Cited by 508Mental Health Research TopicsMental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional Development

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

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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·2011·Archives of General Psychiatry

DOI 10.1001/archgenpsychiatry.2010.180PMC PMC3057480

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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: 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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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: Kessler, Ronald C.
Ormel, Johan
Petukhova, Maria
McLaughlin, Katie A.
Green, Jennifer Greif
Russo, Leo J.
Stein, Dan J.
Zaslavsky, Alan M.
Alonso, Jordi
Andrade, Laura
Benjet, Corina
Demyttenaere, Koen
Haro, Josep Maria
Sagar, Rajesh
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)
DOI: 10.1001/archgenpsychiatry.2010.180
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

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