Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies.
- Authors
- Solmi, Marco; Radua, Joaquim; Olivola, Miriam; Croce, Enrico; Soardo, Livia; Salazar de Pablo, Gonzalo; Il Shin, Jae; Kirkbride, James B; Jones, Peter; Kim, Jae Han; Kim, Jong Yeob; Carvalho, Andrè F; Seeman, Mary V; Correll, Christoph U; Fusar-Poli, Paolo
- Year
- 2022
- Journal
- Molecular psychiatry
- PMID
- 34079068
- DOI
- 10.1038/s41380-021-01161-7
- PMCID
- PMC8960395
Promotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11-34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7-16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9-25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14-29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15-23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17-48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20-41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20-34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20-33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21-46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18.
Meta-analytic median age at onset of mental disorders.The line indicates the median age at onset of mental disorders (ICD-11 diagnostic blocks or spectra above, specific mental disorders below), the bar indicates the 25th and 75th percentiles. ICD-11 blocks of mental disorders. Addiction disorders: disorders due to substance use or addictive behaviour, Anxiety and fear: anxiety and fear-related disorders, OCD related: obsessive-compulsive or related disorders, Schizophrenia spectrum disorders: schizophrenia-spectrum and primary psychotic disorders. ICD-11 specific mental disorders. ADHD attention deficit hyperactivity disorder, ASD: autism spectrum disorder, ATPD, acute and transient psychotic disorder; Binge eating: binge eating disorder, Bipolar disorder: bipolar or related disorders, GAD generalised anxiety disorder, OCD obsessive-compulsive disorder, Phobia: specific phobia, PTSD post-traumatic stress disorder, Separation anxiety: separation anxiety disorder, Social anxiety: social anxiety disorder.
Meta-analytic distribution of age of onset for any mental disorders.Meta-analytic epidemiological proportion (y-axis) and peak age at onset (red line) for any mental disorders in the general population, with 95%CIs (pink shadows).
Meta-analytic distribution of age of onset for specific mental disorders blocks.Meta-analytic epidemiological proportion (y-axis) and peak age at onset (red line) for neurodevelopmental, anxiety and fear-related, obsessive-compulsive related, and feeding or eating disorders (ICD-11 blocks) in the general population, with 95%CIs (pink shadows).
Meta-analytic distribution of age of onset for specific mental disorders blocks.Meta-analytic epidemiological proportion (y-axis) and peak age at onset (red line) for disorders due to substance use or addictive behaviour, personality, mood, and schizophrenia-spectrum and primary psychotic disorders (ICD-11 blocks) in the general population, with 95%CIs (pink shadows).
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| Debate: Urban-rural environments - which is better for mental health? Moving beyond urban-rural dichotomies in psychosis risk for young people. | Kirkbride JB | — | 2025 | → |
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| Finding the Prevalence of Autism in Female Mental Illness: Improving Child Development for an Underdiagnosed and Undertreated Population. | McCrossin R | — | 2025 | → |
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| Genomics of Bipolar Disorder: What the Clinician Needs to Know. | McQuillin A et al. | — | 2025 | → |
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| Utilizing structural MRI and unsupervised clustering to differentiate schizophrenia and Alzheimer's disease in late-onset psychosis. | Hojjati SH et al. | — | 2025 | → |
| Validating the Revised Child Anxiety and Depression Scale-Short Version (RCADS-25) in Chinese Preadolescents. | Lu S et al. | — | 2025 | → |
| Validity evidence for assessing social-emotional psychological strengths in Colombian adolescents using the SEHS-S. | Riaño-Hernández D et al. | — | 2025 | → |
