Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys

Ronald C. Kessler, Johan Ormel, Maria Petukhova, Katie A. McLaughlin, Jennifer Greif Green, Leo J. Russo, Dan J. Stein, Alan M. Zaslavsky, Sergio Aguilar-Gaxiola, Jordi Alonso, Laura Andrade, Corina Benjet, Giovanni De Girolamo, Ron De Graaf, Koen Demyttenaere, John Fayyad, Josep Maria Haro, Chi Yi Hu, Aimee Karam, Sing LeeJean Pierre Lepine, Herbert Matchsinger, Constanta Mihaescu-Pintia, Jose Posada-Villa, Rajesh Sagar, T. Bedirhan Üstün

Research output: Contribution to journalArticlepeer-review


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: Thegoodfit of the latent variablemodelsuggests thatcommoncausal pathways account for most of the comorbidityamongthe 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 bylatentvariablesalsoexistthatwarrantfurtherfocusedstudy.

Original languageEnglish
Pages (from-to)90-100
Number of pages11
JournalArchives of General Psychiatry
Issue number1
Publication statusPublished - Jan 2011

ASJC Scopus subject areas

  • Psychiatry and Mental health


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