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Development of Lifetime Comorbidity in the World Health Organization World Mental Health Surveys
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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.
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Metadata
- Authors
- Kessler, R. C., Ormel, J., Petukhova, M., McLaughlin, K. A., Green, J. G., Russo, L. J., Stein, D. J., Zaslavsky, A. M., Aguilar-Gaxiola, S., Alonso, J., Andrade, L., Benjet, C., de Girolamo, G., de Graaf, R., Demyttenaere, K., Fayyad, J., Haro, J. M., Hu, C. Y., Karam, A., Lee, S., Lepine, J.-P., Matchsinger, H., Mihaescu-Pintia, C., Posada-Villa, J., Sagar, R., & Üstün, T. B.
- Affiliations
- Harvard University (US)
- University Medical Center Groningen (NL)
- Takeda (United States) (US)
- University of Cape Town (ZA)
- Municipal Institute for Medical Research (ES)
- Universidade de São Paulo (BR)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- Universitair Ziekenhuis Leuven (BE)
- University of Balamand (LB)
- Parc Sanitari Sant Joan de Déu (ES)
- Shenzhen KangNing Hospital (CN)
- Chinese University of Hong Kong (HK)
- Leipzig University (DE)
- All India Institute of Medical Sciences (IN)
- World Health Organization (CH)
- ORCID
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2011-01-03
- Volume
- 68
- Issue
- 1
- Pages
- 90
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3057480
- OpenAlex
- W2162994164
- Cited by
- 508
- References
- 66
- Citations by year
- 2026: 19 · 2025: 21 · 2024: 32 · 2023: 31 · 2022: 38 · 2021: 42 · 2020: 33 · 2019: 39 · 2018: 38 · 2017: 28 · 2016: 35 · 2015: 36 · 2014: 31 · 2013: 27 · 2012: 35
- FWCI
- 47.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Lirias (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- World Health Organization
- Kaiser Permanente
- Shire
- Chinese University of Hong Kong
- Université Paris Diderot
- H. Lundbeck A/S
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, U13MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R03TW006481)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- psychiatric comorbidity, latent variables, internalizing disorders, externalizing disorders, anxiety disorders, mood disorders, substance use disorders, behavior disorders, specific phobia, obsessive-compulsive disorder, hyperactivity disorder, oppositional defiant disorder, causal pathways, DSM-IV disorders
- MeSH terms
- Adult, Aged, Anxiety, Mental Disorders, Female, Health Surveys, Humans, International Cooperation, Male, Mental Health, Middle Aged, Models, Psychological, Obsessive-Compulsive Disorder, Phobic Disorders, Psychomotor Agitation, Risk Factors, Time Factors, World Health Organization, Comorbidity, Attention Deficit and Disruptive Behavior Disorders, Mood Disorders, Substance-Related Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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