RT Journal
A1 Kessler RC, Ormel J, Petukhova M, et al
T1 DEvelopment of lifetime comorbidity in the world health organization world mental health surveys
JF Archives of General Psychiatry
JO Archives of General Psychiatry
YR 2011
FD January 3
VO 68
IS 1
SP 90
OP 00
DO 10.1001/archgenpsychiatry.2010.180
UL http://dx.doi.org/10.1001/archgenpsychiatry.2010.180
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 
    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.