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Cited by 27Bipolar Disorder and TreatmentTreatment of Major DepressionPersonality Disorders and Psychopathology

Factors associated with onset-age in major affective disorders

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Miola, Alessandro, Tondo, Leonardo, Salvatore, Paola, Baldessarini, Ross J.·2022·Acta Psychiatrica Scandinavica
DOI 10.1111/acps.13497PMC PMC9826467
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Abstract

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.

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  • Smoking is a risk factor for an earlier age of onset of bipolar disorder.

    “Smoking as a risk factor for an earlier age of onset of BD was also found in an Italian study in more than 1,000 patients of specialized outpatient clinics (41) and in a clinical sample of 195 adolescents from the US with BD (42).”

    From The detrimental effects of smoking on the course and outcome in adults with bipolar disorder—A narrative review (2023) · cites this paper as [41]

    The Results (Table 2) show that tobacco smoking was more common among patients with onset before 18 than among those with onset after 40 in a cohort of 1,033 patients. But the comparison combines bipolar and major depressive disorders, and the paper describes an association rather than establishing smoking as a risk factor for earlier bipolar onset. (LLM, conf=0.87)

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  1. [6]Dagani J, Baldessarini RJ, Signorini G, et al. The age of onset of bipolar disorders. In: de Girolamo G, McGorry P, Sartorius N, eds. Age of Onset of Mental Disorders: Etiopathogenetic and Treatment Implications. Springer Press; 2019: 75‐ 110. doi: 10.1007/978-3-319-72619-9 · DOI

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Authors
Miola, A., Tondo, L., Salvatore, P., & Baldessarini, R. J.
Affiliations
  • University of Padua (IT)
  • Harvard University (US)
Corresponding author
Miola, Alessandro
ORCID
Venue
Acta Psychiatrica Scandinavica
Publisher
Wiley
Published
2022-09-15
Volume
146
Issue
5
Pages
456-467
ISSN
  • 0001-690X (ISSN-L)
  • 1600-0447
DOI
10.1111/acps.13497
PMC
PMC9826467
OpenAlex
W4294586290
Cited by
27
References
76
Citations by year
2026: 8 · 2025: 7 · 2024: 5 · 2023: 5 · 2022: 2
FWCI
3.09
Type
journal article
Language
en
Open access
Licence
Locations
  • Acta Psychiatrica Scandinavica (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
Aretaeus Foundation of Rome
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
age of onset, bipolar disorder, major depressive disorder, mood disorders, early-onset depression, maternal age, child sexual abuse, ADHD comorbidity, suicide attempts, substance abuse, smoking, unemployment, marital status, educational attainment
MeSH terms
Bipolar Disorder, Child, Major Depressive Disorder, Female, Humans, Male, Age of Onset, Mood Disorders, Diagnostic and Statistical Manual of Mental Disorders

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