Weich, Scott, McBride, O., Hussey, D., Exeter, D., Brugha, T. S. (Traolach S.) and McManus, Sally. (2011) Latent class analysis of co-morbidity in the Adult Psychiatric Morbidity Survey in England 2007 : implications for DSM-5 and ICD-11. Psychological Medicine, Vol.41 (No.10). pp. 2201-2212. ISSN 0033-2917

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Abstract

Background. Psychiatric co-morbidity is complex and ubiquitous. Our aim was to describe the extent, nature and patterning of psychiatric co-morbidity within a representative sample of the adult population of England, using latent class analysis. Method. Data were used from the 2007 Adult Psychiatric Morbidity Survey, a two-phase national household survey undertaken in 2007 comprising 7325 participants aged 16 years and older living in private households in England. The presence of 15 common mental health and behavioural problems was ascertained using standardized clinical and validated self-report measures, including three anxiety disorders, depressive episode, mixed anxiety depressive disorder, psychosis, antisocial and borderline personality disorders, eating disorders, post-traumatic stress disorder, attention deficit disorder, alcohol and drug dependencies, problem gambling and attempted suicide. Results. A four-class model provided the most parsimonious and informative explanation of the data. Most participants (81.6%) were assigned to a non-symptomatic or 'Unaffected' class. The remainder were classified into three qualitatively different symptomatic classes : 'Co-thymia' (12.4%), 'Highly Co-morbid' (5.0%) and 'Addictions' (1.0%). Classes differed in mean numbers of conditions and impairments in social functioning, and these dimensions were correlated. Conclusions. Our findings confirm that mental disorders typically co-occur and are concentrated in a relatively small number of individuals. Conditions associated with the highest levels of disability, mortality and cost - psychosis, suicidality and personality disorders - are often co-morbid with more common conditions. This needs to be recognized when planning services and when considering aetiology.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences
Library of Congress Subject Headings (LCSH):	Comorbidity -- Great Britain, Mental health -- Great Britain
Journal or Publication Title:	Psychological Medicine
Publisher:	Cambridge University Press
ISSN:	0033-2917
Date:	2011
Volume:	Vol.41
Number:	No.10
Number of Pages:	12
Page Range:	pp. 2201-2212
Identification Number:	10.1017/S0033291711000249
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
References:	Acock AC (2005). Growth curves and extensions using Mplus. (http://www.caldar.org/presentations/ summer%20institute/2008/Day-2%20Aug%2014-2008/ Track%201/Growth%20Curve%20Presentation.pdf). Accessed: February 2011. Akaike H (1987). Factor analysis and the AIC. Psychometrika 52, 317–332. Andrews G, Goldberg DP, Krueger RF, Carpenter WT, Hyman SE, Sachdev P, Pine DS (2009). Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity ? Psychological Medicine 39, 1993–2000. Andrews G, Slade T, Issakidis C (2002). Deconstructing current comorbidity : data from the Australian National Survey of Mental Health and Well-Being. British Journal of Psychiatry 181, 306–314. Bebbington PE, Nayani T (1995). The psychosis screening questionnaire. International Journal of Methods in Psychiatric Research 5, 11–20. Breslau N, Reboussin BA, Anthony JC, Storr CL (2005). The structure of posttraumatic stress disorder : latent class analysis in 2 community samples. Archives of General Psychiatry 62, 1343–1351. Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, Turner S, Foa EB (2002). Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry 181, 158–162. Brugha TS (2002). The end of the beginning : a requiem for the categorisation of mental disorder ? Psychological Medicine 32, 1149–1154. Cerda´ M, Sagdeo A, Johnson J, Galea S (2010). Genetic and environmental influences on psychiatric comorbidity : a systematic review. Journal of Affective Disorders 126, 14–38. Compton WM, Thomas YF, Stinson FS, Grant BF (2007). Prevalence, correlates, disability and comorbidity of DSM-IV drug abuse and dependence in the United States. Archives of General Psychiatry 64, 566–576. Dunn KM, Jordan K, Croft PR (2006). Characterizing the course of low back pain : a latent class analysis. American Journal of Epidemiology 163, 754–761. First MB, Gibbon M, Spitzer RL, William JBW, Benjamin L (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorder. American Psychiatric Press : Washington, DC. Flensborg-Madsen T, Mortensen EL, Knop J, Becker U, Sher L, Gronbaek M (2009). Comorbidity and temporal ordering of alcohol use disorders and other psychiatric disorders : results from a Danish register-based study. Comprehensive Psychiatry 50, 307–314. Fortin M, Soubhi H, Hudon C, Bayliss EA, van den Akker M (2007). Multimorbidity’s many challenges. BMJ 334, 1016–1017. Goldberg D (2010). Should our major classifications of mental disorders be revised ? British Journal of Psychiatry 196, 255–256. Goldberg DP, Krueger RF, Andrews G, Hobbs MJ (2009). Emotional disorders : cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 2043–2059. Gradus JL, Qin P, Lincoln AK, Miller M, Lawler E, Sørensen HT, Lash TL (2010). Posttraumatic stress disorder and completed suicide. American Journal of Epidemiology 171, 721–727. Grant BF, Hasin DS, Stinson FS, Dawson DA, Ruan WJ, Goldstein RB, Smith SM, Saha TD, Huang B (2005). Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder : results from the National Epidemiologic Survey on alcohol and related condition. Psychological Medicine 35, 1747–1759. Hall J, Howard D (2006). Integrated Care Pathways in Mental Health. Churchill Livingstone : London. Hawgood J, De Leo D (2008). Anxiety disorders and suicidal behaviour: an update. Current Opinion in Psychiatry 21, 51–64. Jane´-Llopis E, Matytsina I (2006). Mental health and alcohol, drugs and tobacco : a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug and Alcohol Review 25, 515–536. Kendler KS (2009). Introduction to ‘A proposal for a metastructure for DSM-V and ICD-11’. Psychological Medicine 39, 1991. Kendler KS, Davis CG, Kessler RC (1997). The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey : a family history study. British Journal of Psychiatry 170, 541–548. Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ (1992). Major depression and generalised anxiety disorder : same genes, (partly) different environments ? Archives of General Psychiatry 49, 716–722. Kendler KS, Prescott CA, Myers J, Neale MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929–937. Kessler RC, Chiu WT, Demler O, Walters EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry 62, 617–627. Kessler RC, Nelson CB, McGonagle KA, Liu J, Swartz M, Blazer DG (1996). Comorbidity of DSM-III-R major depressive disorder in the general population : results from the US National Comorbidity Study. British Journal of Psychiatry 168, (Suppl. 30), 17–30. Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ, Stein DJ, Zaslavsky AM, Aguilar-Gaxiola S, Alonso J, Andrade L, Benjet C, de Girolamo G, de Graaf R, Demyttenaere K, Fayyad J, Haro JM, Hu CY, Karam A, Lee S, Lepine JP, Matchsinger H, Mihaescu-Pintia C, Posada-Villa J, Sagar R, U¨ stu¨n TB (2011). Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry 68, 90–100. Krueger RF (1999). The structure of the common mental disorders. Archives of General Psychiatry 62, 921–926. Krueger RF, South SC (2009). Externalizing disorders : cluster 5 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 2061–2070. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2006). DSM-IV personality disorders in the national comorbidity survey replication. Biological Psychiatry 62, 553–564. Lewis G, Pelosi AJ, Araya R, Dunn G (1992). Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine 22, 465–486. Lo Y, Mendell N, Rubin DB (2001). Testing the number of components in a normal mixture. Biometrika 88, 767–778. Maj M (2005). ‘ Psychiatric comorbidity ’ : an artefact of current diagnostic systems ? British Journal of Psychiatry 186, 182–184. Malgady RG, Rogler LH, Tryon WW (1992). Issues of validity in the Diagnostic Interview Schedule. Journal of Psychiatric Research 26, 59–67. Markon KE (2009). Modelling psychopathology structure : a symptom-level analysis of axis I and II disorders. Psychological Medicine 40, 273–288. McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R (2009). Adult Psychiatric Morbidity in England, 2007 : Results of a Household Survey. The NHS Information Centre for Health and Social Care: London. Merikangas KR, Kalaydjian A (2007). Magnitude and impact of comorbidity of mental disorders from epidemiologic surveys. Current Opinion in Psychiatry 20, 353–358. Merikangas KR, Zhang H, Avenevoli S, Acharyya S, Neuenschwander M, Angst J (2003). Longitudinal trajectories of depression and anxiety in a prospective community