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Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Published online by Cambridge University Press:  25 January 2012

R. C. Kessler ,
S. Avenevoli ,
K. A. McLaughlin ,
J. Greif Green ,
M. D. Lakoma ,
M. Petukhova ,
D. S. Pine ,
N. A. Sampson ,
A. M. Zaslavsky  and
K. Ries Merikangas
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. Avenevoli
Affiliation:
Division of Developmental Translational Research, National Institute of Mental Health, Bethesda, MD, USA
K. A. McLaughlin
Affiliation:
Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
J. Greif Green
Affiliation:
School of Education, Boston University, Boston, MA, USA
M. D. Lakoma
Affiliation:
Department of Population Medicine, Harvard Medical School, Boston, MA, USA
M. Petukhova
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
D. S. Pine
Affiliation:
The Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, MD, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
K. Ries Merikangas
Affiliation:
Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: ncs@hcp.med.harvard.edu)
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Abstract

Background

Research on the structure of co-morbidity among common mental disorders has largely focused on current prevalence rather than on the development of co-morbidity. This report presents preliminary results of the latter type of analysis based on the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).

Method

A national survey was carried out of adolescent mental disorders. DSM-IV diagnoses were based on the Composite International Diagnostic Interview (CIDI) administered to adolescents and questionnaires self-administered to parents. Factor analysis examined co-morbidity among 15 lifetime DSM-IV disorders. Discrete-time survival analysis was used to predict first onset of each disorder from information about prior history of the other 14 disorders.

Results

Factor analysis found four factors representing fear, distress, behavior and substance disorders. Associations of temporally primary disorders with the subsequent onset of other disorders, dated using retrospective age-of-onset (AOO) reports, were almost entirely positive. Within-class associations (e.g. distress disorders predicting subsequent onset of other distress disorders) were more consistently significant (63.2%) than between-class associations (33.0%). Strength of associations decreased as co-morbidity among disorders increased. The percentage of lifetime disorders explained (in a predictive rather than a causal sense) by temporally prior disorders was in the range 3.7–6.9% for earliest-onset disorders [specific phobia and attention deficit hyperactivity disorder (ADHD)] and much higher (23.1–64.3%) for later-onset disorders. Fear disorders were the strongest predictors of most other subsequent disorders.

Conclusions

Adolescent mental disorders are highly co-morbid. The strong associations of temporally primary fear disorders with many other later-onset disorders suggest that fear disorders might be promising targets for early interventions.

Keywords

Adolescenceepidemiologylifetime co-morbiditylifetime prevalencemental disordersNCS-A
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 9 , September 2012 , pp. 1997 - 2010
Copyright
Copyright © Cambridge University Press 2012

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