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Original Investigation |

A Comprehensive Nationwide Study of the Incidence Rate and Lifetime Risk for Treated Mental Disorders

Carsten Bøcker Pedersen, DrMedSc1,2,3; Ole Mors, PhD3,4; Aksel Bertelsen, MD4; Berit Lindum Waltoft, MSc1,3; Esben Agerbo, DrMedSc1,2,3; John J. McGrath, MD5,6; Preben Bo Mortensen, DrMedSc1,2,3; William W. Eaton, PhD7
[+] Author Affiliations
1National Centre for Register-Based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
2Centre for Integrated Register-Based Research, Aarhus University, Aarhus, Denmark
3The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
4Research Department P, Aarhus University Hospital, Risskov, Denmark
5Queensland Brain Institute, The University of Queensland, St Lucia, Australia
6Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Australia
7Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Psychiatry. 2014;71(5):573-581. doi:10.1001/jamapsychiatry.2014.16.
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Importance  Understanding the epidemiologic profile of the life course of mental disorders is fundamental for research and planning for health care. Although previous studies have used population surveys, informative and complementary estimates can be derived from population-based registers.

Objective  To derive comprehensive and precise estimates of the incidence rate of and lifetime risk for any mental disorder and a range of specific mental disorders.

Design, Setting, and Participants  We conducted a follow-up study of all Danish residents (5.6 million persons), to whom all treatment is provided by the government health care system without charge to the patient, from January 1, 2000, through December 31, 2012 (total follow-up, 59.5 million person-years). During the study period, 320 543 persons received first lifetime treatment in a psychiatric setting for any mental disorder; 489 006 persons were censored owing to death; and 69 987 persons were censored owing to emigration. Specific categories of mental disorders investigated included organic mental disorders, substance abuse disorders, schizophrenia, mood disorders, anxiety, eating disorders, personality disorders, mental retardation, pervasive developmental disorders, and behavioral and emotional disorders.

Exposures  Age and sex.

Main Outcomes and Measures  Sex- and age-specific incidence rates and cumulative incidences and sex-specific lifetime risks.

Results  During the course of life, 37.66% of females (95% CI, 37.52%-37.80%) and 32.05% of males (31.91%-32.19%) received their first treatment in a psychiatric setting for any mental disorder. The occurrence of mental disorders varied markedly between diagnostic categories and by sex and age. The sex- and age-specific incidence rates for many mental disorders had a single peak incidence rate during the second and third decades of life. Some disorders had a second peak in the sex- and age-specific incidence rate later in life.

Conclusions and Relevance  This nationwide study provides a first comprehensive assessment of the lifetime risks for treated mental disorders. Approximately one-third of the Danish population received treatment for mental disorders. The distinct signatures of the different mental disorders with respect to sex and age have important implications for service planning and etiologic research.

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Figure 1.
Sex- and Age-Specific Incidence Rates and Cumulative Incidences for Organic Mental Disorders, Substance Abuse Disorders, Schizophrenia, and Mood Disorders

A, Organic mental disorders (ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research [ICD-10-DCR] codes F00-F09). B, Mental and behavioral disorders due to psychoactive substance abuse (ICD-10-DCR codes F10-F19). C, Schizophrenia (ICD-10-DCR code F20). D, Mood disorders (ICD-10-DCR codes F30-F39). Limit lines show the 95% CIs in designated age ranges. Owing to the large sample size, the confidence intervals for the cumulative incidences are very close to the estimates and are therefore not shown. The incidence rates measure the number of persons per 10 000 person-years treated for the first time. The cumulative incidence measures the probability (per 100 persons) of being treated for the disorder before a given age. Because the cumulative incidences are estimated continuously with respect to age and the incidence rates are estimated in age intervals, the abscissa for the cumulative incidence measures the exact age, whereas the abscissa for the incidence rates measures the lowest cutoff point for the age interval. For example, the incidence rate of mood disorder for females aged 50-54.99 years is 19.60 (95% CI, 19.01-20.22) per 10 000 person-years at risk, and the cumulative incidence for females at 50 years of age is 10.89% (10.79%-10.98%).

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Figure 2.
Sex- and Age-Specific Incidence Rates and Cumulative Incidences for Eating Disorders, Mental Retardation, Pervasive Developmental Disorders, and Hyperkinetic Disorder

A, Eating disorders (ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research [ICD-10-DCR] code F50). B, Mental retardation (ICD-10-DCR code F70-F79). C, Pervasive developmental disorders (ICD-10-DCR code F84). D, Hyperkinetic disorder (ICD-10-DCR code F90). Limit lines show the 95% CIs in designated age ranges. Owing to the large sample size, the confidence intervals for the cumulative incidences are very close to the estimates and are therefore not shown. Incidence rates and cumulative incidence are described in Figure 1.

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