Abstract
Previous research suggests that patterns of comorbidity of a limited number of anxiety, depressive, substance use and antisocial personality (ASP) disorders among adults are best reflected by a hierarchical three‐factor structure with two correlated factors (‘anxious‐misery’ and ‘fear’) that are summarized in a second‐order ‘internalizing’ factor and one ‘externalizing’ factor. It has not been examined whether this structure is developmentally stable and robust against additions of more diagnoses. Using data from a prospective‐longitudinal community study of adolescents and young adults we re‐evaluate the three‐factor model originally proposed by Krueger (Archives of General Psychiatry, 1999; 56, 921–926). Using confirmatory factor analysis with identical conventions as in Krueger's original work we found that the three factor model did not fit robustly across age or a wider range of diagnoses. Using explanatory factor analysis we examined alternative structures. We found various clinically meaningful patterns with good fit that go substantially beyond the original three‐factor structure. However, again, there is little consistency in findings when different age groups or different diagnoses are considered. Our findings suggest that psychopathology cannot be reduced to any simple structure. Copyright © 2009 American Psychiatric Association. This article is being copublished by the International Journal of Methods in Psychiatric Research and the American Psychiatric Association ‡.
Keywords: structure, confirmatory factor analysis, exploratory factor analysis, classification
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This article was published online on December 23, 2009. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected (29/12/09).
Correction made here after initial publication.
REFERENCES
- Andrews G., Goldberg D.P., Krueger R.F., Carpenter W.T., Hyman S.E., Sachdev P., Pine D.S. (2009) Exploring the feasibility of a meta‐structure for DSM‐V and ICD‐11: Could it improve utility and validity? Psychological Medicine, 39, 1993–2000. [DOI] [PubMed] [Google Scholar]
- Andrews G., Pine D.S., Hobbs M.J., Anderson T.M., Sunderland M. (in press b) Neurodevelopmental disorders: Cluster 2 of the proposed meta‐structure for DSM‐V and ICD‐11. Psychological Medicine. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Beauducel A. (2001) Problems with parallel analysis in data sets with oblique simple structure. Methods of Psychological Research Online, 6, 2. [Google Scholar]
- Beauducel A., Herzberg P. (2006) On the performance of maximum likelihood versus means and variance adjusted weighted least square estimation in confirmatory factor analysis. Structural Equation Modeling, 13, 186–203. [Google Scholar]
- Beesdo‐Baum K., Höfler M., Gloster A.T., Klotsche J., Lieb R., Beauducel A., Bühner M., Kessler R.C., Wittchen H.‐U. (in this issue) The structure of common mental disorders: A replication study in a community sample of adolescents and young adults. International Journal of Methods in Psychiatric Research. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Beesdo‐Baum K., Jacobi F., Hoyer J., Low N.C.P., Höfler M., Wittchen H.U. (2009a) Pain associated with specific anxiety and depressive disorders in a nationally representative population sample. Social Psychiatry and Psychiatric Epidemiology, DOI: 10.1007/s00127‐009‐0045‐1 [DOI] [PubMed] [Google Scholar]
- Beesdo‐Baum K., Knappe S., Pine D.S. (2009b) Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM‐V. Psychiatric Clinics of North America, 32, 483–524. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Beesdo‐Baum K., Pine D.S., Lieb R., Wittchen H.U. (in press) Incidence and risk patterns of anxiety and depressive disorders and categorization of Generalized Anxiety Disorder. Archives of General Psychiatry. [DOI] [PubMed] [Google Scholar]
- Chung H., Breslow N. (2008) The latent structure of post‐traumatic stress disorder: tests of invariance by gender and trauma type. Psychological Medicine, 38, 563–573. [DOI] [PubMed] [Google Scholar]
