'Given the enormous personal and societal burdens of mental disorders, these observations should lead us to direct a greater part of our thinking about public health interventions to the child and adolescent years and ... to focus on early interventions.'

Ronald C. Kessler, Ph.D., of Harvard Medical School and colleagues based their findins on an analysis of data from the National Comorbidity Survey Replication (NCS-R). Their report is published in the June issue of Archives of General Psychiatry.

Half of All Cases Start by Age 14

Half of all lifetime cases start by age 14 years and three fourths by age 24 years.

Median age of onset is much earlier for anxiety and impulse-control disorders (11 years for both) than for substance use (20 years) and mood disorders (30 years), the researchers found.

Lifetime prevalence for the different classes of disorders were: anxiety disorder, 28.8 percent; mood disorders, 20.8 percent; impulse-control disorders, 24.8 percent; substance use disorders, 14.6 percent and lifetime prevalence for any disorder, 46.4 percent.

Earlier Intervention Urged

"The NCS-R results clearly document that mental disorders are highly prevalent; that lifetime prevalence is, if anything, underestimated; that age-of-onset distribution for most of the disorders considered herein [is] concentrated in a relatively narrow age range during the first two decades of life; and that later-onset disorders occur, in large part, as temporally secondary comorbid conditions," the authors note.

"Given the enormous personal and societal burdens of mental disorders, these observations should lead us to direct a greater part of our thinking about public health interventions to the child and adolescent years and -- with appropriately balanced considerations of potential risks and benefits -- to focus on early interventions aimed at preventing the progression of primary disorders and the onset of comorbid disorders," they conclude.