ArticlesThe prognosis of common mental disorders in adolescents: a 14-year prospective cohort study
Introduction
Adolescence has long been regarded as a time of heightened emotional reactions.1, 2 More than a century ago, Stanley Hall delineated adolescence as a distinct life phase, in which emotional turbulence (or “sturm und drang”) was typical.1 Early psychoanalysts also viewed emotional turmoil as a universal feature of adolescence but without major implications for later mental health.3 These early views have been much debated in the past 40 years. The first systematic cross-sectional surveys of adolescents suggested that mood disturbances were neither inevitable nor universal.4 Far from resolving spontaneously, they tended to predict further distress in the short term.5 Moreover, studies in adults suggested that most functional mental disorders seem to begin before the age of 25 years, and often between 11 and 18 years of age.6 Later research in young adults with mental disorders also showed high rates of antecedent adolescent depressive and anxiety symptoms.7, 8 Adolescence has therefore come to be seen as a time of vulnerability and the point at which much of the disease burden from mental disorders emerges.9
However, the longer term implications of adolescent syndromes remain uncertain. A recent prospective study of mental health and behavioural problems through adolescence showed very high cumulative rates, with more than 60% of participants fulfilling criteria for at least one well-specified disorder in the Diagnostic and Statistical Manual of Mental Disorders at some point between the ages of 9 and 21 years, rising to over 80% if “not otherwise specified” diagnoses were included.10 Although the experience of a mental disorder seemed to be nearly universal at some point in adolescence, relatively few people were affected at any one point in time.10 In view of the increasing emphasis on early clinical intervention, understanding of prognosis is central to service planning.11 Similarly, an understanding of prognostic predictors has the potential to inform preventive and early intervention strategies. Some syndromes, such as deliberate self-harm and eating disorders, seem to be mainly limited to adolescence, with few persisting into adulthood.12, 13 So far, the prognosis of episodes of depression and anxiety in adolescents, the largest single contributors to disease burden in this age group, has not been described.
In this report, we use data from the Victorian Adolescent Health Cohort study—a 14-year study of health from the mid-teenage years to the late 20s. Specifically, we address two questions: how often do common mental disorders persist from adolescence to young adulthood? And what are the demographic, behavioural, and disorder characteristics that predict the continuation of such disorders into young adulthood?
Section snippets
Study participants
Between August, 1992, and January, 2008, we undertook a nine-wave cohort study of health in young people in the state of Victoria, Australia. At baseline, we selected a representative sample of mid-secondary school adolescents (aged 14–15 years), using a two-stage cluster sampling procedure. At stage one, we chose 45 schools at random from a stratified frame of government, Catholic, and independent schools, with a probability proportional to the number of students in each educational sector
Results
Figure 1 shows the flow of participants through the study. Table 1 shows estimates of the prevalence of adolescent prognostic factors and table 2 shows those for common mental disorders across adolescence and young adulthood. 236/821 boys (29%, 95% CI 25–32) and 498/929 girls (54%, 50–57) were cases (CIS-R ≥12) at least once during adolescence. Rates of persisting or recurrent adolescent disorder (two or more waves) were also higher in girls (342/929 [37%; 95% CI 34–40]) than in boys (119/821
Discussion
Our study confirms the very high prevalence of common mental disorders across adolescence and young adulthood. Almost a third of men and more than half of women had an episode of prominent depressive and anxiety symptoms at least once during mid-to-late adolescence. This finding is consistent with adolescence being a high-risk phase for the onset of common mental disorders. Most of those people with young adult disorders had been adolescent cases, a finding that was especially clear for female
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