| Veterans with co-occurring PTSD and BPD symptoms benefit from dialectical behavior therapy: effects of PTSD on BPD symptom trajectories. | Schreiber AM et al. | — | 2025 | → |
| Vulnerability and psychosocial impacts of extreme weather events among young people in Australia. | Ziou M et al. | — | 2025 | → |
| Weight discrimination and eating disorder symptoms in early adolescence: a prospective cohort study. | Nagata JM et al. | — | 2025 | → |
| What do they look for and what do they find? A coproduced qualitative study on young people's experiences of searching for mental health information online. | Loades ME et al. | — | 2025 | → |
| What is the relationship between individual and clusters of lifestyle behaviours during early adolescence with future youth mental health? a prospective cohort study. | Werneck AO et al. | — | 2025 | → |
| Why Young People With Eating Disorder Symptoms Do Not Seek Help-Exploring Barriers to Help-Seeking. | Stadler J et al. | — | 2025 | → |
| Will societal change improve mental health? Lessons from cohorts of adolescents in London and Tokyo. | Nemoto T et al. | — | 2025 | → |
| Within-person association between affect and physical activity related to depressive symptomatology: A systematic review and methodological reflections. | Vuuregge AH et al. | — | 2025 | → |
| Workplace gender composition and long-term sickness absence due to mental disorders: A retrospective cohort study. | Okura S et al. | — | 2025 | → |
| Young people's experiences of transition from child and adolescent mental health services to adult mental health services: A qualitative study. | Adanijo A et al. | — | 2025 | → |
| Young people's perspectives on integrating physical activity interventions into youth substance use treatment practice: a mixed-methods study. | Klamert L et al. | — | 2025 | → |
| Youth depression: An overview of genetic findings and the challenge of heterogeneity. | Thapar A et al. | — | 2025 | → |
| Youth Emotional Pathways to Mental Health Services: I Came to Foundry to "Remember What it Feels Like to Cry". | Ben-David S et al. | — | 2025 | → |
| Youth mental health crisis: A translational view of the COVID-19 pandemic. | Halldorsdottir T | — | 2025 | → |
| Youth, the New Adolescence: A Challenge and a Window of Opportunity for Early Mental Health Interventions. | Munsch S et al. | — | 2025 | → |
| A 10-Year Longitudinal Study of Brain Cortical Thickness in People with First-Episode Psychosis Using Normative Models. | Berthet P et al. | — | 2024 | → |
| Across the multiverse: exploring a diverse set of specifications related to cross-sectional and prospective associations between adolescent alcohol use and emotional problems. | Halladay J et al. | — | 2024 | → |
| Adolescent sleep and its disruption in depression and anxiety. | Chai R et al. | — | 2024 | → |
| Adverse outcomes and mortality in individuals with eating disorder-related electrolyte abnormalities in Ontario, Canada: a population-based cohort study. | Solmi M et al. | — | 2024 | → |
| Affirming schools, population-level data, and holistic public health are key to addressing mental ill-health and substance use disparities among gender and sexuality diverse young people in Australia and Aotearoa New Zealand. | Bailey S et al. | — | 2024 | → |
| A longitudinal birth cohort study of child maltreatment and mental disorders using linked statewide child protection and administrative health data for 83,050 Queensland residents from 1983 to 2014. | Kisely S et al. | — | 2024 | → |
| A never-ending story: The COVID-19 pandemic and the increase of hospital admissions for typical and atypical anorexia nervosa in children, adolescents and young adults in the post-pandemic era in Germany. | Herpertz-Dahlmann B et al. | — | 2024 | → |
| An open data for imaging acute aerobic exercise effects on brain and mind in emerging adulthood. | Ge LK et al. | — | 2024 | → |
| Anxiety symptoms are differentially associated with facial expression processing in boys and girls. | Doucet GE et al. | — | 2024 | → |
| Association between stressful life events and depression, anxiety, and quality of life among urban adolescents and young adults in Latin America. | Diez-Canseco F et al. | — | 2024 | → |
| Association between the levels of toxic heavy metals and schizophrenia in the population of Guangxi, China: A case-control study. | Shen B et al. | — | 2024 | → |
