TY - JOUR
T1 - Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys
AU - Kessler, Ronald C.
AU - Ormel, Johan
AU - Petukhova, Maria
AU - McLaughlin, Katie A.
AU - Green, Jennifer Greif
AU - Russo, Leo J.
AU - Stein, Dan J.
AU - Zaslavsky, Alan M.
AU - Aguilar-Gaxiola, Sergio
AU - Alonso, Jordi
AU - Andrade, Laura
AU - Benjet, Corina
AU - De Girolamo, Giovanni
AU - De Graaf, Ron
AU - Demyttenaere, Koen
AU - Fayyad, John
AU - Haro, Josep Maria
AU - Hu, Chi Yi
AU - Karam, Aimee
AU - Lee, Sing
AU - Lepine, Jean Pierre
AU - Matchsinger, Herbert
AU - Mihaescu-Pintia, Constanta
AU - Posada-Villa, Jose
AU - Sagar, Rajesh
AU - Üstün, T. Bedirhan
PY - 2011/1
Y1 - 2011/1
N2 - 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: Thegoodfit of the latent variablemodelsuggests thatcommoncausal pathways account for most of the comorbidityamongthe 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 bylatentvariablesalsoexistthatwarrantfurtherfocusedstudy.
AB - 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: Thegoodfit of the latent variablemodelsuggests thatcommoncausal pathways account for most of the comorbidityamongthe 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 bylatentvariablesalsoexistthatwarrantfurtherfocusedstudy.
UR - http://www.scopus.com/inward/record.url?scp=78650910903&partnerID=8YFLogxK
U2 - 10.1001/archgenpsychiatry.2010.180
DO - 10.1001/archgenpsychiatry.2010.180
M3 - Article
C2 - 21199968
AN - SCOPUS:78650910903
SN - 0003-990X
VL - 68
SP - 90
EP - 100
JO - Archives of General Psychiatry
JF - Archives of General Psychiatry
IS - 1
ER -