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      Towards a youth mental health paradigm: a perspective and roadmap

      review-article
      1 , 2 , , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 2 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 10 , 11 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 10 , 11
      Molecular Psychiatry
      Nature Publishing Group UK
      Psychiatric disorders, Diagnostic markers

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.

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          Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication.

          Little is known about lifetime prevalence or age of onset of DSM-IV disorders. To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
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            Research domain criteria (RDoC): toward a new classification framework for research on mental disorders.

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              Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

              (2022)
              Summary Background The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019. Methods In this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019. Findings Between 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5–105·9) to 125·3 million (93·0–163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4–3·9) to 4·9% (3·9–6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9–2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1–2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0–163·2; 14·6% [12·2–16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5–21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4–1869·5) per 100 000 population among males and 1703·3 (1261·5–2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America. Interpretation GBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative. Funding Bill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.
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                Author and article information

                Contributors
                peter.uhlhaas@charite.de
                Journal
                Mol Psychiatry
                Mol Psychiatry
                Molecular Psychiatry
                Nature Publishing Group UK (London )
                1359-4184
                1476-5578
                14 August 2023
                14 August 2023
                2023
                : 28
                : 8
                : 3171-3181
                Affiliations
                [1 ]Institute of Neuroscience and Psychology, University of Glasgow, ( https://ror.org/00vtgdb53) Glasgow, UK
                [2 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Child and Adolescent Psychiatry, , Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ; Berlin, Germany
                [3 ]Department of Psychiatry, The University of Melbourne, ( https://ror.org/01ej9dk98) Carlton, VIC Australia
                [4 ]Department of Psychiatry, National Institute of Mental Health and Neurosciences, ( https://ror.org/0405n5e57) Bangalore, India
                [5 ]Department of Psychiatry, McGill University, ( https://ror.org/01pxwe438) Montreal, QC Canada
                [6 ]GRID grid.38142.3c, ISNI 000000041936754X, Division of Digital Psychiatry and Department of Psychiatry, , Beth Israel Deaconess Medical Center, Harvard Medical School, ; Boston, MA USA
                [7 ]Department of Psychology, University of Oregon, ( https://ror.org/0293rh119) Eugene, OR USA
                [8 ]GRID grid.416868.5, ISNI 0000 0004 0464 0574, Office of the Director, , National Institute of Mental Health, ; Bethesda, MD USA
                [9 ]Department of Psychiatry, College of Medicine, University of Ibadan, ( https://ror.org/03wx2rr30) Ibadan, Nigeria
                [10 ]Orygen: National Centre of Excellence in Youth Mental Health, ( https://ror.org/02apyk545) Parkville, VIC Australia
                [11 ]Centre for Youth Mental Health, University of Melbourne, ( https://ror.org/01ej9dk98) Parkville, VIC Australia
                [12 ]Department of Psychiatry, University of Hong Kong, ( https://ror.org/02zhqgq86) Hong Kong, China
                [13 ]Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hostra/Northwell, ( https://ror.org/01ff5td15) Hempstead, NY USA
                [14 ]GRID grid.440243.5, ISNI 0000 0004 0453 5950, Department of Psychiatry, , The Zucker Hillside Hospital, Northwell Health, ; Glen Oaks, NY USA
                [15 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Centre for Psychiatric Neuroscience, Department of Psychiatry, , Lausanne University Hospital, ; Lausanne, Switzerland
                [16 ]Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, ( https://ror.org/0220mzb33) London, UK
                [17 ]ESRC Centre for Society and Mental Health, King’s College London, ( https://ror.org/0220mzb33) London, UK
                [18 ]Department of Psychiatry, The University of British Columbia, ( https://ror.org/03rmrcq20) Vancouver, BC Canada
                [19 ]Brain and Mind Centre, University of Sydney, ( https://ror.org/0384j8v12) Camperdown, NSW Australia
                [20 ]Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, ( https://ror.org/04drvxt59) Boston, MA USA
                [21 ]Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, RWTH, ( https://ror.org/04xfq0f34) Aachen, Germany
                [22 ]JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, ( https://ror.org/02nv7yv05) Jülich, Germany
