title: Multiple comorbidities of 21 psychological disorders and relationships with psychosocial variables: a study of the online assessment and diagnostic system within a web-based population.
abstract: BACKGROUND
  While research in the area of e-mental health has received considerable attention over the last decade, there are still many areas that have not been addressed. One such area is the comorbidity of psychological disorders in a Web-based sample using online assessment and diagnostic tools, and the relationships between comorbidities and psychosocial variables.
  
  
  OBJECTIVE
  We aimed to identify comorbidities of psychological disorders of an online sample using an online diagnostic tool. Based on diagnoses made by an automated online assessment and diagnostic system administered to a large group of online participants, multiple comorbidities (co-occurrences) of 21 psychological disorders for males and females were identified. We examined the relationships between dyadic comorbidities of anxiety and depressive disorders and the psychosocial variables sex, age, suicidal ideation, social support, and quality of life.
  
  
  METHODS
  An online complex algorithm based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, was used to assign primary and secondary diagnoses of 21 psychological disorders to 12,665 online participants. The frequency of co-occurrences of psychological disorders for males and females were calculated for all disorders. A series of hierarchical loglinear analyses were performed to examine the relationships between the dyadic comorbidities of depression and various anxiety disorders and the variables suicidal ideation, social support, quality of life, sex, and age.
  
  
  RESULTS
  A 21-by-21 frequency of co-occurrences of psychological disorders matrix revealed the presence of multiple significant dyadic comorbidities for males and females. Also, for those with some of the dyadic depression and the anxiety disorders, the odds for having suicidal ideation, reporting inadequate social support, and poorer quality of life increased for those with two-disorder comorbidity than for those with only one of the same two disorders.
  
  
  CONCLUSIONS
  Comorbidities of several psychological disorders using an online assessment tool within a Web-based population were similar to those found in face-to-face clinics using traditional assessment tools. Results provided support for the transdiagnostic approaches and confirmed the positive relationship between comorbidity and suicidal ideation, the negative relationship between comorbidity and social support, and the negative relationship comorbidity and quality of life.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).
authors: School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia. aalasadi@gprc.ab.ca.
authors: Ali M
authors: http://orcid.org/0000-0003-2256-1290
authors: AM
authors: Al-Asadi
authors: Britt
authors: http://orcid.org/0000-0003-2912-8043
authors: B
authors: Klein
authors: Denny
authors: http://orcid.org/0000-0002-9902-0858
authors: D
authors: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology; D000465:Algorithms; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000453:epidemiology; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D052018:Bulimia Nervosa / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology; D012944:Social Support; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D059020:Suicidal Ideation; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult
keywords: age; alcohol; co-occurrences; comorbidity; drug; e-mental health; fully automated; generalized anxiety disorder; insomnia, hypersomnia, dependency; multiple comorbidities; obsessive-compulsive disorder; online; panic disorder, major depressive episode; posttraumatic stress disorder; quality of life; sex; social anxiety disorder; social support; suicidal ideation