Peter de Jonge1, Klaas J Wardenaar2, Carmen C W Lim3, Sergio Aguilar-Gaxiola4, Jordi Alonso5, Laura Helena Andrade6, Brendan Bunting7, Somnath Chatterji8, Marius Ciutan9, Oye Gureje10, Elie G Karam11, Sing Lee12, Maria Elena Medina-Mora13, Jacek Moskalewicz14, Fernando Navarro-Mateu15, Beth-Ellen Pennell16, Marina Piazza17, José Posada-Villa18, Yolanda Torres19, Ronald C Kessler20, Kate Scott3. 1. Developmental Psychology,Department of Psychology,Rijksuniversiteit Groningen,Groningen,Netherlands. 2. Department of Psychiatry,Interdisciplinary Center Psychopathology and Emotion Regulation,University Medical Center Groningen,Groningen,Netherlands. 3. Department of Psychological Medicine,University of Otago,Dunedin, Otago,New Zealand. 4. Center for Reducing Health Disparities,UC Davis Health System,Sacramento, California,USA. 5. Health Services Research Unit,IMIM-Hospital del Mar Medical Research Institute,Barcelona,Spain. 6. Núcleo de Epidemiologia Psiquiátrica - LIM 23,Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade,de São Paulo,Brazil. 7. School of Psychology,Ulster University,Londonderry,UK. 8. Department of Information,Evidence and Research, World Health Organization,Geneva,Switzerland. 9. National School of Public Health,Management and Development,Bucharest,Romania. 10. Department of Psychiatry,University College Hospital,Ibadan,Nigeria. 11. Department of Psychiatry and Clinical Psychology,St George Hospital University Medical Center, Balamand University,Faculty of Medicine,Beirut,Lebanon. 12. Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong. 13. National Institute of Psychiatry Ramon de la Fuente Muñiz,Mexico City,Mexico. 14. Institute of Psychiatry and Neurology,Warsaw,Poland. 15. UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia,Murcia,Spain. 16. Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor, Michigan,USA. 17. Universidad Cayetano Heredia,Lima,Peru. 18. Colegio Mayor de Cundinamarca University, Faculty of Social Sciences,Bogota,Colombia. 19. Center for Excellence on Research in Mental Health, CES University,Medellin,Colombia. 20. Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
Abstract
BACKGROUND: The 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. METHODS: We 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). RESULTS: A 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. CONCLUSIONS: These 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.
BACKGROUND: The 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. METHODS: We 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). RESULTS: A 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. CONCLUSIONS: These 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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