TY  - JOUR
PY  - 2011//
TI  - Development of lifetime comorbidity in the World Health Organization world mental health surveys
JO  - Archives of general psychiatry
A1  - Kessler, Ronald C.
A1  - Ormel, Johan
A1  - Petukhova, Maria
A1  - McLaughlin, Katie A.
A1  - Green, Jennifer Greif
A1  - Russo, Leo J.
A1  - Stein, Dan J.
A1  - Zaslavsky, Alan M.
A1  - Aguilar-Gaxiola, Sergio
A1  - Alonso, Jordi
A1  - Andrade, Laura
A1  - Benjet, Corina
A1  - de Girolamo, Giovanni
A1  - de Graaf, Ron
A1  - Demyttenaere, Koen
A1  - Fayyad, John
A1  - Haro, Josep Maria
A1  - Hu, Chi Yi
A1  - Karam, Aimee
A1  - Lee, Sing
A1  - Lépine, Jean-Pierre
A1  - Matchsinger, Herbert
A1  - Mihaescu-Pintia, Constanta
A1  - Posada-Villa, Jose
A1  - Sagar, Rajesh
A1  - Üstün, Bedirhan T.
SP  - 90
EP  - 100
VL  - 68
IS  - 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: 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.<p /> <p>Language: en</p>
LA  - en
SN  - 0003-990X
UR  - http://dx.doi.org/10.1001/archgenpsychiatry.2010.180
ID  - ref1
ER  -