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Original Investigation |

Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort ONLINE FIRST

Diana Paksarian, PhD1; Lihong Cui, MS1; Jules Angst, MD2; Vladeta Ajdacic-Gross, PhD2; Wulf Rössler, MD3,4; Kathleen R. Merikangas, PhD1
[+] Author Affiliations
1Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland
2Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
3Institute of Psychiatry, Laboratory of Neuroscience, University of São Paulo, São Paulo, Brazil
4Collegium Helveticum, University of Zurich and Swiss Technical Institute, Zurich, Switzerland
JAMA Psychiatry. Published online September 07, 2016. doi:10.1001/jamapsychiatry.2016.1921
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Importance  Epidemiologic evidence indicates that most of the general population will experience a mental health disorder at some point in their lives. However, few prospective population-based studies have estimated trajectories of risk for mental disorders from young through middle adulthood to estimate the proportion of individuals who experience persistent mental disorder across this age period.

Objectives  To describe the proportion of the population who experience persistent mental disorder across adulthood and to estimate latent trajectories of disorder risk across this age period.

Design, Setting, and Participants  A population-based, prospective cohort study was conducted between 1979 and 2008 in the canton of Zurich, Switzerland. A stratified random sample of 591 Swiss citizens was enrolled in 1978 at ages 19 years (men) and 20 years (women); 7 interviews were performed during a 29-year period. Men were sampled from military enrollment records and women from electoral records. From those initially enrolled, participants with high levels of psychiatric symptoms were oversampled for follow-up. Data analysis was performed from July 28, 2015, to June 8, 2016.

Main Outcomes and Measures  Latent trajectories, estimated using growth mixture modeling, of past-year mood/anxiety disorder (ie, major depressive episode, phobias, panic, generalized anxiety disorder, and obsessive-compulsive disorder), substance use disorder (ie, drug abuse or dependence and alcohol abuse or dependence), and any mental disorder (ie, any of the above) assessed during in-person semistructured interviews at each wave. Diagnoses were based on DSM-III, DSM-III-R, and DSM-IV criteria.

Results  Of the 591 participants at baseline, 299 (50.6%) were female. Persistent mental health disorder across multiple study waves was rare. Among 252 individuals (42.6%) who participated in all 7 study waves, only 1.2% met criteria for disorder every time. Growth mixture modeling identified 3 classes of risk for any disorder across adulthood: low (estimated prevalence, 40.0%; 95% CI, −8.7% to 88.9%), increasing-decreasing (estimated prevalence, 15.3%; 95% CI, 1.0% to 29.6%), and increasing (estimated prevalence, 44.7%; 95% CI, −0.9% to 90.1%). Although no classes were characterized by persistently high disorder risk, for those in the increasing-decreasing class, risk was high from the late 20s to early 40s. Sex-specific models indicated 4 trajectory classes for women but only 3 for men.

Conclusions and Relevance  Persistently high mental health disorder risk across 3 decades of adulthood was rare in this population-based sample. Identifying early determinants of sex-specific risk trajectories would benefit prevention efforts.

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Figure 1.
Persistence of Past-Year Mental Health Disorder by Number of Waves of Study Participation

Any disorder (A), mood/anxiety disorder (B), and substance use disorder (C) at 0 through 7 study waves by number of waves of participation. Fifty-one individuals participated in 1 wave, 50 in 2 waves, 44 in 3 waves, 55 in 4 waves, 64 in 5 waves, 75 in 6 waves, and 252 in all 7 waves.

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Figure 2.
Predicted Prevalence of Past-Year Mental Health Disorder Across Age

Weighted predicted prevalence of any disorder (A), mood/anxiety disorder (B), and substance use disorder (C) shown by age and sex. Error bars indicate 95% CId.

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Figure 3.
Latent Trajectories of Past-Year Mental Health Disorder Risk by Disorder Type

Growth mixture models of any disorder, using a 3-class model (A); mood/anxiety disorder, using a 3-class model (B); and substance use disorder, using a 2-class model (C) across age.

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Figure 4.
Latent Trajectories of Past-Year Mental Health Disorder Risk by Sex

Growth mixture models of any disorder in men, using a 3-class model (A), and women, using a 4-class model (B), across age.

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