Epidemiology and Psychiatric Sciences

Special Articles

Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles

G. de Girolamoa1 c1, J. Dagania1, R. Purcella2, A. Cocchia3 and P. D. McGorrya2

a1 IRCCS Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy

a2 Department of Psychiatry, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Australia

a3 A.O. Ospedale Niguarda Ca' Granda, Programma 2000, Via Livigno, 3, 20128 Milan, Italy


Purpose of review. In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention.

Recent findings. The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes.

Summary. Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.

(Received July 01 2011)

(Revised October 04 2011)

(Accepted October 28 2011)

(Online publication December 13 2011)


c1 Address for correspondence: Giovanni de Girolamo, M.D., IRCCS Fatebenefratelli, Via Pilastroni 4, Brescia, Italy. (Email: gdegirolamo@fatebenefratelli.it)