Slade T, Watson D. The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychol Med 36: 1593-1600

School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia.
Psychological Medicine (Impact Factor: 5.94). 12/2006; 36(11):1593-600. DOI: 10.1017/S0033291706008452
Source: PubMed

ABSTRACT Patterns of co-occurrence among the common mental disorders may provide information about underlying dimensions of psychopathology. The aim of the current study was to determine which of four models best fits the pattern of co-occurrence between 10 common DSM-IV and 11 common ICD-10 mental disorders.
Data were from the Australian National Survey of Mental Health and Well-Being (NSMHWB), a large-scale community epidemiological survey of mental disorders. Participants consisted of a random population-based sample of 10641 community volunteers, representing a response rate of 78%. DSM-IV and ICD-10 mental disorder diagnoses were obtained using the Composite International Diagnostic Interview (CIDI), version 2.0. Confirmatory factor analysis (CFA) was used to assess the relative fit of competing models.
A hierarchical three-factor variation of a two-factor model demonstrated the best fit to the correlations among the mental disorders. This model included a distress factor with high loadings on major depression, dysthymia, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD) and neurasthenia (ICD-10 only); a fear factor with high loadings on social phobia, panic disorder, agoraphobia and obsessive-compulsive disorder (OCD); and an externalizing factor with high loadings on alcohol and drug dependence. The distress and fear factors were best conceptualized as subfactors of a higher order internalizing factor.
A greater focus on underlying dimensions of distress, fear and externalization is warranted.

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    • "GAD and panic disorder have distinct biology (Wilkinson et al. 1998), medical co-morbidities (Davies et al. 2012; Davies & Allgulander, 2013) and differ in the frequency of reports of genetic association with depression (Roy et al. 1995; Kendler, 1996, Kendler et al. 2003, 2007). Factor analyses of cross-sectional data in large populations had suggested that GAD may be more closely associated with depression than is panic disorder (Krueger, 1999; Vollebergh et al. 2001; Slade & Watson, 2006). Although this finding was confirmed in a population of adolescents and young adults (Beesdo-Baum et al. 2009), there remains a controversy over whether this factor structure is robust to addition of other diagnoses and in other age groups (Wittchen et al. 2009). "
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    ABSTRACT: Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years. Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule - Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data. In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0-9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3-4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9-9.9) but those for PD became weaker. Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.
    Psychological Medicine 08/2015; DOI:10.1017/S003329171500149X · 5.94 Impact Factor
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    • "Breslau et al., 2000; Brewin et al., 2000; Kendler et al., 2002; Koenen et al., 2008; O'Donnell et al., 2004). In addition, by using factor analysis, some studies have found that PTSD and depression load onto the same higher-order factor (Anxious Misery/ Distress; Cox et al., 2002; Miller et al., 2008; Slade and Watson, 2006). And in the quantitative hierarchical model of mood and anxiety disorders proposed by Watson (2005), PTSD is grouped into the subclass of distress disorders along with MDD, suggesting that PTSD and depression share identical elements of one form of psychopathology. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) and depression are highly comorbid in association with serious clinical consequences. Nevertheless, to date, no study using latent class or latent profile analysis (LCA/LPA) has examined patterns of co-occurring PTSD and depression symptoms among natural disaster survivors, nor has the distinctiveness of DSM-5 PTSD and depression symptoms been clarified in the aftermath of trauma. This study was primarily aimed at filling these gaps. LPA was used to examine self-reported PTSD and depression symptoms in an epidemiological sample of 1196 Chinese earthquake survivors. A 4-class solution characterized by low symptoms (53.9%), predominantly depression (18.2%), predominantly PTSD (18.9%) and combined PTSD-depression (9.0%) patterns fit the data best. Demographic characteristics and earthquake-related exposures were specifically or consistently associated with the non-parallel profiles varying in physical health impairment. A sample exposed to specific traumatic events was assessed by self-report measures. The distinctiveness of DSM-5 PTSD and depression symptoms following an earthquake suggests that PTSD and depression may be independent sequelae of psychological trauma rather than a manifestation of a single form of psychopathology. The current findings support the distinction between PTSD and depression constructs, and highlight the need for identifications of natural disaster survivors at high risk for PTSD and/or depression, and interventions individually tailored to one's symptom presentations. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 07/2015; 186:58-65. DOI:10.1016/j.jad.2015.06.058 · 3.38 Impact Factor
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    • "was able to show that the DSM-IV mood and anxiety disorders loaded onto a 81 single higher-order latent dimension. This latent dimension, which has since been referred to 82 as internalizing liability, has demonstrated excellent fit using data from several countries as 83 well as different research settings (Beesdo-Baum et al., 2009; Krueger and Markon, 2006; 84 Slade and Watson, 2006; Wright et al., 2013). "
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    ABSTRACT: Background Recent evidence has emerged suggesting that multiple mood and anxiety disorders may be better assessed using a single dimension representing internalizing liability. The current study seeks to demonstrate the validity and utility of internalizing liability when accounting for suicidality, treatment seeking, and disability over and above any disorder specific relationship. Methods Data were from the 2007 Australian National Survey of Mental Health and Wellbeing. A model containing a single factor was fit to the data as a means of explaining the shared relationship across seven DSM-IV mood and anxiety disorders. The shared and specific relationships between lifetime and past 12 months internalizing and mental health consultations, suicidality, and disability were examined using Multiple Indicators, Multiple Causes models. Results General levels of latent internalizing were significantly related to all covariates of interest across both lifetime and past 12 months diagnoses. Models that included the specific relationship between various internalizing disorders and the clinical correlates failed to significantly improve model fit over and above a model that already included the general relationship between latent internalizing and the covariates. Limitations Limitations include the use of cross-sectional data and diagnostic assessments based on self-report lay-administered interviews. Conclusions The overall internalizing latent variable sufficiently explains the majority of the relationship between multiple mood and anxiety disorders and suicidality, treatment seeking, and disability. Researchers should focus on investigating the shared or common components across all mood and anxiety disorders particularly with respect to individuals presenting with higher rates of suicidality, treatment seeking behavior, and disability.
    Journal of Affective Disorders 01/2015; 171:6–12. DOI:10.1016/j.jad.2014.09.012 · 3.38 Impact Factor
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