European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry
Workshop
Age of onset of mental disorders:
Etiopathogenetic and treatment implications
W01
Age of onset of bipolar disorders:
A systematic review and meta-analysis
G. de Girolamo ∗, M. Bani , J. Dagani , C. Ferrari , A. Pastore ,
G. Signorini
1 Saint John of God Clinical Research Center, Psychiatric Epidemiology
and Evaluation Unit, Brescia, Italy
2 Saint John of God Clinical Research Center, Statistics services,
Brescia, Italy
3 University “Aldo Moro”, Department of Basic Medical
Sciences-Neuroscience and Sense Organs- Childhood and Adolescence
Neuropsychiatry Unit, Bari, Italy
∗ Corresponding author.
Introduction Although the onset of bipolar disorder (BD) is usu-
ally estimated in early adulthood (Burke et al., 1990; Kessler et al.,
1997), it is still not clear which age-specific triggering factors may
contribute to the underlying vulnerability.
Objectives/aims The presentmeta-analysis attempts to clarify the
number of untreated years of BD, from first symptoms appear-
ance, to first actions carried out by health services (first diagnosis,
treatment and hospitalization).
Methods A literature search of three databases PubMed, Web
of Science and Psychology and Behavioral Sciences Collection
was performed, looking for peer-reviewed publications in English,
French, German and Italian language that reported the AOO of BD;
the search string adopted was “bipolar and onset”. Standardized
mean differences were calculated between (i) mean AOO, opera-
tionally defined as onset of first symptoms/episodes, and (ii) mean
AOO, operationally defined according to four criteria: first contact
with services, date of the diagnosis, first pharmacological treat-
ment, or first hospitalization.
Results The searches yielded 8710 articles; 2424 of these arti-
cles met the inclusion criteria. A final set of 19 studies presenting
multiple definitions of AOO has been analyzed, revealing an overall
effect size of 6.96 of untreated years (Cohen’s d = 0.65)
Conclusion To our knowledge, this is the first meta-analysis that
addresses the definition and the modulation of the AOO in bipo-
lar disorder. Identifying the time-frame of untreated illness is very
important for the best planning of timely interventions.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
W02
The age of onset of anxiety disorders
in samples from the general
population: A meta-analysis
J. de Lijster ∗, B. Dierckx , E. Utens , F. Verhulst , C. Zieldorff ,
G. Dieleman , J. Legerstee
Erasmus MC Sophia Children’s Hospital, department of Child and
Adolescent Psychiatry/psychology, Rotterdam, Netherlands
∗ Corresponding author.
Workshop Age of onset of mental disorders: etiopathogenetic
and treatment implications.
Background Age of onset (AOO) of anxiety disorders could serve
as a vital statistic in the formulation of mental health policy. Previ-
ous reviews have reported on the AOO of anxiety disorders in the
general population. However, these review studies did not system-
atically estimate the AOO of different anxiety disorder subtypes,
and did not examine factors that might have influenced reported
AOO.
Objective The aims of the present study were (1) to estimate
the AOO for all anxiety disorders and for specific subtypes, (2) to
examine gender differences in AOO of anxiety disorders, and (3) to
examine the influence of study characteristics on reported AOO.
Method Seven electronic databases were searched with key-
words representing anxiety disorder subtypes, AOO and study
design. The inclusion criteria were studies using a general popu-
lation sample that provided data on AOO for all anxiety disorders,
or specific anxiety disorders, according to DSM-III-R, DSM-IV or
ICD-10 criteria. Meta-analysis was used to estimate AOO and gen-
der differences, while meta-regression was used to examine the
influence of study characteristics.
Results A total of 1028 titles were examined, which yielded 24
studiesmeeting the inclusion criteria. Meta-analysis found an aver-
age AOO of all anxiety disorders of 21.3 years (95% CI: 17.46 to
25.07). Separation anxiety disorder, specific phobia and social pho-
bia had their mean onset before the age of 15 years, whereas AOO of
agoraphobia, obsessive compulsive disorder, post-traumatic stress
disorder, panic disorder and generalized anxiety disorder began
on average between 21.1 and 34.9 years. Anxiety disorder is more
common in women, but meta-analysis revealed no difference in
AOO between genders. Prospective study design and higher devel-
opmental level of the study country were associated with earlier
AOO.
Conclusion Results from this meta-analysis indicate that anxi-
ety disorder subtypes differ in mean AOO, with onsets ranging
from early adolescence to young adulthood. These findings suggest
that prevention strategies of anxiety disorders should be directed
towards the factors associated with the development of subtypes
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