title: A dimensional liability model of age differences in mental disorder prevalence: evidence from a national sample.
abstract: Recent theories have proposed a metastructure that organizes related mental disorders into broad dimensions of psychopathology (i.e., internalizing and externalizing dimensions). Prevalence rates of most mental disorders, when examined independently, are substantially lower in older than in younger adults, which may affect this metastructure. Within a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093), we developed a dimensional liability model of common psychiatric disorders to clarify whether aging affects specific disorders or general dimensions of psychopathology. Significant age differences existed across age groups (18-24, 25-34, 35-44, 45-54, 55-64, 65-75 and 75+), such that older adults showed lower prevalence rates of most disorders compared to younger adults. We next investigated patterns of disorder comorbidity for past-year psychiatric disorders and found that a distress-fear-externalizing liability model fit the data well. This model was age-group invariant and indicated that the observed lower prevalence of mental disorders with advancing age originates from lower average means on externalizing and internalizing liability dimensions. This unifying dimensional liability model of age and mental disorder comorbidity can help inform the role of aging on mental disorder prevalence for research and intervention efforts, and service planning for the impending crisis in geriatric mental health.
authors: Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, Paris, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France. Electronic address: nico.hoertel@yahoo.fr.
authors: Nicolas
authors: N
authors: Hoertel
authors: Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA.
authors: Kibby
authors: K
authors: McMahon
authors: Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA.
authors: Mark
authors: M
authors: Olfson
authors: Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, USA.
authors: Melanie M
authors: MM
authors: Wall
authors: Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA.
authors: Jorge Mario
authors: JM
authors: Rodríguez-Fernández
authors: Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, Paris, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.
authors: Cédric
authors: C
authors: Lemogne
authors: Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, 92130 Issy-les-Moulineaux, Paris, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.
authors: Frédéric
authors: F
authors: Limosin
authors: Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA.
authors: Carlos
authors: C
authors: Blanco
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000987:Antisocial Personality Disorder / Q000453:epidemiology; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
keywords: Age differences; Age invariance; Comorbidity; Elderly; Internalizing-externalizing; Mental disorders; Older adults; Psychiatric disorders