Development of Lifetime Comorbidity in the World Health Organization World Mental Health Surveys

Author(s):Show less -

Kessler, Ronald C. ^[1] ; Ormel, Johan ^{[2, 3, 4]} ; Petukhova, Maria ^[1] ; McLaughlin, Katie A. ^[1] ; Green, Jennifer Greif ^[1] ; Russo, Leo J. ^[5] ; Stein, Dan J. ^[6] ; Zaslavsky, Alan M. ^[1] ; Aguilar-Gaxiola, Sergio ^[7] ; Alonso, Jordi ^[8] ; Andrade, Laura ^{[9, 10]} ; Benjet, Corina ^[11] ; de Girolamo, Giovanni ^[12] ; de Graaf, Ron ^[13] ; Demyttenaere, Koen ^[14] ; Fayyad, John ^{[15, 16]} ; Haro, Josep Maria ^[17] ; Hu, Chi Yi ^{[18, 19]} ; Karam, Aimee ^{[15, 16]} ; Lee, Sing ^[20] ; Lepine, Jean-Pierre ^[21] ; Matchsinger, Herbert ^[22] ; Mihaescu-Pintia, Constanta ^[23] ; Posada-Villa, Jose ^[24] ; Sagar, Rajesh ^[25] ; Uestuen, T. Bedirhan ^[26]

Affiliation:Show less -

^[1] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 - USA

^[2] Univ Med Ctr Groningen, Dept Psychiat, NL-9713 AV Groningen - Netherlands

^[3] Univ Groningen, Grad Sch Behav & Cognit Neurosci, Groningen - Netherlands

^[4] Univ Groningen, Grad Sch Expt Psychopathol, Groningen - Netherlands

^[5] Shire Pharmaceut Res & Dev, Chesterbrook, PA - USA

^[6] Univ Cape Town, Dept Psychiat, ZA-7925 Cape Town - South Africa

^[7] Univ Calif Davis, Sch Med, Ctr Reducing Hlth Dispar, Davis, CA 95616 - USA

^[8] Ctr Invest Biomed Red CIBER Epidemiol & Salud Pub, Inst Municipal Invest Med, Hlth Serv Res Unit, Barcelona - Spain

^[9] Univ Sao Paulo, Sch Med, Inst Psychiat, Sect Psychiat Epidemiol, Sao Paulo - Brazil

^[10] Univ Sao Paulo, Sch Med, Dept Psychiat, Sect Psychiat Epidemiol, Sao Paulo - Brazil

^[11] Natl Inst Psychiat, Mexico City, DF - Mexico

^[12] Carattere Sci Ctr S Giovanni Dio Fatebenefratelli, Ist Ricovero & Cura, Brescia - Italy

^[13] Netherlands Inst Mental Hlth & Addict, Utrecht - Netherlands

^[14] Univ Hosp Gasthuisberg, Dept Psychiat, B-3000 Louvain - Belgium

^[15] Balamand Univ, St George Hosp Univ Med Ctr, Beirut - Lebanon

^[16] Med Inst Neuropsychol Disorders, Inst Dev Res Advocacy & Appl Care, Fac Med, Beirut - Lebanon

^[17] CIBER Salud Mental, Fundacio St Joan de Deu, Barcelona - Spain

^[18] Shenzhen Inst Mental Hlth, Shenzhen - Peoples R China

^[19] Shenzhen Kangning Hosp, Shenzhen - Peoples R China

^[20] Chinese Univ Hong Kong, Shatin, Hong Kong - Peoples R China

^[21] Uni Paris Diderot & Paris Descartes, Hop Lariboisiere Fernand Widal, AP HP, INSERM, U705, CNRS, UMR 7157, Paris - France

^[22] Univ Leipzig, Dept Psychiat, Leipzig - Germany

^[23] Natl Sch Publ Hlth & Hlth Serv Management, Bucharest - Romania

^[24] Cundinamarca Univ, Colegio Mayor, Bogota - Colombia

^[25] All India Inst Med Sci, New Delhi - India

^[26] WHO, Evidence & Informat Policy Dept Hlth Financing &, CH-1211 Geneva - Switzerland

• Document type: Journal article
• Source: ARCHIVES OF GENERAL PSYCHIATRY; v. 68, n. 1, p. 90-100, JAN 2011.
• Web of Science Citations: 217

Abstract

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. (AU)

• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants