The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population
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.
- SourceAvailable from: Matthew Sunderland[Show abstract] [Hide abstract]
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 · 3.71 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Background: Factor analytic studies have found that depressive, bipolar, posttraumatic, obsessive-compulsive, and anxiety disorders—jointly referred to as the emotional disorders—form an internalizing spectrum that includes distress and fear subfactors. However, placement of some disorders is uncertain. Also, prior research analyzed dichotomous interview-based diagnoses or dimensional self-report measures. We investigated this structure using a third-generation measure—the Interview for Mood and Anxiety Symptoms (IMAS)—that combines strengths of a clinical interview with dimensional assessment. Methods: The interview was administered to 385 students and 288 psychiatric outpatients. Participants were reinterviewed two months later. Results: Exploratory and confirmatory factor analyses identified three factors: distress (depression, generalized anxiety, posttraumatic stress, irritability, and panic syndrome), fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive), and bipolar (mania and obsessive-compulsive). The structure was consistent over time and across samples, except that panic and agoraphobia had higher factor loadings in patients. Longitudinal analyses revealed high temporal stability of the factors (test-retest r =.72 to .87), but also substantial disorder-specific stability. Conclusions: This investigation—which bridges diagnostic and self-report studies—found three subfactors of internalizing psychopathology. It provided support for a new subfactor, clarified the placement of obsessive-compulsive and bipolar disorders, and demonstrated that this model generalizes across populations. The accumulating research suggests the need to recognize formally the close links among the emotional disorders, as well as empirical clusters within this spectrum. The IMAS demonstrated strong psychometric properties and can be useful for various research and clinical applications by providing dimensional, interview-based assessment of the emotional disorders.Psychological Medicine 10/2014; In Press. DOI:10.1017/S0033291714002815 · 5.43 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) featured extensive changes to the posttraumatic stress disorder (PTSD) diagnosis. PTSD was moved out of the anxiety disorders into a new class of “trauma- and stressor-related disorders,” and the definition of what constitutes a traumatic experience was revised. Three new symptoms were added, existing ones were modified, and a new four-cluster organization and diagnostic algorithm were introduced. Finally, a new dissociative subtype was added to the diagnosis. We review these changes, discuss some of the controversies surrounding them, and then introduce a new debate involving a radically different conceptualization of PTSD proposed for International Classification of Diseases, 11th edition.Clinical Psychology Science and Practice 09/2014; 21(3). DOI:10.1111/cpsp.12070 · 2.92 Impact Factor