| Associations between mesolimbic connectivity, and alcohol use from adolescence to adulthood. | Morales AM et al. | — | 2024 | → |
| Associations of generalized anxiety and social anxiety symptoms with sleep duration, amount of intense exercise, and excessive internet use among adolescents. | Kajastus K et al. | — | 2024 | → |
| Atypical functional connectome is associated with low reflective functioning in incarcerated adolescents. | Derome M et al. | — | 2024 | → |
| Barriers and facilitators to identifying depression in adolescents: A cross-cultural qualitative study in Brazil, Nepal, and Nigeria. | Collins SA et al. | — | 2024 | → |
| Brain Reactivity and Vulnerability to Social Feedback Following Acute Stress in Early Adolescence. | Celen Z et al. | — | 2024 | → |
| Cannabinoids for treating psychiatric disorders in youth: a systematic review of randomized controlled trials. | Köck P et al. | — | 2024 | → |
| Cannabis use disorder: from neurobiology to treatment. | Le Foll B et al. | — | 2024 | → |
| Caregiving burden, depression, and anxiety in informal caregivers of people with mental illness in China: a cross-sectional survey. | Yao H et al. | — | 2024 | → |
| Characterising the anxiogenic network from functional connectivity analysis of the CO<sub>2</sub> challenge model. | Graham D et al. | — | 2024 | → |
| Childhood risk factors and clinical and service outcomes in adulthood in people with intellectual disabilities. | Perera B et al. | — | 2024 | → |
| Clinical and functional outcomes at 7-year follow-up of children presenting putative antecedents of schizophrenia at age 9-12 years. | Cullen AE et al. | — | 2024 | → |
| Depression, anxiety and self-esteem in adolescent girls with polycystic ovary syndrome: a systematic review and meta-analysis. | Li Y et al. | — | 2024 | → |
| Depression in childhood to early adulthood and respiratory health in early adulthood. | Wang G et al. | — | 2024 | → |
| Differential Impact of Adolescent or Adult Stress on Behavior and Cortical Parvalbumin Interneurons and Perineuronal Nets in Male and Female Mice. | Santos-Silva T et al. | — | 2024 | → |
| DNA methylation as a possible mechanism linking childhood adversity and health: results from a 2-sample mendelian randomization study. | Schuurmans IK et al. | — | 2024 | → |
| Do school-based prevention programs impact co-occurring alcohol use and psychological distress during adolescence? | Halladay J et al. | — | 2024 | → |
| Drug-induced megacolon in schizophrenia: a pharmacovigilance study of antipsychotic medications from the Japanese Adverse Drug Event database: a disproportionality analysis. | Tokumitsu K et al. | — | 2024 | → |
| Effectiveness of a multi-component sleep-mood group intervention on improving insomnia in university students - a pilot randomized controlled trial. | Pape LM et al. | — | 2024 | → |
| Effects of Early Stress Exposure on Anxiety-like Behavior and <i>MORC1</i> Expression in Rats. | Mundorf A et al. | — | 2024 | → |
| Evaluating a computer-based body exposure paradigm for the treatment of body image disturbance in adolescent Anorexia Nervosa: effects on the attentional bias and emotions. | Sasse L et al. | — | 2024 | → |
| Family-based interventions versus standard care for people with schizophrenia. | Chien WT et al. | — | 2024 | → |
| Feasibility and acceptability of a multi-component mental wellbeing program for young high-performance athletes in Australian Rules Football. | Hoare E et al. | — | 2024 | → |
| Gender-specific correlates for suicide mortality in people with schizophrenia: a 9-year population-based study. | Pan Z et al. | — | 2024 | → |
| Illuminating Hypomania in Early Adolescence: Associations Between Dark-Side and Bright-Side Hypomania, Insomnia, and Health-Related Quality of Life. | Eisenhut L et al. | — | 2024 | → |
| Improving Child and Adolescent Mental Health: A Bibliometric Analysis of Related Intervention Studies. | Chen G et al. | — | 2024 | → |
| Infant BMI trajectories as early risk markers of poor psychosocial health in preadolescence. | Gallagher C et al. | — | 2024 | → |
| Intolerance of uncertainty enhances adolescent fear generalization in both perceptual-based and category-based tasks: fNIRS studies. | Zhou X et al. | — | 2024 | → |
