Many common mental disorders of adolescence persist into adulthood

By Will Boggs MD

NEW YORK (Reuters Health) - Although more than half of the common mental disorders faced by adolescents resolve without consequence, many persist into adulthood, according to results from a 14-year study.

"Treat emotional problems in teenagers seriously," advised study co-author Dr. George C. Patton, in an email to Reuters Health. "Many recover, but for many it is the beginning of an ongoing mental disorder. What happens for a young person around this first episode is likely to make a big difference as to which path the problem takes."

A recent study showed that more than 60% of individuals fulfilled criteria for at least one mental disorder at some point between the ages of nine and 21 years, but the longer term implications of these syndromes remain uncertain.

Dr. Patton, from the University of Melbourne in Australia, and colleagues used data from the Victorian Adolescent Health Consort study, a 14-year study of health from the mid-teenage years to the late 20s, to investigate how often common mental disorders persist from adolescence to young adulthood and what characteristics might predict their persistence.

Most participants were evaluated with the revised Clinical Interview Schedule, the Composite International Diagnostic Interview, or the General Health Questionnaire.

About 29% of boys (236/821) and 54% of girls (498/929) had "an episode of prominent depressive and anxiety symptoms at least once during mid-to-late adolescence," the authors reported

One in 6 men (18%) and nearly a third of women (31%) had adolescent disorders that persisted into young adulthood, and among these, 55% of men and 70% of women had the disorder continuously from adolescence to young adulthood.

As for the question of recurrence, 47% of male participants and 65% of female participants with an adolescent disorder had at least one further episode in young adulthood.

Across the 14-year study, 38% of male cases and 24% of female cases of common mental disorders were first identified in young adulthood, according to the January 16th online report in The Lancet.

Individuals with two or more waves of adolescent disorder were more than three times as likely to have the adolescent disorder continue into young adulthood as were individuals with a single adolescent episode.

Female participants had higher risks for ongoing disorders than did male participants, and parental separation or divorce predicted adolescent disorders persisting into young adulthood. In contrast, high-risk adolescent alcohol use was associated with lower odds of persistent mental disorder.

In a model based on the data, levels of persistent mental disorder were lower in the transition from young adulthood to adulthood than in the transition from adolescence to young adulthood.

"Given the extent of social influences on neural systems implicated in adolescent emotional development, the resolution of many disorders by the late 20s gives grounds for optimism about the scope for prevention of recurrence," the researchers say. "Early clinical interventions that shorten the duration of episodes have the potential to reduce the later life disease burden from these disorders."

"One of the main messages is that these problems are very common, almost universal, but there is a real risk of them becoming entrenched, particularly in females and we think in those with a fair bit of social instability," Dr. Patton said. "So the message is one of taking emotional problems in adolescents seriously and where they persist for more than a few weeks getting an assessment from a family physician or a clinical psychologist."

Dr. Patton added, "One of the positive points was that there was an overall improvement in teen-onset mental health problems as these young people reached their late twenties. That may be things like moving out of home, marriage, parenthood, employment beginning to have a positive effect on their mental health."

Dr. Olga Eyre and Dr. Anita Thapar from Cardiff University School of Medicine in the UK wrote a commentary that accompanied this report. Dr. Eyre told Reuters Health by email, "There is evidence regarding the sorts of treatments that help with adolescent mental disorders such as anxiety and depression, but it is less clear whether these would prevent recurrence of mental disorder in adulthood. The authors of the paper suggest that treatment aimed at shortening adolescent episodes might improve long-term outcomes for some, although this needs to be tested."

"In short," Dr. Eyre said, "it is not possible to draw definite conclusions about what is likely to be most successful in preventing the recurrence of adolescent mental disorders in adulthood. More work is required on identifying those at greatest risk of recurrence, then testing existing early intervention/prevention programs, especially their long-term benefits."

"Although it is difficult to know for certain who will have difficulties later on and what will prove the most effective way of preventing this recurrence, early identification and treatment of mental disorders in adolescence is important to alleviate the distress and impairment experienced by individuals with mental health difficulties and their families," Dr. Eyre concluded.

SOURCES: http://bit.ly/1bdpddI and http://bit.ly/1deaJtS

Lancet 2014.

(c) Copyright Thomson Reuters 2014. Click For Restrictions - http://about.reuters.com/fulllegal.asp