The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study

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• 作者：Prof George C Patton ; MD^a ; ^e ; ^{george.patton@rch.org.au" class="auth_mail} ; Carolyn Coffey ; PhD^e ; Helena Romaniuk ; PhD^a ; ^f ; Prof Andrew Mackinnon ; PhD^b ; Prof John B Carlin ; PhD^a ; ^c ; ^f ; Prof Louisa Degenhardt ; PhD^c ; ^g ; Craig A Olsson ; PhD^a ; ^d ; ^e ; ^h ; Paul Moran ; MDⁱ
• 刊名：The Lancet
• 出版年：19-25 April, 2014
• 年：2014
• 卷：383
• 期：9926
• 页码：1404-1411
• 全文大小：311 K

文摘

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Summary

Background

Most adults with common mental disorders report their first symptoms before 24 years of age. Although adolescent anxiety and depression are frequent, little clarity exists about which syndromes persist into adulthood or resolve before then. In this report, we aim to describe the patterns and predictors of persistence into adulthood.

Methods

We recruited a stratified, random sample of 1943 adolescents from 44 secondary schools across the state of Victoria, Australia. Between August, 1992, and January, 2008, we assessed common mental disorder at five points in adolescence and three in young adulthood, commencing at a mean age of 15路5 years and ending at a mean age of 29路1 years. Adolescent disorders were defined on the Revised Clinical Interview Schedule (CIS-R) at five adolescent measurement points, with a primary cutoff score of 12 or higher representing a level at which a family doctor would be concerned. Secondary analyses addressed more severe disorders at a cutoff of 18 or higher.

Findings

236 of 821 (29%; 95% CI 25-32) male participants and 498 of 929 (54%; 51-57) female participants reported high symptoms on the CIS-R (鈮?2) at least once during adolescence. Almost 60% (434/734) went on to report a further episode as a young adult. However, for adolescents with one episode of less than 6 months duration, just over half had no further common mental health disorder as a young adult. Longer duration of mental health disorders in adolescence was the strongest predictor of clear-cut young adult disorder (odds ratio [OR] for persistent young adult disorder vs none 3路16, 95% CI 1路86-5路37). Girls (2路12, 1路29-3路48) and adolescents with a background of parental separation or divorce (1路62, 1路03-2路53) also had a greater likelihood of having ongoing disorder into young adulthood than did those without such a background. Rates of adolescent onset disorder dropped sharply by the late 20s (0路57, 0路45-0路73), suggesting a further resolution for many patients whose symptoms had persisted into the early 20s.

Interpretation

Episodes of adolescent mental disorder often precede mental disorders in young adults. However, many such disorders, especially when brief in duration, are limited to the teenage years, with further symptom remission common in the late 20s. The resolution of many adolescent disorders gives reason for optimism that interventions that shorten the duration of episodes could prevent much morbidity later in life.

Funding

Australia's National Health and Medical Research Council.