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The Space of Common Psychiatric Disorders in Adolescents: Comorbidity Structure and Individual Latent Liabilities

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Objective

To construct a virtual space of common adolescent psychiatric disorders, spanned by factors reflecting major psychopathological dimensions; and to locate psychiatric disorders in that space, examine whether the major psychopathological dimensions can be hierarchically organized, and determine the distribution of the latent scores of individuals in the space spanned by those dimensions.

Method

Exploratory factor analyses of data from the National Comorbidity Survey Adolescent Supplement (NCS-A) using the psychiatric diagnoses as indicators were used to identify the latent major psychopathological dimensions. The loadings of the disorders on those dimensions were used as coordinates to calculate the distance among disorders. The distribution of individuals in the space was based on the latent scores on the factors reflecting the major psychopathological conditions.

Results

A model with 3 correlated factors provided an excellent fit (Comparative Fit Index [CFI] = 0.97, Tucker-Lewis Index [TLI] = 0.95, the root mean squared error of approximation [RMSEA] = 0.008) for the structure of disorders and a 4-factor model could be hierarchically organized, ultimately yielding a general psychopathology factor. Distances between disorders ranged from 0.079 (between social phobia and generalized anxiety disorder [GAD]) and 1.173 (between specific phobia and conduct disorder [CD]). At the individual level, there were 546 distinct liabilities observed (22% of all 2,455 potential liabilities).

Conclusion

A novel way of understanding psychiatric disorders in adolescents is as existing in a space with a limited number of dimensions with no disorder aligning along 1 single dimension. These dimensions are hierarchically organized, allowing analyses at different levels of organization. Furthermore, individuals with psychiatric disorders present with a broad range of liabilities, reflecting the diversity of their clinical presentations.

Section snippets

Sample

The NCS-A is a nationally representative sample of US adolescents aged 13 to 18 years. Adolescents were interviewed between February 2001 and January 2004 in dual-frame household and school samples as described elsewhere.21, 22 The household sample included 904 adolescents from households in the National Comorbidity Survey Replication (NCS-R).23 The household sample included school drop-outs and adolescents residing in areas where schools refused to participate. The school sample included 9,244

12-Month Prevalence of Disorders and Identification of Dimensions

As previously reported,31 the NCS-A was broadly representative of the US population of adolescents aged 13 to 17 years. Female adolescents composed 51.1% of the sample. Individuals of non-Hispanic white ethnicity comprised the largest racial/ethnic group (55.7%), followed by non-Hispanic blacks (19.3%), Hispanics (18.9%), and others (6.1%). There was a broad range of 12-month prevalence among the disorders examined. The most prevalent disorder was specific phobia (15.8%), followed by ODD

Discussion

This is the first study to use a formal measure of similarity of proximity between disorders in a nationally representative sample of adolescents, and to examine the distribution of liability to psychiatric disorders in that sample. We found that interrelationships among 12-month psychiatric disorders were well described by 3 or 4 correlated dimensions representing different facets of underlying internalizing and externalizing dimensions. When the factors were used to span a space and their

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  • Cited by (0)

    The National Comorbidity Survey Adolescent Supplement (NCS-A) and the larger program of related NCS surveys are supported by grant U01-MH60220 from NIMH. Work on this manuscript was supported by National Institutes of Health (NIH) grants DA019606, DA023200, MH0760551, and MH082773 (C.B.), and the New York State Psychiatric Institute (C.B., M.O.). The sponsors had no additional role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

    Dr. Wall, Ms. He, and Ms. Jin served as the statistical experts for this research.

    Disclosure: Drs. Blanco, Wall, Krueger, Olfson, Burstein, Merikangas, and Ms. He and Ms. Jin report no biomedical financial interests or potential conflicts of interest.

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