How common is comorbidity and why does it occur?

Confirmatory Factor Analysis of Comorbidity between Depression and Aggression in a Child-Adolescent Community Sample: Nosological, Prognosis and Etiological Implications

Comorbidity between depression and aggression in the child-adolescent population remains a controversial phenomenon. To our knowledge, no longitudinal study using structural equation modeling (SEM) has confirmed whether the relationship between depression and aggression is due to the fact that they share internalizing and externalizing supraordinal factors at the level of the syndrome or is due to the fact that they share common characteristics in relation to an underlying factor at the level of symptoms. We examined longitudinal comorbid relationships in a community sample (N = 251) at three waves ages from 10 to 13 years. The SEM showed that longitudinally, the comorbidity between depression and aggression is due to the fact that they share characteristics of the same underlying factor at the symptom level. These results have implications for the classification, diagnosis, and treatment of comorbidity between depression and aggression in a child-adolescent population.

Comorbidities Between Specific Learning Disorders and Psychopathology in Elementary School Children in Germany

Children with reading and/or spelling disorders have increased rates of behavioral and emotional problems and combinations of these. Some studies also find increased rates of attention-deficit/hyperactivity disorder (ADHD), conduct disorder, anxiety disorder, and depression. However, the comorbidities of, e.g., arithmetic disorders with ADHD, anxiety disorder, and depression have been addressed only rarely. The current study explored the probability of children with specific learning disorders (SLD) in reading, spelling, and/or arithmetic to also have anxiety disorder, depression, ADHD, and/or conduct disorder. The sample consisted of 3,014 German children from grades 3 and 4 (mean age 9;9 years) who completed tests assessing reading, spelling as well as arithmetic achievement and intelligence via a web-based application. Psychopathology was assessed using questionnaires filled in by the parents. In children with a SLD we found high rates of anxiety disorder (21%), depression (28%), ADHD (28%), and conduct disorder (22%). Children with SLD in multiple learning domains had a higher risk for psychopathology and had a broader spectrum of psychopathology than children with an isolated SLD. The results highlight the importance of screening for and diagnosing psychiatric comorbidities in children with SLD.

A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia

ISSUES

The aim of this paper was to conduct a systematic review of the prevalence of comorbid mental health conditions in people accessing treatment for substance use in Australia.

APPROACH

A systematic review identified studies meeting the following eligibility criteria: reporting original data published in English; sample presenting for substance use treatment in Australia; assessing the prevalence of mental health and substance use conditions and reporting the percentage of participants with co-occurring mental health and substance use conditions. A narrative analysis was conducted because of the heterogeneity of methods used to assess key outcome variables and small number of studies assessing particular mental health outcomes. The abstracts of 1173 records were screened, and 59 full articles were assessed for eligibility. Eighteen studies were included in the review.

KEY FINDINGS

Prevalence estimates of current mental disorders in substance use treatment clients varied (47 to 100%). Mood and anxiety disorders were particularly prevalent, with the prevalence of current depression ranging from 27 to 85% and current generalised anxiety disorder ranging from 1 to 75%.

IMPLICATIONS

The high prevalence of mood and anxiety disorders in substance use treatment settings indicates a need for clinicians to screen and assess for these disorders as part of routine clinical care, and be familiar with evidence-based management and treatment strategies.

CONCLUSION

Although further studies are required to determine the prevalence of the full range of mental health disorders in this population, these findings emphasise the high prevalence of comorbid mental disorders are among individuals accessing substance use treatment in Australia. [Kingston REF, Marel C, Mills KL. A systematic review of the prevalence of comorbid mental health disorders in people presenting for substance use treatment in Australia. Drug Alcohol Rev 2017;36:527-539].

Substance use disorders comorbid with mood and anxiety disorders in the Australian general population

INTRODUCTION AND AIMS

Substance use disorders (SUDs) are common and frequently co-occur with mood and anxiety disorders. This paper provides a detailed analysis of patterns, prevalence and correlates of mood and anxiety disorders among those with a (i) pure SUD; (ii) SUD plus a mood or anxiety disorder (SUDs + 1); and (iii) SUD plus a mood and anxiety disorder (SUDs + 2).

DESIGN AND METHODS

Data came from the 2007 National Survey of Mental Health and Wellbeing; a nationally representative household survey of 8841 Australians aged 16-85 years.

RESULTS

The 12-month prevalence of SUDs was 5.1%. Of those with a 12-month SUD, 65% met the criteria for pure SUDs, 19% for SUDs + 1 and 16% for SUDs + 2. Major depression was the most common mood disorder in both comorbid groups. One-third of SUDs + 1 experienced social phobia, while over half of SUDs + 2 experienced generalised anxiety disorder. Compared with pure SUDs, SUDs + 1 experienced two times more and SUDs + 2 experienced over four times more days out of role in the preceding 30 days. Both comorbid groups were more likely to experience severe levels of impairment. SUDs + 2 were over 18 times more likely to experience suicidal thoughts in the same year. SUDs + 1 were over three times and SUDs + 2 were over 10 times more likely to have had one or more consultations with a health professional in the previous year.

DISCUSSIONS AND CONCLUSIONS

These findings highlight the complexities inherent with responding to and treating multiple comorbidities among substance users and emphasise the need for coordinated, cohesive responses from drug and alcohol treatment services.[Prior K, Mills K, Ross J, Teesson M. Substance use disorders comorbid with mood and anxiety disorders in the Australian general population. Drug Alcohol Rev 2017;36:317-324].

Comorbidity in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing

OBJECTIVE

The aim of the present study was to report the prevalence and patterns of 12 month comorbidity in the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB). In this paper the comorbidity between common mental disorders (affective, substance use and anxiety) and between physical and mental disorders is examined.

METHOD

The 2007 NSMHWB was a nationally representative household survey of 8841 Australian adults (16-85 years) that assessed participants for symptoms of the most prevalent ICD-10 mental disorders.

RESULTS

The common mental disorder classes (affective, anxiety and substance use disorders) often occur together and 25.4% of persons with an anxiety, affective or substance use disorder had at least one other class of mental disorder. A small proportion (3.5%, 95% confidence interval (CI) = 2.3-4.7%) had all three classes of disorder. Mental disorder and physical disorder comorbidity was also common, with 28% (95%CI = 25.1-30.9%) of those with a chronic physical disorder also having a mental disorder. Comorbidity was associated with greater severity and greater health service use.

CONCLUSIONS

Comorbidity is widespread and remains a significant challenge for the delivery of effective health-care services and treatment.