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Prognosis of Adolescent Mental Disorders

February 10, 2014

Prognosis of Adolescent Mental Disorders

  1. Alain Joffe, MD, MPH, FAAP

In a prospective study, about 40% of males and 50% of females with a single episode of adolescent anxiety or depression went on to have similar problems as young adults.

  1. Alain Joffe, MD, MPH, FAAP

Most adults with common mental health problems retrospectively report first symptoms before age 24. Investigators in Australia analyzed data from a 14-year adolescent cohort study to examine prospectively the persistence of adolescent onset depression and anxiety into young adulthood.

Of 1900 adolescents from 44 secondary schools assessed five times during adolescence and three times in young adulthood, 1750 had analyzable data (mean age at enrollment, 14.5 years; 53% girls). Anxiety and depression during adolescence were assessed using the Revised Clinical Interview Schedule (CIS-R; threshold for clinical intervention, score ≥12). Results include:

  • 54% of girls and 29% of boys scored ≥12 on the CIS-R at least once during adolescence.

  • 37% of girls and 14% of boys experienced persistence or recurrence of symptoms during adolescence.

  • From ages 21–29, 52% of women and 31% of men met diagnostic criteria at least once on adult measures of anxiety or depression.

  • During the 14-year study, 76% of female adult cases and 62% male adult cases were first identified before age 21.

  • 65% of girls and 47% of boys with an adolescent disorder had at least one additional episode after age 21; 31% and 18%, respectively, had more than one adult episode.

  • More girls (54%) than boys (39%) with a single episode during adolescence went on to have an adult disorder; the percentages increased to 70% and 55%, respectively, in those with two or more adolescent episodes.

  • Prevalence of adult disorders peaked at age 24 (women, 27%; men, 15%), falling to 15% and 7%, respectively by age 29.

Comment

This prospective study confirms that most adult anxiety and depression begins in adolescence, but it also provides some optimism for affected families. Fewer than half of adolescents with a single episode during adolescence went on to have similar problems as young adults, and for those who did, the prevalence of adult disorders decreased from ages 21 to 29. Since the risk for persistence to adulthood is greater for adolescents with more than one episode, prompt recognition and treatment of the first episode might lead to fewer cases after age 21.

  • Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication Editorial boards Adolescent Medicine: State of the Art Reviews; JAMA Pediatrics

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