MENTAL ILLNESS: TREATMENT : Research Supports Calls for Earlier Attention to Disorders
Several serious mental disorders traditionally viewed as illnesses of adulthood are more likely to begin during adolescence than any other time of life, a study by the National Institute of Mental Health has found.
The study supports the belief of many experts that greater emphasis should be placed on diagnosing and treating mental disorders among people under age 20.
“These findings underscore the importance of detecting and treating mental illnesses and substance abuse early, before they ruin a person’s life,” said NIMH director Lewis L. Judd. “Greater attention to mental health in childhood and adolescence could prevent a great deal of misery and economic loss nationwide.”
The study provides the basis for an NIMH-sponsored public hearing today at the Hyatt Regency hotel in downtown Los Angeles. The hearing is designed to focus greater attention on childhood mental disorders. Compared to research on adults with mental disorders, few studies have examined the development of problems in childhood or how to best diagnose and treat young people, according to experts.
An estimated 7.5 million people under the age of 20 are thought to have serious mental disorders--about 12% of all youths, NIMH officials report.
Experts at the hearing are expected to discuss the availability of mental health services for youths and review an NIMH plan recently submitted to Congress to increase funding for research on children and adolescents from $92.3 million this year to $283.3 million in 1995. Only one in five youths with mental disorders receives appropriate treatment, officials say.
But according to the NIMH study, published in the June issue of the Archives of General Psychiatry, people under 20 are in the peak age range for developing depression, obsessive-compulsive disorders, phobias and substance abuse disorders.
“Until about the late ‘70s, people weren’t even convinced children or adolescents could develop mental disorders,” said Kimberly Christie Burke, a statistician at the NIMH and co-author of the work. “In this paper, we tried to calculate the probability of developing a disorder at a given age. We found the peak (age for developing) some disorders clearly occurs in childhood.”
The probability study was based on data from a five-city NIMH survey of mental health disorders among 20,000 adults from 1980 to 1984.
Adults were asked specific questions to determine if they had ever suffered from a mental health disorder that had impaired their lives or had required treatment. Subjects were asked to recall their age at the onset of the disorder.
The study revealed:
Serious depression is likely to first occur at one of two peak times--15 to 19 years or 25 to 29 years.
The most likely age for alcohol and drug abuse disorders is 15 to 19.
The peak time of onset of phobias is between 5 and 9 years.
Panic disorder can strike during adolescence but most commonly first occurs in the late 20s.
Obsessive-compulsive disorder, in which individuals are driven to perform meaningless rituals that interfere with daily life, often begins as early as 15 to 19 years among females.
Calculating the probability of disorder onset for various age groups is considered more accurate than previous studies, which relied on computing the average age of onset. Those estimates can be misleading, said Dr. Jack Burke, co-author of the study.
One weakness with the new study is that it relies on the subjects’ memory to recall when their symptoms began. But researchers used strict criteria to define each disorder, Jack Burke said.
“An effort is made to be sure the symptoms persisted for a minimum of two weeks, for depression. For other disorders, it’s longer than that,” he said. “These are really serious, clinical disorders. We’re not dealing with the kinds of ups and downs we normally experience.”
Researchers do not know why some mental disorders are more likely to begin in childhood and adolescence, Jack Burke said.
“Most people feel these serious disorders are the result of genetic factors and whatever environmental or stress-related factors there might be,” he said. “At a stress-related period of life, people might be more vulnerable to the onset. We don’t know that. It’s just a hypothesis.”
But, he said, improved knowledge about how and why the disorders occur could prevent suffering in adulthood.
“We’re learning that these disorders like depression tend to be recurrent. We hope if we can treat them early and effectively they won’t recur later in life.”
Part of the NIMH hearing, which will be co-chaired by Judd and actress Patty Duke, a longtime mental health advocate, will be devoted to increasing public awareness and improving treatment.
“We’re trying to place a much greater priority on the child and adolescent disorders,” said Jack Burke. “We may know these disorders are common, but we’re very concerned about the lack of services for people and the difficulty in having disorders recognized.”
