Towards a youth mental health paradigm: a perspective and roadmap

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.

Fig. 1. Age of onset of mental disorders.

Distribution of age of onset of mental disorders in the general population based on the meta-analysis by Solmi et al. [9]: Meta-analytic epidemiologic proportion (y-axis) for anxiety disorders (5.5/15.5 years), substance use disorders (19.5 years), schizophrenia/psychotic disorders (20.5 years), eating disorders (15.5 years), personality disorders (20.5 years), obsessive-compulsive (14.5) and mood disorders (20.5 years) (ICD-10 blocks). The dotted horizontal lines represent the peak age of onset for each diagnostic category.

Fig. 2. Sensitive periods during brain development.

Overview of sensitive periods during brain development: The curves indicate the plastic potential for different neural systems between 0 and 30 years of age: (a) threat-regulation involving cortical-hippocampal-amygdala circuits (b) HPA-axis system (c) PFC/Connectivity subsumes local changes in PFC-properties (E/I-balance, Dopamine) as well as long-range connectivity with cortical-subcortical target regions (d) Reward System comprising striatum and connectivity with PFC and (e) social-Cognitive Processes. HPA-axis hypothalamic-pituitary-adrenal axis, PFC prefrontal cortex, E/I balance Excitation/Inhibition-balance, PFC prefrontal cortex.

Fig. 3. Diagnostic models in youth mental health.

Diagnostic Models in Youth Mental Health: (A) diagnostic staging model focused on symptoms and functioning. B A transdiagnostic, pluripotential staging model in which variable subthreshold symptoms may overlap but give rise to a range of end-stage disorders. CHR indicates clinical high risk. C Growth Charts: Detection of emerging mental disorders in the general population. Four proposed domains of assessment and their age sex- and age-adjusted norms are displayed. Once a threshold of divergence from normative trajectories is reached, individuals could be offered options of closer tracking, more comprehensive assessments, or preventative or clinical interventions. The latter would range from low-risk preventive interventions when such departures begin to manifest clinically (at earlier stages), or treatment of manifest abnormalities that are functionally relevant and/or lead to distress (at later stages). Panels (A, B) are adapted from [165].