| Longitudinal Associations Between Anxiety and Depressive Symptoms in Adolescence, Early Adulthood, and Old Age: Cross-Lagged Panel Network Analyses. | Wang S et al. | — | 2024 | → |
| Longitudinal study examining the relationship between physical activity and psychiatric hospitalizations in canadian adolescents and young adults utilizing record linkage. | Fahim M et al. | — | 2024 | → |
| Long-term consequences of COVID-19 on mental and physical health in young adults. | Falbová D et al. | — | 2024 | → |
| Lurasidone uses and dosages in Spain: RETROLUR, a real-world retrospective analysis using artificial intelligence. | Mora F et al. | — | 2024 | → |
| Materiality of evidence-based policy making for child and adolescent psychiatry in Japan. | Usami M | — | 2024 | → |
| Mental health in the virtual world: Are we ready for the metaverse era? | Mamede T et al. | — | 2024 | → |
| Mentalizing the Clinical High-Risk for Psychosis Model: A Staged Intervention Framework. | Debbané M et al. | — | 2024 | → |
| MS analysis of the plasma metabolome reveals major changes of amino acid and energy metabolism for early-onset schizophrenia. | Zhou M et al. | — | 2024 | → |
| Multimodal neural correlates of childhood psychopathology. | Royer J et al. | — | 2024 | → |
| Natural language processing in mixed-methods evaluation of a digital sleep-alcohol intervention for young adults. | Griffith FJ et al. | — | 2024 | → |
| Neither seen nor heard: the evidence gap on the effect of covid-19 on mental health in children. | Ford T et al. | — | 2024 | → |
| Olanzapine for young PEople with aNorexia nervosa (OPEN): results of a feasibility study. | Said O et al. | — | 2024 | → |
| Personality changes during adolescence predict young adult psychosis proneness and mediate gene-environment interplays of schizophrenia risk. | Antonucci LA et al. | — | 2024 | → |
| Prediction of adolescent depression from prenatal and childhood data from ALSPAC using machine learning. | Yoo A et al. | — | 2024 | → |
| Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders. | Reilly EE et al. | — | 2024 | → |
| Prenatal Exposure to MAM Impairs mPFC and Hippocampal Inhibitory Function in Mice during Adolescence and Adulthood. | He Z et al. | — | 2024 | → |
| Prevalence and risk of psychiatric disorders in young people: prospective cohort study exploring the role of childhood trauma (the HUNT study). | Stangeland H et al. | — | 2024 | → |
| Prevalence of autistic traits and their relationships with other psychopathological domains in young adults seeking psychiatric attention: a cluster analysis. | Demartini B et al. | — | 2024 | → |
| Prevention of Emotional Problems in Spanish Schoolchildren: Effectiveness of the Super Skills Multimedia Program to Promote Social-Emotional Skills. | Orgilés M et al. | — | 2024 | → |
| Primary care approach to first-episode psychosis. | Mok TJL et al. | — | 2024 | → |
| Protecting Emergency Responders with Evidence-Based Interventions (PEREI): protocol for a randomized controlled trial for early career emergency responders, significant others, and supervisors. | Nixon RDV et al. | — | 2024 | → |
| Protocol of the Nutritional, Psychosocial, and Environmental Determinants of Neurodevelopment and Child Mental Health (COINCIDE) study. | Lobo E et al. | — | 2024 | → |
| Psychological distress and academic success: a two-year study comparing the outcome of two online interventions at a university counseling and consultation service in Italy. | Mammarella S et al. | — | 2024 | → |
| Psychological well-being and the reversal of childhood overweight and obesity in the UK: a longitudinal national cohort study. | Putra IGNE et al. | — | 2024 | → |
| Psychometric properties of the Turkish version of the universal mental health literacy scale for adolescents. | Ciydem E et al. | — | 2024 | → |
| Psychotherapy 2.0 - Application context and effectiveness of sensor technology in psychotherapy with children and adolescents: A systematic review. | Alt AK et al. | — | 2024 | → |
| Psychotic experiences and psychological distress in adolescents: an examination of longitudinal bidirectional effects across sex. | Fekih-Romdhane F et al. | — | 2024 | → |
