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Comorbidity Within Mental Disorders: a Comprehensive Analysis Based on 145 990 Survey Respondents from 27 Countries J Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries J. Mcgrath, C. Lim, O. Plana-Ripoll, Y. Holtz, E. Agerbo, N. Momen, P. Mortensen, C. Pedersen, J. Abdulmalik, S. Aguilar-Gaxiola, et al. To cite this version: J. Mcgrath, C. Lim, O. Plana-Ripoll, Y. Holtz, E. Agerbo, et al.. Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries. Epi- demiology and Psychiatric Sciences, Cambridge : Cambridge University Press, 2020, 29, pp.e153. 10.1017/S2045796020000633. hal-03124148 HAL Id: hal-03124148 https://hal.ehesp.fr/hal-03124148 Submitted on 28 Jan 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Distributed under a Creative Commons Attribution - NonCommercial - NoDerivatives| 4.0 International License Epidemiology and Psychiatric Comorbidity within mental disorders: Sciences a comprehensive analysis based on 145 990 cambridge.org/eps survey respondents from 27 countries J. J. McGrath1,2,3 ,C.C.W.Lim2,3, O. Plana-Ripoll4, Y. Holtz2, E. Agerbo4,5,6, 4 4,5,6 4,5,6,7 8 Original Article N. C. Momen , P. B. Mortensen , C. B. Pedersen , J. Abdulmalik , S. Aguilar-Gaxiola9, A. Al-Hamzawi10, J. Alonso11,12,E.J.Bromet13, R. Bruffaerts14, Cite this article: McGrath JJ et al (2020). Comorbidity within mental disorders: a B. Bunting15, J. M. C. de Almeida16 , G. de Girolamo17, Y. A. De Vries18,19, comprehensive analysis based on 145 990 20 21 22,23 3,24 25 26,27 survey respondents from 27 countries. S. Florescu , O. Gureje , J. M. Haro , M. G. Harris ,C.Hu , E. G. Karam , Epidemiology and Psychiatric Sciences 29, 28 29 30 31 32 e153, 1–9. https://doi.org/10.1017/ N. Kawakami , A. Kiejna , V. Kovess-Masfety , S. Lee , Z. Mneimneh , S2045796020000633 F. Navarro-Mateu33, R. Orozco34, J. Posada-Villa35,36, A. M. Roest37, S. Saha2,3, Received: 9 April 2020 K. M. Scott38, J. C. Stagnaro39, D. J. Stein40, Y. Torres41, M. C. Viana42,Y.Ziv43, Revised: 3 July 2020 Accepted: 3 July 2020 R. C. Kessler44 and P. de Jonge18,19 Key words: 1National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; 2Queensland Brain Institute, Cross-sectional study; diagnosis and University of Queensland, St Lucia QLD 4072, Australia; 3Queensland Centre for Mental Health Research, The Park classification; epidemiology; population survey Centre for Mental Health, Queensland, Australia; 4National Centre for Register-based Research, Aarhus University, 5 Author for correspondence: Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Peter de Jonge, Denmark; 6Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark; 7Big Data Centre E-mail: [email protected] for Environment and Health, Aarhus University, Aarhus, Denmark; 8Department of Psychiatry, University College Hospital, Ibadan, Nigeria; 9Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA; 10College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq; 11Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; 12CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain; 13Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA; 14Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; 15School of Psychology, Ulster University, Londonderry, UK; 16Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; 17IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; 18Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands; 19Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, the Netherlands; 20National School of Public Health, Management and Development, Bucharest, Romania; 21Department of Psychiatry, University College Hospital, Ibadan, Nigeria; 22Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain; 23Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia; 24School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; 25Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China; 26Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon; 27Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; 28Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; 29Wroclaw Medical University;University of Lower Silesia, Wroclaw, Poland; 30Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France; 31Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; 32Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA; 33UDIF-SM, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Región de Murcia, Spain; 34National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico; 35Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia; 36Cundinamarca University, calle 28 # 5B 02, Bogotá, 11001000 (zip), Colombia; 37Faculty of Behavioural and Social Sciences, Department © The Author(s), 2020. Published by Developmental Psychology, University of Groningen, Groningen, the Netherlands; 38Department of Psychological Cambridge University Press. This is an Open Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; 39Departamento de Psiquiatría Access article, distributed under the terms of y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina; 40Department of Psychiatry & the Creative Commons Attribution- Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, NonCommercial-NoDerivatives licence (http:// University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa; 41Center for Excellence creativecommons.org/licenses/by-nc-nd/4.0/), on Research in Mental Health, CES University, Medellin, Colombia; 42Department of Social Medicine, Postgraduate which permits non-commercial re-use, 43 distribution, and reproduction in any medium, Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil; Mental Health Services, Israeli 44 provided the original work is unaltered and is Ministry of Health, Jerusalem, Israel and Department of Health Care Policy, Harvard Medical School, Boston MA, properly cited. The written permission of USA Cambridge University Press must be obtained for commercial re-use or in order to create a Abstract derivative work. 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. 2 J. J. McGrath et al. Methods. The WHO World Mental Health (WMH) surveys assessed 145 990 adult respon- dents 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 subse- quent 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 dis- orders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders. Introduction Methods Comorbidity within mental disorder is common – individuals Samples and procedures with one type of mental disorder often develop other types of Data came from 29 coordinated
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