                [23 ]Department of Psychiatry, Weill Cornell Cornell Medicall College, New York, NY USA
                [24 ]Departments of Pediatrics and Psychiatry, Brigham and Women’s Hospital/Harvard Medical School, ( https://ror.org/04b6nzv94) Boston, MA USA
                [25 ]Department of Psychiatry, University of Pittsburgh, ( https://ror.org/01an3r305) Pittsburgh, PA USA
                [26 ]GRID grid.413757.3, ISNI 0000 0004 0477 2235, Department of Psychiatry and Psychotherapy, , Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, ; Mannheim, Germany
                [27 ]CORE-Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, ( https://ror.org/035b05819) Hellerup, Denmark
                [28 ]GRID grid.38142.3c, ISNI 000000041936754X, McLean Hospital/Harvard Medical School, ; Belmont, MA USA
                [29 ]GRID grid.1058.c, ISNI 0000 0000 9442 535X, Centre for Adolescent Health, , Murdoch Children’s Research Institute, University of Melbourne, ; Parkville, VIC Australia
                [30 ]Departments of Psychiatry and Neuroscience, Faculty of Medicine and Centre Hospitalier Universitaire Sainte Justine, University of Montreal, ( https://ror.org/0161xgx34) Montreal, QC Canada
                [31 ]Department of Psychology and Psychiatry, University of Toronto, ( https://ror.org/03dbr7087) Toronto, ON Canada
                [32 ]Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, ( https://ror.org/01hynnt93) Mannheim, Germany
                [33 ]Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, ( https://ror.org/0220mzb33) London, UK
                [34 ]The John Hopkins Schizophrenia Center, Johns Hopkins University, ( https://ror.org/00za53h95) Baltimore, MD USA
                [35 ]Division of Service and Intervention Research, National Institute of Mental Health, ( https://ror.org/04xeg9z08) Bethesda, MD USA
                [36 ]Centre for Population Neuroscience and Stratified Medicine, ISTBI, Fudan University, ( https://ror.org/013q1eq08) Shanghai, China
                [37 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Psychiatry and Neuroscience, , Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ; Berlin, Germany
                [38 ]Department of Psychiatry, Yale University, ( https://ror.org/03v76x132) New Haven, CT USA
                [39 ]Program for Specialized Treatment Early in Psychosis (STEP), New Haven, VIC USA
                [40 ]Departments of Epidemiology and Psychiatry, Columbia University, ( https://ror.org/00hj8s172) New York, NY USA
                [41 ]GRID grid.413734.6, ISNI 0000 0000 8499 1112, New York State Psychiatric Institute, ; New York, NY USA
                [42 ]Department of Psychosis, Institute of Mental Health, ( https://ror.org/04c07bj87) Buangkok, Singapore
                [43 ]Duke-NUS Medical School, ( https://ror.org/02j1m6098) Singapore, Singapore
                [44 ]Department of Psychiatry, Beth Israel Deaconess Medical Center, ( https://ror.org/04drvxt59) Boston, MA USA
                [45 ]Laboratory for Cellular Neuropathology, McLean Hospital, ( https://ror.org/01kta7d96) Belmont, MA USA
                [46 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Psychiatry, , Harvard Medical School, ; Boston, MA USA
                [47 ]Department of Social and Behavioral Sciences, New York University, ( https://ror.org/0190ak572) New York, NY USA
                [48 ]Department of Epidemiology, Columbia University, ( https://ror.org/00hj8s172) New York, NY USA
                [49 ]School of Medicine, Faculty of Health, Deakin University, ( https://ror.org/02czsnj07) Melbourne, VIC Australia
                [50 ]Department of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, ( https://ror.org/027m9bs27) Manchester, UK
                Author information
                http://orcid.org/0000-0002-0892-2224
                http://orcid.org/0000-0003-1431-3852
                http://orcid.org/0000-0002-2252-9189
                http://orcid.org/0000-0002-5362-7937
                http://orcid.org/0000-0002-1086-6639
                http://orcid.org/0000-0003-1968-1646
                http://orcid.org/0000-0003-4174-2126
                http://orcid.org/0000-0001-8832-9895
                http://orcid.org/0000-0002-5945-888X
                http://orcid.org/0000-0001-9039-2615
                http://orcid.org/0000-0002-7108-9650
                http://orcid.org/0000-0001-5619-1123
                http://orcid.org/0000-0001-5039-8326
                http://orcid.org/0000-0003-1495-9338
                http://orcid.org/0000-0003-1401-3008
                http://orcid.org/0000-0002-7740-6469
                http://orcid.org/0000-0003-1556-2332
                http://orcid.org/0000-0001-7665-4826
                http://orcid.org/0000-0002-0401-9791
                Article
                2202
                10.1038/s41380-023-02202-z
                10618105
                37580524
                31a77b04-9b81-4f4e-bc33-229165155342
                © The Author(s) 2023

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 31 January 2023
                : 4 July 2023
                : 21 July 2023
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                © Springer Nature Limited 2023

                Molecular medicine
                psychiatric disorders,diagnostic markers
                Molecular medicine
                psychiatric disorders, diagnostic markers

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