CG123 Common mental health disorders - National Institute for ...

Common mental health disordersNegative life events, particularly those relating to health, can also impact on thedevelopment of depression and anxiety, although vulnerabilities will vary betweenindividuals (Harris, 2000). The ONS survey identified poor physical health and problemswith alcohol use as predictors of anxiety and depression (Salokangas &Poutanen, 1998), while King and colleagues (2008) found that current poorer physicaland mental health functional status, based on the 12-Item Short Form HealthSurvey (SF-12) questionnaire, was linked to the development of depression. However,it is also important to note that depression may lead to secondary disability thatcompounds, and is difficult to distinguish from, the depression itself.Early life experiences as well as current social stressors must also be considered.A poor parent–child relationship, marital discord and divorce, neglect, and physicaland sexual abuse almost certainly increase a person’s vulnerability to depression inlater life (Fava & Kendler, 2000) and can play a vital role in the development of GAD.Barlow (2000) reported that good parenting experiences are important in providingchildren with a secure base from which to explore the world. Problems inchild–parent attachment have been linked to feelings of diminished personal controlof potentially threatening events (Barlow, 2000), which can in turn increase susceptibilityto psychological illness.However, when considering the importance of life events it is important to rememberthat events may not have a causal impact on the development of symptoms.Instead, they may act as a trigger among people who are biologically or psychologicallypredisposed to a disorder, for example OCD (Gothelf et al., 2004; Khanna et al.,1988). The authors of the ONS survey make the point that although these risk factorsare associated with disorders and tend to increase the duration of episodes it is notclear whether or not they cause the onset of an episode.2.2.4 Development, course and prognosisFor many people the onset of common mental health disorders occurs in adolescenceor early adult life, but the disorders can affect people at any point. Earlier onset isgenerally associated with poorer outcomes. Kessler and colleagues (2005a) reportedan estimated median age of onset for anxiety disorders of 11 years and for mooddisorders of 30 years in their US National Comorbidity sample. Half of all lifetimecases had started by 14 years and three quarters by 24 years. Many anxiety disordersalso have a chronic course. This chronic course may be associated with a considerabledelay in presenting to services, with consequent significant personal and socialimpairment. Therefore, Kessler and colleagues (2005a) concluded that interventionsaimed at prevention or early treatment needed to focus on young people.DepressionThe average age of the first episode of major depression is the mid-20s and althoughthe first episode may occur at any time, from early childhood through to old age, asubstantial proportion of people have their first depressive episode in childhood oradolescence (Fava & Kendler, 2000).22