its psychiatric importance has probably been over-estimated”

Rutter et al

phase

survey wave 1 wave 2 wave 3 wave 4 wave 5 wave 6 wave 7 wave 8 wave 9year 1992 1993 1993 1994 1994 1995 1998 2001/03 2006/08

mean age 14.9 yr 15.5 yr 15.9 yr 16.4 yr 16.8 yr 17.4 yr 20.7 yr 24.1 yr 29.1 yrsample n 898 1727 1697 1628 1575 1530 1601 1520 1501

design Total intended sample = 1037( w1) + 995 (w2) = 2032

ascertainment 96% (1943) of sample participated at least once in waves 1-6

Adolescent Young adult

2 entry points

Victorian Adolescent Health Cohort Study

0

1

2

3

4

5

6

7

% s

elf-h

arm

15·9 16·4 16·8 17·4 20·7 24·1 29·0Average age

Available case Sensitivity

Self-harm in Young Victorians across 15 years

Continuity of teen eating disorders YA Substance abuse and High Depression Anxiety

YA Low weight and High Depression Anxiety

Continuity of common mental disorder between adolescence & young adulthood: Males

Two thirds of males with any teen disorder do not have a further episode 60% of adult male disorders

had no teen history

Continuity of common mental disorder between adolescence & young adulthood

58% of females with any teen disorder have a further episode

Two thirds of adult female disorder have a teen history

Predictors of persistence of single episodes into young adults

OR1

Female sex 2.9 (1.6 - 5.1)

Parenta l divorce /separation 1.2 (0.65 - 2.1)

Adolescent measures

Any antisocia l behaviour none 1.4 (0.70 - 3.0)

Any high ri sk a lcohol use none 0.41 (0.21 - 0.82)

Any cigarette smoking none 1.7 (0.94 - 3.0)

Any cannabis use none 1.1 (0.56 - 2.1)

(95% CI)

Background factors

One occurrence in waves 2 TO 6 (N=280)

N (%) OR2

Poor concentration none 105 (38) 1

one or two 127 (45) 1.1 (0.50 - 2.5)

definite 48 (17) 1.1 (0.36 - 3.4)

Worry none 46 (16) 1

one or two 116 (41) 1.2 (0.30 - 4.9)

definite 118 (42) 3.9 (1.1 - 14)

Anxiety symptoms none 93 (33) 1

one or two 131 (47) 1.6 (0.65 - 4.2)

definite 56 (20) 3.8 (1.3 - 11)

Depressive symptoms none 80 (29) 1

one or two 146 (52) 1.1 (0.44 - 2.9)

definite 54 (19) 2.5 (0.88 - 7.1)

Depressive ideas none 51 (18) 1

one or two 120 (43) 1.2 (0.36 - 3.8)

definite 109 (39) 2.5 (0.82 - 7.5)

Fatigue none 46 (16) 1

one or two 87 (31) 0.40 (0.13 - 1.3)

definite 147 (53) 0.77 (0.29 - 2.0)

Irritablity none 51 (18) 1

one or two 149 (53) 1.1 (0.38 - 3.1)

definite 80 (29) 1.9 (0.63 - 5.8)

Obsessive & compulsive symptoms none 130 (46) 1

one or two 76 (27) 0.60 (0.23 - 1.6)

definite 74 (26) 1.2 (0.49 - 2.8)

Sleep problems none 90 (32) 1

one or two 134 (48) 0.53 (0.23 - 1.2)

definite 56 (20) 0.63 (0.23 - 1.7)

Somatic symptoms none 149 (53) 1

one or two 91 (33) 0.69 (0.30 - 1.6)

definite 40 (14) 0.59 (0.17 - 2.0)

(95% CI)

Transient teen disorder: young adult outcomes

Natural history of common mental disorder

Natural history of common mental disorder

Natural history of common mental disorder

Revisting emotional turmoil

• Window of heightened vulnerability • Emotional problems very common esp girls • Related behavioural problems common and

mostly transient • Many but not all disorders resolve by young

adulthood

Persisting disorder characteristics

• Recurrent or persistent for at least 6 months • Females more than males • Worry and obsessional symptoms • Persisting symptoms esp of depression

ideation and anxiety

My colleagues

Lyndal Bond John Carlin Rico Catalano Carolyn Coffey Louisa Degenhardt Fiona Gore Wayne Hall Sheryl Hemphill Rebecca Mathews Paul Moran Susan Sawyer John Toumbourou Russell Viner Theo Vos

Prevalence of an axis I mental disorder in females 18-24 across European Countries

N (%) OR2

Poor concentration none 194 (49) 1

one wave 111 (28) 1.0 (0.53 - 2.0)

>one wave 95 (24) 2.3 (1.2 - 4.5)

Worry none 89 (22) 1

one wave 119 (30) 2.5 (1.1 - 5.6)

>one wave 192 (48) 5.1 (2.3 - 11)

Anxiety symptoms none 152 (38) 1

one wave 126 (32) 1.4 (0.71 - 2.7)

>one wave 122 (31) 2.7 (1.4 - 5.2)

Depressive symptoms none 210 (53) 1

one wave 106 (27) 1.8 (0.95 - 3.5)

>one wave 84 (21) 3.2 (1.6 - 6.3)

Depressive ideas none 98 (25) 1

one wave 108 (27) 2.9 (1.3 - 6.5)

>one wave 194 (49) 3.7 (1.8 - 7.6)

Fatigue none 49 (12) 1

one wave 67 (17) 1.4 (0.49 - 4.1)

>one wave 284 (71) 1.4 (0.56 - 3.5)

Irritablity none 132 (33) 1

one wave 114 (29) 1.5 (0.78 - 3.1)

>one wave 154 (39) 1.9 (0.98 - 3.6)

Obsessive & compulsive symptoms none 126 (32) 1

one wave 122 (31) 1.3 (0.63 - 2.5)

>one wave 152 (38) 3.5 (1.8 - 6.7)

Sleep problems none 172 (43) 1

one wave 122 (31) 1.2 (0.68 - 2.3)

>one wave 106 (27) 1.3 (0.66 - 2.5)

Somatic symptoms none 205 (51) 1

one wave 114 (29) 1.3 (0.67 - 2.3)

>one wave 81 (20) 2.3 (1.2 - 4.6)

(95% CI)

Persisting teen disorder: young adult outcomes

Self-harm in early adolescence Pubertal stagePre/Early (n= 395)Mid (n=1239)Late/Complete (n=1893)

1.02.1 (0.7, 6.3)4.3 (1.3, 14)

Age 0.51 (0.34, 0.78)

Grade 9 (vs. 7)Males (n=850)

Females (n=902)1.3 (0.4, 1.6)3.0 (1.1, 7.8)

Self-harm in early adolescence

Pubertal stagePre/Early (n= 395)Mid (n=1239)Late/Complete (n=1893)

1.02.1 (0.7, 6.3)4.3 (1.3, 14)

Age 0.51 (0.34, 0.78)

Grade 9 (vs. 7)Males (n=850)

Females (n=902)1.3 (0.4, 1.6)3.0 (1.1, 7.8)