study : the Zurich Cohort Study. Archives of General Psychiatry 60, 993–1000. Morgan JF, Reid F, Lacey JH (1999). The SCOFF questionnaire : assessment of a new screening tool for eating disorders. BMJ 319, 1467–1468. Muthe´n LK, Muthe´n BO (2007). Mplus User’s Guide (4th edn). Muthe´n and Muthe´n:, Los Angeles, CA. Nagin DS (2005). Group-Based Modeling of Development. Harvard University Press : Boston, MA. Neely-Barnes S (2010). Latent class models in social work. Social Work Research 34, 114–121. Nock MK, Hwang I, Sampson NA, Kessler RC (2009). Mental disorders, comorbidity and suicidal behavior : results from the National Comorbidity Survey Replication. Molecular Psychiatry 15, 868–876. Nylund KL, Asparouhov T, Muthe´n BO (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling 14, 535–569. Petry NM, Stinson FS, Grant BF (2005). Comorbidity of DSM-IV pathological gambling and other psychiatric disorders : results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 66, 564–574. Pirkola S, Saarni S, Suvisaari J, Elovainio M, Partonen T, Aalto AM, Honkonen T, Perala J, Lonnqvist J (2009). General health and quality-of-lifemeasures in active, recent, and comorbid mental disorders : a population-based health 2000 study. Comprehensive Psychiatry 50, 108–114. Ramaswany V, De Sarbo W, Reibstein D, Robinson W (1993). An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Marketing Science 12, 103–124. Richardson J, Steiger H, Schmitz N, Joober R, Bruce KR, Gauvin L, Anestin AS, Dandurand C, Howard H, de Guzman R (2008). Relevance of 5-HTTLPR polymorphism and childhood abuse to increased psychiatric comorbidity in women with bulimia-spectrum disorders. Journal of Clinical Psychiatry 69, 981–990. Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, ten Have M, Stein MB (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts : a population-based longitudinal study of adults. Archives of General Psychiatry 62, 1249–1257. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption, part II. Addiction 88, 791–804. Schwartz G (1978). Estimating the dimension of a model. Annals of Statistics 6, 461–464. Sclove SL (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika 52, 333–343. Shorter E, Tyrer P (2003). Separation of anxiety and depressive disorders : blind alley in psychopharmacology and classification of disease. British Medical Journal 327, 158–160. Singh JB, Zarate CA (2006). Pharmacological treatment of psychiatric comorbidity in bipolar disorder : a review of controlled trials. Bipolar Disorders 8, 696–709. Slade T, Watson D (2006). The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychological Medicine 36, 1593–1600. Stockwell T, Sitharthan T, McGrath D, Lang E (1994). The measurement of alcohol dependence and impaired control in community samples. Addiction 89, 167–174. Tyrer P (2001). The case for cothymia: mixed anxiety and depression as a single diagnosis. British Journal of Psychiatry 179, 191–193. Tyrer P, Nur U, Crawford M, Karlsen S, MacLean C, Rao B, Johnson T (2005). The Social Functioning Questionnaire : a rapid and robust measure of perceived functioning. International Journal of Social Psychiatry 51, 265–275. Veen G, de Rijk RH, Giltay EJ, van Vliet IM, van Pelt J, Zitman FG (2009). The influence of psychiatric comorbidity on the dexamethasone/CRH test in major depression. European Neuropsychopharmacology 19, 409–415. Vermunt JK, Magidson J (2002). Latent class cluster analysis. In Advances in Latent Class Models (ed. J. A. Hagenaars and A. L. McCutcheon). Cambridge University Press : Cambridge, UK. Vollebergh WAM, Iedema J, Bijl RV, de Graaf R, Ormel J (2001). The structure and stability of common mental disorders. Archives of General Psychiatry 58, 597–603. Wardle H, Sproston K, Orford J, Erens B, Griffiths M, Constantine R, Pigott S (2007). British Gambling Prevalence Survey 2007. National Centre for Social Research : London. WHO (1999). SCAN Schedules for Clinical Assessment in Neuropsychiatry Version 2.1. World Health Organization : Geneva. WHO (2003). Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) Screen. World Health Organization : Geneva. Wilcox HC, Storr CL, Breslau N (2009). Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Archives of General Psychiatry 66, 305–311. Wittchen HU, Jacobi F (2005). Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. European Neuropsychopharmacology 15, 357–376.
URI:	http://wrap.warwick.ac.uk/id/eprint/39627

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