Factors associated with onset‐age in major affective disorders

• Published in: Acta psychiatrica Scandinavica Vol. 146; no. 5; pp. 456 - 467
• Main Authors: Miola, Alessandro, Tondo, Leonardo, Salvatore, Paola, Baldessarini, Ross J.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2022; John Wiley and Sons Inc
• Subjects: Affective disorders; Age; age at onset; Age of Onset; Aggressive behavior; Attention deficit hyperactivity disorder; bipolar disorder; Bipolar Disorder - epidemiology; Bipolar Disorder - psychology; Child; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - psychology; Diagnostic and Statistical Manual of Mental Disorders; Drug abuse; Female; Humans; major depression; Male; Mental disorders; Mood Disorders - epidemiology; Morbidity; Original; Suicide; Suicides & suicide attempts; bipolar disorder; morbidity; age at onset; major depression
• ISSN: 0001-690X; 1600-0447; 1600-0447
• DOI: 10.1111/acps.13497

Background Research findings on factors associated with onset‐age (OA) with bipolar (BD) and major depressive disorders (MDD) have been inconsistent, but often indicate greater morbidity following early OA. Methods We considered factors associated with OA in 1033 carefully evaluated, systematically followed mood disorder subjects with DSM‐5 BD (n = 505) or MDD (n = 528), comparing rates of descriptive and clinical characteristics following early (age <18), intermediate (18–40), or later onset (≥40 years), as well as regressing selected measures versus OA. Exposure time (years ill) was matched among these subgroups. Results As hypothesized, many features were associated with early OA: familial psychiatric illness, including BD, greater maternal age, early sexual abuse, nondepressive first episodes, co‐occurring ADHD, suicide attempts and violent suicidal behavior, abuse of alcohol or drugs, smoking, and unemployment. Other features increased consistently with later OA: %‐time‐depressed (in BD and MDD, women and men), as well as depressions/year and intake ratings of depression, educational levels, co‐occurring medical disorders, rates of marriage and number of children. Conclusions OA averaged 7.5 years earlier in BD versus MDD (30.7 vs. 38.2). Some OA‐associated measures may reflect maturation. Associations with family history and suicidal risk with earlier OA were expected; increases of time‐depressed in both BD and MDD with later OA were not. We conclude that associations of OA with later morbidity are complex and not unidirectional but may be clinically useful.