- Cox B.J., Clara I.P., Enns M.W. (2002) Posttraumatic stress disorder and the structure of common mental disorders. Depression and Anxiety, 15, 168–171. [DOI] [PubMed] [Google Scholar]
- Fabrigar L., Wegener D., MacCallum R., Strahan E. (1999) Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4, 272–299. [Google Scholar]
- Fergusson D.M., Horwood L.J., Lynskey M.T. (1993) Prevalence and comorbidity of DSM‐III‐R diagnoses in a birth cohort of 15 year olds. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1127–1134. [DOI] [PubMed] [Google Scholar]
- Goldberg D.P., Krueger R.F., Andrews G., Hobbs M.J. (2009) Emotional disorders: Cluster 4 of the proposed meta‐structure for DSM‐V and ICD‐11. Psychological Medicine, 39, 2043–2059. [DOI] [PubMed] [Google Scholar]
- Gorsuch R. (1983) Factor Analysis, Lawrence Erlbaum. [Google Scholar]
- Harman H. (1976) Modern Factor Analysis, University of Chicago Press. [Google Scholar]
- Hu L., Bentler P.M. (1998) Fit indices in covariance structure analysis: Sensitivity to under‐parameterized model misspecification. Psychological Methods, 3, 424–453. [Google Scholar]
- Jacobi F., Wittchen H.‐U., Hölting C., Höfler M., Pfister H., Müller N., Lieb R. (2004) Prevalence, comorbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological Medicine, 34, 597–611. [DOI] [PubMed] [Google Scholar]
- Kessler R.C., Chiu W.T., Demler O., Walters E.E. (2005) Prevalence, severity, and comorbidity of 12‐month DSM‐IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kessler R.C., McGonagle K.A., Zhao S., Nelson C.B., Hughes M., Eshleman S., Wittchen H.‐U., Kendler K.S. (1994) Lifetime and 12‐month prevalence of DSM‐III‐R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51, 8–19. [DOI] [PubMed] [Google Scholar]
- Kraemer H.C. (1997) What is the ‘right’ statistical measure of twin concordance (or diagnostic reliability and validity)? Archives of General Psychiatry, 54, 1121–1124. [DOI] [PubMed] [Google Scholar]
- Krueger R.F. (1999) The structure of common mental disorders. Archives of General Psychiatry, 56, 921–926. [DOI] [PubMed] [Google Scholar]
- Krueger R.F., Caspi A., Moffitt T.E., Silva P.A. (1998) The structure and stability of common mental disorders (DSM‐III‐R): A longitudinal‐epidemiological study. Journal of Abnormal Psychology, 107, 216–227. [DOI] [PubMed] [Google Scholar]
- Krueger R.F., Markon K.E. (2006a) Reinterpreting comorbidity: A model‐based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology, 2, 111–133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krueger R.F., Markon K.E. (2006b) Understanding psychopathology. Melding behavior genetics, personality, and quantitative psychology to develop an empirically based model. Current Directions in Psychological Science, 15, 113–117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lieb R., Isensee B., von Sydow K., Wittchen H.‐U. (2000) The early developmental stages of psychopathology study (EDSP): A methodological update. European Addiction Research, 6, 170–182. [DOI] [PubMed] [Google Scholar]
- Muthen B. (2006) Should substance use disorders be considered as categorical or dimensional? Addiction, 101, 6–16. [DOI] [PubMed] [Google Scholar]
- Muthen B., Asparouhov T. (2006) Item response mixture modelling: Application to tobacco dependence criteria. Addiction Behaviors, 31, 1050–1066. [DOI] [PubMed] [Google Scholar]
- Newman D.L., Moffitt T.E., Caspi A., Magdol L., Silva P.A. (1996) Psychiatric disorder in a birth cohort of young adults: Prevalence, comorbidity, clinical significance, and new case incidence from age 11 to 21. Journal of Consulting and Clinical Psychology, 64, 552–562. [PubMed] [Google Scholar]
- Reed V., Gander F., Pfister H., Steiger A., Sonntag H., Trenkwalder C., Sonntag A., Hundt W., Wittchen H.‐U. (1998) To what degree the Composite International Diagnostic Interview (CIDI) correctly identify DSM‐IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research, 7, 142–155. [Google Scholar]
