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

J. Mcgrath 1, 2 C. Lim 1 O. Plana-Ripoll 2 Y. Holtz 1 E. Agerbo 2 N. Momen 2 P. Mortensen 2 C. Pedersen 2 J. Abdulmalik 3 S. Aguilar-Gaxiola A. Al-Hamzawi 4 J. Alonso 5 E. Bromet 6 R. Bruffaerts 7 B. Bunting 8 J. de Almeida 9 G. de Girolamo 10 Y. de Vries 11 S. Florescu 12 O. Gureje 3 J. Haro 13, 14 M. Harris 15 C. Hu 16 E. Karam 17 N. Kawakami 18 A. Kiejna 19 Viviane Kovess-Masféty 20 S. Lee 21 Z. Mneimneh 22 F. Navarro-Mateu R. Orozco 23 J. Posada-Villa 24 A. Roest 11 S. Saha 1 K. Scott 25 J. Stagnaro 26 D. Stein 27 Y. Torres 28 M. Viana 29 Y. Ziv 30 R. Kessler 31 P. de Jonge 11
Abstract : 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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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, Cambridge : Cambridge University Press, 2020, 29, pp.e153. ⟨10.1017/S2045796020000633⟩. ⟨hal-03124148⟩

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