The cross-national structure of mental disorders: results from the World Mental Health Surveys

Peter de Jonge*, Klaas J. Wardenaar, Carmen C W Lim, Sergio Aguilar-Gaxiola, Jordi Alonso, Laura Helena Andrade, Brendan Bunting, Somnath Chatterji, Marius Ciutan, Oye Gureje, Elie G Karam, Sing Lee, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Beth-Ellen Pennell, Marina Piazza, José Posada-Villa, Yolanda Torres, Ronald C KesslerKate Scott

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

17 Citations (Scopus)

Abstract

BackgroundThe 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.MethodsWe 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).ResultsA 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.ConclusionsThese 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.

Original languageEnglish
Pages (from-to)2073-2084
Number of pages12
JournalPsychological Medicine
Volume48
Issue number12
Early online date19-Dec-2017
DOIs
Publication statusPublished - Sep-2018

Keywords

  • psychiatric disorders
  • mental disorders
  • comorbidity
  • epidemiology
  • SUBSTANCE USE DISORDERS
  • COMMON DSM-IV
  • EXTERNALIZING PSYCHOPATHOLOGY
  • PSYCHIATRIC COMORBIDITY
  • GENERAL-POPULATION
  • GENDER-DIFFERENCES
  • EARLY ADULTHOOD
  • TERM STABILITY
  • META-STRUCTURE
  • UNITED-STATES

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