Differences are observed in the age of onset of mental disorders, which may be influenced by genetic and/or environmental factors. While most individuals develop symptoms of PTSD within three months of the trauma, some symptoms can appear later and persist for months and sometimes years. Understanding the factors associated with the onset of symptoms could lead to better understanding of the disorder and earlier and improved intervention strategies for patients.

What is the evidence for illness onset of PTSD?

Moderate to high quality evidence finds the average age of onset of PTSD is 26.6 years, with no differences between males and females. The median age at onset is around 30 years.

The overall median prevalence of PTSD tends to reduce over time, from 28.8% at one-month post trauma to 17% at 12 months post trauma. Median prevalence post non-intentional (accidental) trauma also decreases over time (30.1% to 14%), while median prevalence post intentional (non-accidental) trauma is lower initially and increases over time (11.8% to 23.3%).

Around 24.5% of people diagnosed with PTSD had a delayed onset of illness, with most experiencing earlier milder symptoms. The prevalence of delayed-onset PTSD is highest in professional groups and those who experienced combat trauma.

August 2021

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Differences observed in the age at onset of bipolar disorder may be influenced by genetic and/or environmental factors. Understanding these factors could lead to better understanding of the disorder, early identification, and improved intervention strategies for patients.

What is the evidence for age at onset of bipolar disorder?

Moderate quality evidence suggests the median age at onset of bipolar disorder is around 33 years old. Moderate to high quality evidence finds a trimodal distribution, with 45% of people with bipolar disorder showing an early-onset age (~17 years), 35% showing a mid-onset age (~26 years), and 20% showing a late-onset age (~42 years).

High quality evidence shows younger age at onset is associated with increased severity of depression. Moderate to high quality evidence finds younger age at onset is associated with having a personality disorder or longer delays to treatment. Moderate quality evidence finds younger age at onset is associated with suicide attempts, anxiety disorders, and substance use disorders. There were no associations between younger age at onset and severity of mania symptoms, first polarity being mania, psychotic symptoms, rapid cycling, or mixed bipolar episodes.

March 2022

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Differences are observed in the age at onset of psychotic symptoms, which may be influenced by genetic or environmental risk factors, or sex. Understanding the factors that impact on age at the onset of symptoms could lead to better understanding of the risk factors for the disorder and earlier and improved intervention strategies.

What is the evidence for age at onset of schizophrenia?

Moderate to high quality evidence suggests the median age at onset of schizophrenia is around 25 years old. The incidence (i.e., new cases) of schizophrenia is higher in males up until around 40 years of age, then higher in females after around 50 years of age. Substance use, in particular cannabis, is associated with an earlier age at onset of psychosis, with no effect of tobacco use. There was also a small effect of an earlier age at onset in people with a family history of psychosis.

Moderate quality evidence finds small associations between an earlier age at onset and more hospitalisations, more negative, but not positive symptoms, more relapses, poorer overall functioning, and poorer overall clinical outcomes (in males only).

March 2022

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