Document Detail

Development of lifetime comorbidity in the World Health Organization world mental health surveys.
MedLine Citation:
PMID:  21199968     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Although numerous studies have examined the role of latent variables in the structure of comorbidity among mental disorders, none has examined their role in the development of comorbidity.
OBJECTIVE: To study the role of latent variables in the development of comorbidity among 18 lifetime DSM-IV disorders in the World Health Organization World Mental Health Surveys.
DESIGN: Nationally or regionally representative community surveys.
SETTING: Fourteen countries.
PARTICIPANTS: A total of 21 229 survey respondents.
MAIN OUTCOME MEASURES: First onset of 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders assessed retrospectively in the World Health Organization Composite International Diagnostic Interview.
RESULTS: Separate internalizing (anxiety and mood disorders) and externalizing (behavior and substance disorders) factors were found in exploratory factor analysis of lifetime disorders. Consistently significant positive time-lagged associations were found in survival analyses for virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders. Within-domain (ie, internalizing or externalizing) associations were generally stronger than between-domain associations. Most time-lagged associations were explained by a model that assumed the existence of mediating latent internalizing and externalizing variables. Specific phobia and obsessive-compulsive disorder (internalizing) and hyperactivity and oppositional defiant disorders (externalizing) were the most important predictors. A small number of residual associations remained significant after controlling the latent variables.
CONCLUSIONS: The good fit of the latent variable model suggests that common causal pathways account for most of the comorbidity among the disorders considered herein. These common pathways should be the focus of future research on the development of comorbidity, although several important pairwise associations that cannot be accounted for by latent variables also exist that warrant further focused study.
Ronald C Kessler; Johan Ormel; Maria Petukhova; Katie A McLaughlin; Jennifer Greif Green; Leo J Russo; Dan J Stein; Alan M Zaslavsky; Sergio Aguilar-Gaxiola; Jordi Alonso; Laura Andrade; Corina Benjet; Giovanni de Girolamo; Ron de Graaf; Koen Demyttenaere; John Fayyad; Josep Maria Haro; Chi yi Hu; Aimee Karam; Sing Lee; Jean-Pierre Lepine; Herbert Matchsinger; Constanta Mihaescu-Pintia; Jose Posada-Villa; Rajesh Sagar; T Bedirhan Ustün
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of general psychiatry     Volume:  68     ISSN:  1538-3636     ISO Abbreviation:  Arch. Gen. Psychiatry     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-01-04     Completed Date:  2011-02-09     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  0372435     Medline TA:  Arch Gen Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  90-100     Citation Subset:  AIM; IM    
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MeSH Terms
Anxiety / diagnosis,  epidemiology*
Attention Deficit and Disruptive Behavior Disorders / epidemiology
Health Surveys*
International Cooperation
Mental Disorders / diagnosis,  epidemiology*
Mental Health*
Middle Aged
Models, Psychological*
Mood Disorders / epidemiology
Obsessive-Compulsive Disorder / epidemiology
Phobic Disorders / epidemiology
Psychomotor Agitation / epidemiology*,  psychology
Risk Factors
Substance-Related Disorders / epidemiology
Time Factors
World Health Organization
Grant Support
R01 DA016558/DA/NIDA NIH HHS; R01 DA016558/DA/NIDA NIH HHS; R01 DA016558-06/DA/NIDA NIH HHS; R01 MH069864/MH/NIMH NIH HHS; R01 MH069864-04/MH/NIMH NIH HHS; R01 MH070884/MH/NIMH NIH HHS; R01 MH070884-05/MH/NIMH NIH HHS; R01-MH069864/MH/NIMH NIH HHS; R01MH070884/MH/NIMH NIH HHS; R03 TW006481/TW/FIC NIH HHS; R03 TW006481-03/TW/FIC NIH HHS; R03-TW006481/TW/FIC NIH HHS; R13-MH066849/MH/NIMH NIH HHS; U01 MH060220/MH/NIMH NIH HHS; U01 MH060220-10/MH/NIMH NIH HHS; U01-MH60220/MH/NIMH NIH HHS; U13 MH066849/MH/NIMH NIH HHS; U13 MH066849-09/MH/NIMH NIH HHS
Comment In:
Arch Gen Psychiatry. 2011 Jan;68(1):10-1   [PMID:  21199961 ]

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