title: Development of lifetime comorbidity in the World Health Organization world mental health surveys.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Nationally or regionally representative community surveys.
  
  
  METHODS
  Fourteen countries.
  
  
  METHODS
  A total of 21 229 survey respondents.
  
  
  METHODS
  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.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA. kessler@hcp.med.harvard.edu
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.forename: Johan
authors.initials: J
authors.lastname: Ormel
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.forename: Katie A
authors.initials: KA
authors.lastname: McLaughlin
authors.forename: Jennifer Greif
authors.initials: JG
authors.lastname: Green
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Russo
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Sergio
authors.initials: S
authors.lastname: Aguilar-Gaxiola
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.forename: Laura
authors.initials: L
authors.lastname: Andrade
authors.forename: Corina
authors.initials: C
authors.lastname: Benjet
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.forename: Koen
authors.initials: K
authors.lastname: Demyttenaere
authors.forename: John
authors.initials: J
authors.lastname: Fayyad
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.forename: Chi yi
authors.initials: Cy
authors.lastname: Hu
authors.forename: Aimee
authors.initials: A
authors.lastname: Karam
authors.forename: Sing
authors.initials: S
authors.lastname: Lee
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lepine
authors.forename: Herbert
authors.initials: H
authors.lastname: Matchsinger
authors.forename: Constanta
authors.initials: C
authors.lastname: Mihaescu-Pintia
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sagar
authors.forename: T Bedirhan
authors.initials: TB
authors.lastname: Ustün
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D007391:International Cooperation; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008603:Mental Health; D008875:Middle Aged; D008960:Models, Psychological; D019964:Mood Disorders / Q000453:epidemiology; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology; D010698:Phobic Disorders / Q000453:epidemiology; D011595:Psychomotor Agitation / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D013997:Time Factors; D014944:World Health Organization