- Regier D.A., Narrow W.E., Kuhl E.A., Kupfer D.J. (2009) The conceptual development of DSM‐V. American Journal of Psychiatry, 166, 645–650. [DOI] [PubMed] [Google Scholar]
- Sivo S.A., Fan X., Witta E.L., Willse J.T. (2006) The search for ‘optimal’ cutoff properties: Fit index criteria in structural equation modeling. Journal of Experimental Education, 74, 267–288. [Google Scholar]
- Slade T., Watson D. (2006) The structure of common DSM‐IV and ICD‐10 mental disorders in the Australian general population. Psychological Medicine, 36, 1593–1600. [DOI] [PubMed] [Google Scholar]
- Turner N. (1998) The effect of common variance and structure patterns on random data eigenvalues: Implications for the accuracy of parallel analysis. Educational and Psychological Measurement, 58, 541–568. [Google Scholar]
- Vollebergh W.A.M., Iedema J., Bijl R.V., De Graaf R., Smit F., Ormel J. (2001) The structure and stability of common mental disorders. The NEMESIS study. Archives of General Psychiatry, 58, 597–603. [DOI] [PubMed] [Google Scholar]
- Watson D. (2005) Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM‐V. Journal of Abnormal Psychology, 114, 522–536. [DOI] [PubMed] [Google Scholar]
- Watson D., O'Hara M.W., Scott S. (2008) Hierarchical structures of affect and psychopathology and their implications for the classification of emotional disorders. Depression and Anxiety, 25, 282–288. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U. (1994) Reliability and validity studies of the WHO‐Composite International Diagnostic Interview (CIDI): A critical review. Journal of Psychiatric Research, 28, 57–84. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U., Beesdo‐Baum K., Gloster A.T. (2009) A new meta‐structure of mental disorders: A helpful step into the future or a harmful step back to the past? A commentary on the Andrews series papers. Psychological Medicine, 39, 2083–2087. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U., Höfler M., Merikangas K.R. (1999a) Towards the identification of core psychopathological processes? Archives of General Psychiatry, 56, 929–931. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U., Jacobi F. (2005) Size and burden of mental disorders in Europe: A critical review and appraisal of 27 studies. European Neuropsychopharmacology, 15, 357–367. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U., Kessler R.C., Pfister H., Lieb R. (2000) Why do people with anxiety disorders become depressed? A prospective‐longitudinal community study. Acta Psychiatrica Scandinavica, 102(Suppl. 406), 14–23. [PubMed] [Google Scholar]
- Wittchen H.‐U., Lachner G., Wunderlich U., Pfister H. (1998a) Test–retest reliability of the computerized DSM‐IV version of the Munich‐Composite International Diagnostic Interview (M‐CIDI). Social Psychiatry and Psychiatric Epidemiology, 33, 568–578. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U., Lieb R., Schuster P., Oldehinkel A.J. (1999b) When is onset? Investigations into early developmental stages of anxiety and depressive disorders In: Childhood Onset of ‘Adult’ Psychopathology, Clinical and Research Advances (ed. Rapoport JL.), pp. 259–302, American Psychiatric Press. [Google Scholar]
- Wittchen H.‐U., Nelson C.B., Lachner G. (1998b) Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychological Medicine, 28, 109–126. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U., Perkonigg A., Lachner G., Nelson C.B. (1998c) Early developmental stages of psychopathology study (EDSP) – objectives and design. European Addiction Research, 1998c; 4, 18–27. [DOI] [PubMed] [Google Scholar]
- Wittchen H.‐U., Pfister H. (1997) DIA‐X‐Interviews: Manual für Screening‐Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA‐X‐Lifetime); Ergänzungsheft (DIA‐X‐Lifetime); Interviewheft Querschnittuntersuchung (DIA‐X‐12 Monate); Ergänzungsheft (DIA‐X‐12Monate); PC‐Programm zur Durchführung des Interviews (Längs‐ und Querschnittuntersuchung); Auswertungsprogramm, Swets & Zeitlinger.