The epidemiology of emerging adulthood psychiatric disorders William Copeland, PhD Center for Developmental Epidemiology Duke University Society for the Study of Emerging Adulthood October 2011
No conflicts of interest or financial disclosures Grant support from NIMH, NIDA, NARSAD, and W.T. Grant
Tenets of Epidemiological Approach Start early Everyone must be included Assessment is difficult Everything in context
Psychiatric Landscape of EA What s normal and abnormal? Are there different pathways? How did they get here? What is missing?
GSMS
Total Assessments GSMS Assessment Schedule 1200 1000 800 600 400 200 0 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 25 Age
Emerging Adult disorders Panic disorder Generalized anxiety disorder OCD Social phobia Major depression Antisocial Personality disorder Alcohol disorders Marijuana disorders Nicotine disorders Not otherwise specified disorders: Impairment resulting from psychiatric symptoms
Psychiatric Landscape of EA What s normal and abnormal? How common are psychiatric disorders? Does this differ by sex? How do these rates compare to other developmental periods?
What is normal? 3 month Prevalence No Dx 80% Any dx 20% 1 dx 9% 2 dx 6% 3+ dx 5%
How common are psychiatric disorders? 3 month prevalence ASPD Depression Agoraphobia OCD Panic Social GAD 0 1 2 3 4 5 Prevalence
How common are psychiatric disorders? 3 month prevalence Cannabis Dependence Cannabis abuse Alcohol Dependence Alcohol Abuse Nicotine Dependence 0 2 4 6 8 10 Prevalence
How common are psychiatric disorders? Sex differences ASPD Depression Agoraphobia Females Males OCD Panic Social GAD 0 1 2 3 4 5 6 Prevalence
How common are psychiatric disorders? Sex differences Cannabis Dependence Cannabis abuse Females Males Alcohol Dependence Alcohol Abuse Nicotine Dependence 0 3 6 9 12 15 Prevalence
Prevalence How common are psychiatric disorders? Age Curves 10 8 Anxiety Depression DBD 6 4 2 0 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Age
Prevalence How common are psychiatric disorders? Age Curves 15 12 Alcohol Cannabis Nicotine 9 6 3 0 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Age
Psychiatric Landscape of EA Are there different pathways? Marriage? Parenthood? Education?
Are there different pathways? Married (38.5% by age 26) ASPD Depression Agoraphobia Married Unmarried OCD Panic Social GAD 0 1 2 3 4 5 Prevalence
Are there different pathways? Married (38.5% by age 26) Cannabis Dependence Married Unmarried Cannabis abuse Alcohol Dependence Alcohol Abuse Nicotine Dependence 0 3 6 9 12 Prevalence
Are there different pathways? Parenthood (32.1% by age 26) ASPD Depression Agoraphobia OCD Panic Social GAD Kids No Kids 0 1 2 3 4 5 Prevalence
Are there different pathways? Parenthood (32.1% by age 26) Cannabis Dependence Kids No Kids Cannabis abuse Alcohol Dependence Alcohol Abuse Nicotine Dependence 0 2 4 6 8 10 Prevalence
Are there different pathways? College (50.4% by age 26) ASPD Depression College High school only Agoraphobia OCD Panic Social GAD 0 1 2 3 4 5 6 Prevalence
Are there different pathways? College (50.4% by age 26) Cannabis Dependence Cannabis abuse Alcohol Dependence College High school only Alcohol Abuse Nicotine Dependence 0 2 4 6 8 10 Prevalence
Prevalence Are there different pathways? Sex Differences: Parenthood 25 20 No kids Kids 15 10 5 0 Male Female Male Female Panic Alcohol
Prevalence Are there different pathways? Sex Differences: Education 25 20 No college College 15 10 5 0 Male Female Male Female Alc. Abuse Alc. Dependence
Psychiatric Landscape of EA How did they get here? Prior exposure to psychopathology Specific risk pathways
Prevalence How did they get here? Cumulative Prevalence 100 80 60 40 20 0 13 14 15 16 17 18 19 20 21 22 23 24 25 Age Copeland WE, Shanahan L, Costello EJ, Erkanli A, & Angold A. (2011) Cumulative Prevalence of Psychiatric Disorders by Young Adulthood. Journal of the American Academy of Child and Adolescent Psychiatry 50(3): 252-261. PMCID: PMC3049293
How did they get here? Prior exposure for those with an EA disorder 23% 53% 24% Childhood diagnosis No childhood diagnosis NOS disorder only
How did they get here? Specific pathways Substance ADHD Adult Anxiety Dx No adult anxiety ODD CD Depression Anxiety 0 10 20 30 40 Percent
Spurious effects? Epiphenomenol Comorbidity Conduct Disorder Depression Depression Childhood/Adolescence Emerging Adulthood
How did they get here? Specific pathways: Adult anxiety Substance ADHD ODD CD Depression Anxiety 0 2 4 6 8 10 Odds Ratios
How did they get here? Specific pathways: Adult depression Substance ADHD ODD CD Depression Anxiety 0 1 2 3 4 5 Odds Ratio
How did they get here? Specific pathways: ASPD Substance ADHD ODD CD Depression Anxiety 0 1 2 3 4 5 Odds Ratio
How did they get here? Specific pathways: Alcohol dx. Substance ADHD ODD CD Depression Anxiety 0 1 2 3 4 5 Odds Ratio
How did they get here? Specific pathways: THC dx. Substance ADHD ODD CD Depression Anxiety 0 1 2 3 4 5 Odds Ratio
Childhood disorders Anxiety Emerging adult disorders Anxiety Depression ASPD Substance + (+) Depression + CD + ODD + + ADHD Substance +
Psychiatric Landscape of EA What is missing?
Prevalence Age Curves: Behavioral disorders 10 8 6 4 2 0 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Age
What is missing? Conduct disorder symptoms Staying out late Stealing Lying Breaking in Firestarting Use of weapon Fights Bullying 0 1 2 3 4 5 Prevalence
What is missing? Oppositional defiant disorder symptoms Angry/Resentful Touchy Blaming others Annoying Rule-breaking Argumentative Losing temper 0 1 2 3 4 5 Prevalence
Prevalence What is missing? # of behavioral symptoms 75 60 5.7% with 3+ behavioral items 45 30 15 0 0 1 2 3 4 5+ # of behavioral symptoms
Prevalence How common are psychiatric disorders? Impairment 75 60 45 30 15 0 No dx Anxiety Depression ASPD Alcohol Cannabis Nicotine Behavioral
Take Away points What s normal and abnormal? At any moment, 1 in every 5 EAs has a DSM disorder and 1 in 10 has multiple disorders The most common category is substance-related Most disorders have sex-specific rates Almost all disorders are more or less common in EA than in adolescence Are there different pathways? Effects of life choices are strong, complex Effects are often sex-specific Cannot consider psychopathology in EA without reference to these transitions
Take Away points How did they get here? Some exposure to psychiatric distress in childhood/adolescence is common ODD part of history of all anxiety and depressive disorders Evidence of both homotypic and heterotypic pathways What is missing? Little attention to disorders of behavioral control in adulthood Rates of behavioral symptoms are nontrivial Those with such symptoms continue to display widespread impairment
Why is all of this important? Public health Public perception Informed clinical care Targeted prevention Clues about pathophysiology
E. Jane Costello (PI) Duke University Medical Center Adrian Angold Duke University Medical Center Barbara Maughan King s College London Lilly Shanahan UNC-Greensboro Special thanks to the subjects and their families for continued participation! Thank you!