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Persistent mental disorders rare across 3 decades of adulthood

Recent findings indicated a small proportion of the population will experience persistent mental illness across multiple decades of adulthood, despite the potentially large proportion who may experience mental illness at some point in adulthood.

“There exists a sizable body of evidence regarding lifetime prevalence of mental health disorder in the population. Estimates from large-scale, cross-sectional population surveys that were initially criticized for being too high have been replicated and followed by even higher estimates of cumulative risk from prospective studies that repeatedly assessed mental health disorder over time,” Diana Paksarian, PhD, of the NIMH, Bethesda, Maryland, and colleagues wrote. “Although a few studies have estimated trajectories of mental health disorder from childhood or adolescence through early adulthood, to our knowledge, no studies have estimated risk trajectories past age 30 years to assess the degree of persistence across the early to later stages of adulthood.”

To assess trajectories of risk for mental disorders across adulthood and risk across this age period, researchers conducted a population-based, prospective cohort study of 591 Swiss citizens from 1979 to 2008. Study participants were enrolled at ages 19 and 20 years. Seven interviews were conducted to determine past-year mood and anxiety disorders or substance use disorders during the 29-year study period.

Persistent mental health disorders across multiple waves were rare. Among the 252 participants who completed all seven study waves, 1.2% met criteria for disorder every time.

Researchers found three classes of risk for any disorder during adulthood, including low (estimated prevalence = 40%; 95% CI, –8.7 to 88.9), increasing-decreasing (estimated prevalence = 15.3%; 95% CI, 1-29.6), and increasing (estimated prevalence = 44.7%; 95% CI, –0.9 to 90.1).

No classes were characterized by persistently high disorder risk. However, risk was high from age late 20s to early 40s among individuals in the increasing-decreasing class.

Sex-specific analysis indicated four trajectory classes for women but only three for men.

“Because of its sample size, the present study was underpowered to examine predictors of the probable course. However, from the etiologic perspective, the natural question is what determines these different trajectories,” Carlos Blanco, MD, PhD, of the National Institute on Drug Abuse, Bethesda, Maryland, and colleagues wrote in an accompanying editorial. “There is growing interest in and enthusiasm for precision medicine among researchers, clinicians, and society at large. Before this promise can be fully realized, it will be necessary to develop a ‘precision epidemiology’ that complements the estimation of population averages with a better understanding of the pathways to disease and the course of disorder for each individual. Without such a personalized, precise understanding of disorder epidemiology, it will be difficult to devise and deliver truly personalized treatments.” – by Amanda Oldt

Disclosure: Paksarian and Blanco report no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.