Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles.
OBJECTIVE
In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention.


RESULTS
The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes.


CONCLUSIONS
Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.
IRCCS Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy. gdegirolamo@fatebenefratelli.it
G
G
de Girolamo
J
J
Dagani
R
R
Purcell
A
A
Cocchi
P D
PD
McGorry
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy; D002648:Child; D003430:Cross-Sectional Studies; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000628:therapy; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult