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Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries

  • J. J. McGrath (a1) (a2) (a3), C. C. W. Lim (a2) (a3), O. Plana-Ripoll (a4), Y. Holtz (a2), E. Agerbo (a4) (a5) (a6), N. C. Momen (a4), P. B. Mortensen (a4) (a5) (a6), C. B. Pedersen (a4) (a5) (a6) (a7), J. Abdulmalik (a8), S. Aguilar-Gaxiola (a9), A. Al-Hamzawi (a10), J. Alonso (a11) (a12), E. J. Bromet (a13), R. Bruffaerts (a14), B. Bunting (a15), J. M. C. de Almeida (a16), G. de Girolamo (a17), Y. A. De Vries (a18) (a19), S. Florescu (a20), O. Gureje (a21), J. M. Haro (a22) (a23), M. G. Harris (a3) (a24), C. Hu (a25), E. G. Karam (a26) (a27), N. Kawakami (a28), A. Kiejna (a29), V. Kovess-Masfety (a30), S. Lee (a31), Z. Mneimneh (a32), F. Navarro-Mateu (a33), R. Orozco (a34), J. Posada-Villa (a35) (a36), A. M. Roest (a37), S. Saha (a2) (a3), K. M. Scott (a38), J. C. Stagnaro (a39), D. J. Stein (a40), Y. Torres (a41), M. C. Viana (a42), Y. Ziv (a43), R. C. Kessler (a44) and P. de Jonge (a18) (a19)...

Abstract

Aims

Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.

Methods

The WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.

Results

Each prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.

Conclusions

Survey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Author for correspondence: Peter de Jonge, E-mail: peter.de.jonge@rug.nl

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Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries

  • J. J. McGrath (a1) (a2) (a3), C. C. W. Lim (a2) (a3), O. Plana-Ripoll (a4), Y. Holtz (a2), E. Agerbo (a4) (a5) (a6), N. C. Momen (a4), P. B. Mortensen (a4) (a5) (a6), C. B. Pedersen (a4) (a5) (a6) (a7), J. Abdulmalik (a8), S. Aguilar-Gaxiola (a9), A. Al-Hamzawi (a10), J. Alonso (a11) (a12), E. J. Bromet (a13), R. Bruffaerts (a14), B. Bunting (a15), J. M. C. de Almeida (a16), G. de Girolamo (a17), Y. A. De Vries (a18) (a19), S. Florescu (a20), O. Gureje (a21), J. M. Haro (a22) (a23), M. G. Harris (a3) (a24), C. Hu (a25), E. G. Karam (a26) (a27), N. Kawakami (a28), A. Kiejna (a29), V. Kovess-Masfety (a30), S. Lee (a31), Z. Mneimneh (a32), F. Navarro-Mateu (a33), R. Orozco (a34), J. Posada-Villa (a35) (a36), A. M. Roest (a37), S. Saha (a2) (a3), K. M. Scott (a38), J. C. Stagnaro (a39), D. J. Stein (a40), Y. Torres (a41), M. C. Viana (a42), Y. Ziv (a43), R. C. Kessler (a44) and P. de Jonge (a18) (a19)...

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