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Journal Articles Epidemiology and Psychiatric Sciences Year : 2020

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

1 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
2 Aarhus University [Aarhus]
3 University College Hospital [Ibadan, Nigeria]
4 AL-Qadisiyah University
5 CIBERESP - Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública = Consortium for Biomedical Research of Epidemiology and Public Health
6 SBU - Stony Brook University [SUNY]
7 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
8 University of Ulster
9 NOVA - Universidade Nova de Lisboa = NOVA University Lisbon
10 Istituto Centro San Giovanni di Dio Fatebenefratelli
11 University of Groningen [Groningen]
12 National School of Public Health, Management and Development
13 KSU - King Saud University [Riyadh]
14 UB - Universitat de Barcelona
15 Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital
16 UOB - University of Balamand [Liban]
17 UTokyo - The University of Tokyo
18 Wrocław Medical University
19 EHESP - École des Hautes Études en Santé Publique [EHESP]
20 CUHK - The Chinese University of Hong Kong [Hong Kong]
21 University of Michigan [Ann Arbor]
22 INPRF - National Institute of Psychiatry Ramón de la Fuente Muñiz [Mexico City]
23 Cundinamarca University
24 University of Otago [Dunedin, Nouvelle-Zélande]
25 UBA - Universidad de Buenos Aires [Buenos Aires]
26 University of Cape Town
27 CES University
28 Federal University of Espírito Santo
29 Israeli Ministry of Health
30 HMS - Harvard Medical School [Boston]
S. Aguilar-Gaxiola
  • Function : Author
B. Bunting
  • Function : Author
M. Harris
F. Navarro-Mateu
  • Function : Author
D. Stein
  • Function : Author
Y. Torres
  • Function : Author


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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hal-03124148 , version 1 (28-01-2021)


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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. Epidemiology and Psychiatric Sciences, 2020, 29, pp.e153. ⟨10.1017/S2045796020000633⟩. ⟨hal-03124148⟩
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