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)