Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.
Level 4 - case-series / case-control
Nationally representative cross-sectional survey evaluating lifetime prevalence and retrospective age of onset.
PubMed 15939837 · doi:10.1001/archpsyc.62.6.593
What was done
Face-to-face household survey conducted between February 2001 and April 2003 as part of the National Comorbidity Survey Replication. A nationally representative sample of 9,282 English-speaking US adults aged 18 and older were interviewed using the fully structured World Health Organization Composite International Diagnostic Interview (CIDI) to assess lifetime prevalence and age-of-onset distributions for DSM-IV anxiety, mood, impulse-control, and substance use disorders.
What was found
Lifetime prevalence was 46.4% for any disorder, 28.8% for anxiety disorders, 24.8% for impulse-control disorders, 20.8% for mood disorders, and 14.6% for substance use disorders. Median age of onset was 11 years for anxiety and impulse-control disorders, 20 years for substance use disorders, and 30 years for mood disorders. Half of all lifetime cases started by age 14 years and 75% by age 24 years. Projected lifetime risk at age 75 years was 50.8%. Lifetime prevalence estimates were higher in more recent cohorts compared to earlier cohorts.
Why it matters
This study demonstrates that mental disorders affect nearly half the adult population and predominantly emerge during childhood and adolescence. These findings underscore the critical importance of targeting prevention and early intervention efforts toward youth.
Limits
The study relied on retrospective recall to determine age of onset, introducing potential recall and telescoping biases. The sample was restricted to English-speaking non-institutionalized adults aged 18 years and older, excluding institutionalized populations, homeless individuals, non-English speakers, and current youth. Diagnoses were derived from fully structured lay interviews rather than clinical evaluations.
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