| Pubertal hormones and mental health problems in children and adolescents: a systematic review of population-based studies. | Luo D et al. | — | 2024 | → |
| Puberty and NeuroDevelopment in adolescents (PANDA): a study protocol. | Bray KO et al. | — | 2024 | → |
| Puberty interacts with sleep and brain network organization to predict mental health. | Mitchell ME et al. | — | 2024 | → |
| Public engagement to refine a whole-school intervention to promote adolescent mental health. | Bonell C et al. | — | 2024 | → |
| Risk of psychiatric hospitalization in low-income youth: longitudinal findings from the 100 Million Brazilian Cohort. | Toledo L et al. | — | 2024 | → |
| Scalable Technology for Adolescents and Youth to Reduce Stress in the Treatment of Common Mental Disorders in Jordan: Protocol for a Randomized Controlled Trial. | Akhtar A et al. | — | 2024 | → |
| Schizophrenia spectrum disorders in children and adolescents: Clinical, phenomenological, diagnostic, and prognostic features across subtypes. | Poletti M et al. | — | 2024 | → |
| Screen time and mental health: a prospective analysis of the Adolescent Brain Cognitive Development (ABCD) Study. | Nagata JM et al. | — | 2024 | → |
| Sex-specific maladaptive responses to acute stress upon in utero THC exposure are mediated by dopamine. | Valeria S et al. | — | 2024 | → |
| Shared experiences, shared support: A qualitative study on the importance of relatability in interpersonal relationships for youth mental health in South Africa. | Henry J et al. | — | 2024 | → |
| Social Anxiety and Depression in Portuguese and Spanish Adolescents: The Moderating Role of Emotional Intelligence. | Soto-Sanz V et al. | — | 2024 | → |
| Social processes as the missing link: cross-sectionally testing a conceptual model on social mediators of early psychopathological development. | Achterhof R et al. | — | 2024 | → |
| Social support and self-efficacy during early adolescence: Dual impact of protective and promotive links to mental health and wellbeing. | Cherewick M et al. | — | 2024 | → |
| The double disadvantage faced by adolescents from low socioeconomic backgrounds with mental health problems affects earnings up to mid-life. | Evans-Lacko S et al. | — | 2024 | → |
| The economic burden of schizophrenia spectrum disorders: clinical and functional correlates and predictors of direct costs. A retrospective longitudinal study. | Calzavara Pinton I et al. | — | 2024 | → |
| The Indirect Effects of Fathers' Parenting Style and Parent Emotion Regulation on the Relationship Between Father Self-Efficacy and Children's Mental Health Difficulties. | Carbone A et al. | — | 2024 | → |
| The Lancet Commission on self-harm. | Moran P et al. | — | 2024 | → |
| The mediating role of behavioral risk factors in the pathway between childhood disadvantage and adult psychological distress in a Finnish employee cohort. | Salmela J et al. | — | 2024 | → |
| The neurodevelopmental regulatory role and clinical value of hsa-circ-CORO1C-hsa-miR-708-3p-JARID2 + LNPEP axis in early-onset schizophrenia. | Li Z et al. | — | 2024 | → |
| The role of eco-anxiety in the presentation of bulimia nervosa: a case report. | Runfola CD et al. | — | 2024 | → |
| Trajectories of Inflammation in Youth and Risk of Mental and Cardiometabolic Disorders in Adulthood. | Palmer ER et al. | — | 2024 | → |
| Trends in Adolescent Health: Successes and Challenges From 2010 to the Present. | Beckwith S et al. | — | 2024 | → |
| Understanding the transdiagnostic mechanisms underlying emerging psychopathology in adolescence: study protocol of a 1-year prospective epidemiological (EMERGE) study. | Häfeli XA et al. | — | 2024 | → |
| Unraveling the complexities of adolescent depression: A call for action. | Zhang Y et al. | — | 2024 | → |
| Where do neurodevelopmental conditions fit in transdiagnostic psychiatric frameworks? Incorporating a new neurodevelopmental spectrum. | Michelini G et al. | — | 2024 | → |
| With Apologies to Monty Python: Is Every Cell Sacred? | Price ME et al. | — | 2024 | → |
| Young adults, particularly young women, account for an increasingly large share of Dutch mental healthcare expenditure over the period between 2015 and 2021. | Dijkstra L et al. | — | 2024 | → |