Journal
PSYCHOLOGICAL MEDICINE
Volume 48, Issue 12, Pages 2073-2084Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0033291717003610
Keywords
psychiatric disorders; mental disorders; comorbidity; epidemiology
Categories
Funding
- VICI grant from the Netherlands Organization for Scientific research (NWO-ZonMW) [91812607]
- United States National Institute of Mental Health (NIMH) [R01 MH070884]
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- United States Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center [FIRCA R03-TW006481]
- Pan American Health Organization
- Eli Lilly and Company
- Ortho-McNeil Pharmaceutical Inc.
- GlaxoSmithKline
- Bristol-Myers Squibb
- State of Sao Paulo Research Foundation (FAPESP) Thematic Project [03/00204-3]
- Ministry of Social Protection
- Center for Excellence on Research in Mental Health (CES University)
- National Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]
- National Council on Science and Technology [CONACyT-G30544- H]
- Health & Social Care Research & Development Division of the Public Health Agency
- National Institute of Health of the Ministry of Health of Peru
- Iceland, Liechtenstein, and Norway through funding from the EEA Financial Mechanism [PL 0256]
- Norwegian Financial Mechanism
- Polish Ministry of Health
- Ministry of Public Health
- Regional Health Authorities of Murcia (Servicio Murciano de Salud)
- Regional Health Authorities of Murcia (Consejeria de Sanidad y Politica Social)
- Fundacion para la Formacion e Investigacion Sanitarias (FFIS) of Murcia
- National Institute of Mental Health (NIMH) [U01-MH60220]
- Robert Wood Johnson Foundation (RWJF) [044708]
- Brazilian Council for Scientific and Technological Development (CNPq) [307784/2016-9]
- FOGARTY INTERNATIONAL CENTER [R03TW006481] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF MENTAL HEALTH [R01MH070884, R01MH069864, U01MH060220, R13MH066849] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON DRUG ABUSE [R01DA016558, K05DA015799] Funding Source: NIH RePORTER
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BackgroundThe patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data are available on the placement of eating disorders, bipolar disorder and psychotic experiences (PEs) in this structure.MethodsWe evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six PEs. Respondents (n = 5478-15 499) were included from 10 high-, middle- and lower middle-income countries across the world aged 18 years or older. Confirmatory factor analyses (CFAs) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. Measurement invariance was evaluated with multigroup CFA (MG-CFA).ResultsA second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and PEs with a separate factor.ConclusionsThese results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders.
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