Mental Disorders from Childhood to Adulthood: The Dunedin Study
Lead Research Organisation:
King's College London
Department Name: Inst of Psychiatry School Offices
Abstract
At present, very little information about a patient s developmental history is incorporated into making a psychiatric diagnosis. As a result, patients having different etiology and different prognosis are often mixed as apples and oranges with the same diagnosis. This unknown heterogeneity interferes when doctors make treatment choices and when scientists identify groups to take part in neuroscience and genetics research. Our research aims to identify developmental subtypes within mental disorders, based on age of onset (childhood, adolescence, adulthood) and subsequent course (persistent, recurrent, or time-limited). We study a 1000 men and women, born in 1972, who represent the general population. Their mental health has been measured at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, and 32, when 96% of the original cohort took part. Mental health will be measured again at age 38. Identifying developmental subtypes to improve precision of psychiatric diagnoses should improve the quality of both treatment and research, and also reduce the costs.
Technical Summary
Objective:
The proposed research aims to build knowledge about four behavioural disorders: depression, schizophreniform, antisocial, and substance abuse disorders. In all four disorders, developmental subtypes have been proposed as a way forward to carve up the heterogeneity that now hinders scientific and clinical progress. We will study the heterogeneity within each disorder over the first four decades of life, by analysing varaition in age of onset (early versus later) and subsequent course (persistent, recurrent, or time-limited). We aim to ascertain the existence, discriminant valdity, and implications of developmental subgroups within disorders.
Methods:
The Dunedin Study has traced the development of a representative 1972 birth cohort of 1,000 New Zealand men and women at birth and ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, and 32. New data will be gathered at age 37/38. Psychiatric data from childhood to age 38 will be analysed to identify developmental subgroups within each disorder.
Hypotheses address:
a) different childhood risk factors and family psychiatric histories for developmental subgroups,
(b)different adult outcomes in worklife, family life, and physical health for developmental subgroups,
(c) proximal life events that precipitate adult-onset disorder, (d) temporal comorbid sequences in which one type of disorder reliably leads to onset of another, and (e)whether findings apply to women and men, or if sex-specific models are needed.
Implications for diagnosis:
Findings will improve current DSM and ICD classification systems by enabling clinicians to use a patient s developmental history to know more about a disorder s probably etiology and prognosis.
Implications for genetic and neuroscience research: Findings will characterise psychiatric phenotypes more precisely, and show which subtypes have familial and neuro-developmental features.
Implications for prevention:
Findings will (a) yield recommendations for tailoring interventions to fit developmental subtypes, (b) clarify the relative importance of preventing onset versus recurrence, (c) identify factors posing pervasive risk for many disorders as top prevention priorities, and (d) point to common sequences of disorders, which suggest that treating disorder A may prevent disorder B.
The proposed research aims to build knowledge about four behavioural disorders: depression, schizophreniform, antisocial, and substance abuse disorders. In all four disorders, developmental subtypes have been proposed as a way forward to carve up the heterogeneity that now hinders scientific and clinical progress. We will study the heterogeneity within each disorder over the first four decades of life, by analysing varaition in age of onset (early versus later) and subsequent course (persistent, recurrent, or time-limited). We aim to ascertain the existence, discriminant valdity, and implications of developmental subgroups within disorders.
Methods:
The Dunedin Study has traced the development of a representative 1972 birth cohort of 1,000 New Zealand men and women at birth and ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, and 32. New data will be gathered at age 37/38. Psychiatric data from childhood to age 38 will be analysed to identify developmental subgroups within each disorder.
Hypotheses address:
a) different childhood risk factors and family psychiatric histories for developmental subgroups,
(b)different adult outcomes in worklife, family life, and physical health for developmental subgroups,
(c) proximal life events that precipitate adult-onset disorder, (d) temporal comorbid sequences in which one type of disorder reliably leads to onset of another, and (e)whether findings apply to women and men, or if sex-specific models are needed.
Implications for diagnosis:
Findings will improve current DSM and ICD classification systems by enabling clinicians to use a patient s developmental history to know more about a disorder s probably etiology and prognosis.
Implications for genetic and neuroscience research: Findings will characterise psychiatric phenotypes more precisely, and show which subtypes have familial and neuro-developmental features.
Implications for prevention:
Findings will (a) yield recommendations for tailoring interventions to fit developmental subtypes, (b) clarify the relative importance of preventing onset versus recurrence, (c) identify factors posing pervasive risk for many disorders as top prevention priorities, and (d) point to common sequences of disorders, which suggest that treating disorder A may prevent disorder B.