Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys

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 & 6 others Jean Pierre Lepine, Herbert Matchsinger, Constanta Mihaescu-Pintia, Jose Posada-Villa, Rajesh Sagar, T. Bedirhan Üstün

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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: 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.

Original languageEnglish
Pages (from-to)90-100
Number of pages11
JournalArchives of General Psychiatry
Volume68
Issue number1
DOIs
Publication statusPublished - Jan 2011

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Health Surveys
Comorbidity
Mental Health
Diagnostic and Statistical Manual of Mental Disorders
Attention Deficit and Disruptive Behavior Disorders
Obsessive-Compulsive Disorder
Survival Analysis
Anxiety Disorders
Mood Disorders
Mental Disorders
Statistical Factor Analysis
Anxiety
Outcome Assessment (Health Care)
Interviews
Global Health
World Health Organization
Research
Surveys and Questionnaires

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Kessler, R. C., Ormel, J., Petukhova, M., McLaughlin, K. A., Green, J. G., Russo, L. J., ... Üstün, T. B. (2011). Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry, 68(1), 90-100. https://doi.org/10.1001/archgenpsychiatry.2010.180

Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. / Kessler, Ronald C.; Ormel, Johan; Petukhova, Maria; McLaughlin, Katie A.; Green, Jennifer Greif; Russo, Leo J.; Stein, Dan J.; Zaslavsky, Alan M.; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Andrade, Laura; Benjet, Corina; De Girolamo, Giovanni; De Graaf, Ron; Demyttenaere, Koen; Fayyad, John; Haro, Josep Maria; Hu, Chi Yi; Karam, Aimee; Lee, Sing; Lepine, Jean Pierre; Matchsinger, Herbert; Mihaescu-Pintia, Constanta; Posada-Villa, Jose; Sagar, Rajesh; Üstün, T. Bedirhan.

In: Archives of General Psychiatry, Vol. 68, No. 1, 01.2011, p. 90-100.

Research output: Contribution to journalArticle

Kessler, RC, Ormel, J, Petukhova, M, McLaughlin, KA, Green, JG, Russo, LJ, Stein, DJ, Zaslavsky, AM, Aguilar-Gaxiola, S, Alonso, J, Andrade, L, Benjet, C, De Girolamo, G, De Graaf, R, Demyttenaere, K, Fayyad, J, Haro, JM, Hu, CY, Karam, A, Lee, S, Lepine, JP, Matchsinger, H, Mihaescu-Pintia, C, Posada-Villa, J, Sagar, R & Üstün, TB 2011, 'Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys', Archives of General Psychiatry, vol. 68, no. 1, pp. 90-100. https://doi.org/10.1001/archgenpsychiatry.2010.180
Kessler, Ronald C. ; Ormel, Johan ; Petukhova, Maria ; McLaughlin, Katie A. ; Green, Jennifer Greif ; Russo, Leo J. ; Stein, Dan J. ; Zaslavsky, Alan M. ; Aguilar-Gaxiola, Sergio ; Alonso, Jordi ; Andrade, Laura ; Benjet, Corina ; De Girolamo, Giovanni ; De Graaf, Ron ; Demyttenaere, Koen ; Fayyad, John ; Haro, Josep Maria ; Hu, Chi Yi ; Karam, Aimee ; Lee, Sing ; Lepine, Jean Pierre ; Matchsinger, Herbert ; Mihaescu-Pintia, Constanta ; Posada-Villa, Jose ; Sagar, Rajesh ; Üstün, T. Bedirhan. / Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. In: Archives of General Psychiatry. 2011 ; Vol. 68, No. 1. pp. 90-100.
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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

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AU - Haro, Josep Maria

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AU - Lepine, Jean Pierre

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AU - Mihaescu-Pintia, Constanta

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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.

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