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Pathways to comorbidity: the transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study.
J Affect Disord. 2004 Nov 01; 82(3):461-7.JA

Abstract

BACKGROUND

To describe transitions to comorbidity within a 3-year period in three cohorts of subjects with at baseline a 12-month pure mood, anxiety or substance use disorder but no lifetime history of any other disorder category. To assess the role of personal and social vulnerability factors, life events, clinical factors and functional disability in the pathway to comorbidity.

METHODS

Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study of a representative sample of 7076 adults aged 18-65, interviewed in three waves (baseline, 1 and 3 years after baseline) with the Composite International Diagnostic Interview.

RESULTS

15.2% of 99 pure mood, 10.5% of 220 anxiety and 6.8% of 192 substance use disorder cases became comorbid. Comorbid transition from pure mood disorder was multivariately associated with higher age, external mastery and severity of the disorder. Comorbidity developing from pure anxiety disorder was associated with past and recent stressful life circumstances (childhood trauma, negative life events) and physical functional disability. Predictors of comorbid transition from pure substance use disorder were personal and social vulnerability variables only (high neuroticism, low social support).

LIMITATIONS

Although NEMESIS was performed among a substantial number of cases, the number of cases with a pure disorder at baseline subsequently developing comorbidity was low. This limited analysing determinants of different comorbid conditions.

CONCLUSIONS

Risk factors for comorbid transitions vary depending on whether subjects have a primary mood, anxiety or substance use disorder. Interventions aimed at primary prevention of comorbidity to reduce psychiatric burden in populations with a history of pure disorders are indicated in response to clearly identified risk factors.

Authors+Show Affiliations

Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands. rgraaf@trimbos.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15555699

Citation

de Graaf, Ron, et al. "Pathways to Comorbidity: the Transition of Pure Mood, Anxiety and Substance Use Disorders Into Comorbid Conditions in a Longitudinal Population-based Study." Journal of Affective Disorders, vol. 82, no. 3, 2004, pp. 461-7.
de Graaf R, Bijl RV, Ten Have M, et al. Pathways to comorbidity: the transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study. J Affect Disord. 2004;82(3):461-7.
de Graaf, R., Bijl, R. V., Ten Have, M., Beekman, A. T., & Vollebergh, W. A. (2004). Pathways to comorbidity: the transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study. Journal of Affective Disorders, 82(3), 461-7.
de Graaf R, et al. Pathways to Comorbidity: the Transition of Pure Mood, Anxiety and Substance Use Disorders Into Comorbid Conditions in a Longitudinal Population-based Study. J Affect Disord. 2004 Nov 1;82(3):461-7. PubMed PMID: 15555699.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pathways to comorbidity: the transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study. AU - de Graaf,Ron, AU - Bijl,Rob V, AU - Ten Have,Margreet, AU - Beekman,Aartjan T F, AU - Vollebergh,Wilma A M, PY - 2003/09/04/received PY - 2004/03/01/revised PY - 2004/03/01/accepted PY - 2004/11/24/pubmed PY - 2005/4/5/medline PY - 2004/11/24/entrez SP - 461 EP - 7 JF - Journal of affective disorders JO - J Affect Disord VL - 82 IS - 3 N2 - BACKGROUND: To describe transitions to comorbidity within a 3-year period in three cohorts of subjects with at baseline a 12-month pure mood, anxiety or substance use disorder but no lifetime history of any other disorder category. To assess the role of personal and social vulnerability factors, life events, clinical factors and functional disability in the pathway to comorbidity. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study of a representative sample of 7076 adults aged 18-65, interviewed in three waves (baseline, 1 and 3 years after baseline) with the Composite International Diagnostic Interview. RESULTS: 15.2% of 99 pure mood, 10.5% of 220 anxiety and 6.8% of 192 substance use disorder cases became comorbid. Comorbid transition from pure mood disorder was multivariately associated with higher age, external mastery and severity of the disorder. Comorbidity developing from pure anxiety disorder was associated with past and recent stressful life circumstances (childhood trauma, negative life events) and physical functional disability. Predictors of comorbid transition from pure substance use disorder were personal and social vulnerability variables only (high neuroticism, low social support). LIMITATIONS: Although NEMESIS was performed among a substantial number of cases, the number of cases with a pure disorder at baseline subsequently developing comorbidity was low. This limited analysing determinants of different comorbid conditions. CONCLUSIONS: Risk factors for comorbid transitions vary depending on whether subjects have a primary mood, anxiety or substance use disorder. Interventions aimed at primary prevention of comorbidity to reduce psychiatric burden in populations with a history of pure disorders are indicated in response to clearly identified risk factors. SN - 0165-0327 UR - https://www.unboundmedicine.com/medline/citation/15555699/Pathways_to_comorbidity:_the_transition_of_pure_mood_anxiety_and_substance_use_disorders_into_comorbid_conditions_in_a_longitudinal_population_based_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165032704000898 DB - PRIME DP - Unbound Medicine ER -