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Critical Issues in the Evaluation of Comorbidity of Psychiatric Disorders

Published online by Cambridge University Press:  06 August 2018

Hans-Ulrich Wittchen
Hans-Ulrich Wittchen*
Affiliation:
Clinical Psychology, Max Planck Institute of Psychiatry, Kraepelinstrasse 10, 80804 München, Germany
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Abstract

Comorbidity has become an increasingly popular theme in psychiatry and clinical psychology, although its heuristic value was recognised long ago. Frequently used in research and practice, no definition of comorbidity is uniformly accepted and it has no comprehensive and coherent theoretical framework. These factors have led to substantial variation in the magnitude of comorbidity across studies. The variability in the definition, assessment and design of comorbidity studies has led to an increasingly complex and confusing picture about the potential value of this concept. The full exploration of mechanisms of comorbidity requires an interdisciplinary approach to investigating nosology, assessment, and underlying models of comorbidity, as well as experimental study designs beyond the scope of clinical and epidemiological studies. A more precise specification of comorbidity patterns might help identify common biochemical and cognitive markers relevant in the aetiology of specific mental disorders as well as comorbid conditions. Critical issues that might help us understand and explain the variability of findings are described.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue S30: Comorbidity of Mood Disorders , June 1996 , pp. 9 - 16
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Andrews, G. (1996) Comorbidity and the general neurotic syndrome. British Journal of Psychiatry, 168 (Suppl. 30), 76–84.CrossRefGoogle Scholar
Angst, J. (1996) Comorbidity of mood disorders: a longitudinal prospective study. British Journal of Psychiatry, 168 (Suppl. 30), 31–37.Google Scholar
Angst, J., Merikangas, K. R., Scheidegger, P., et al (1990) Recurrent brief depression: a new subtype of affective disorder. Journal of Affective Disorder, 19, 87–98.Google Scholar
Boyd, J. H., Burke, J. D., Gruenberg, E., et al (1984) Exclusion criteria of DSM–III: a study of co-occurrence of hierarchy-free syndromes. Archives of General Psychiatry, 41, 983–989.CrossRefGoogle ScholarPubMed
Burke, J. D., Wittchen, H.-U., Regier, D. A., et al (1990) Extracting information from diagnostic interviews on cooccurrence of symptoms of anxiety and depression. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 649–667. Washington, DC: APP.Google Scholar
Caron, C. & Rutter, M. (1991) Comorbidity in child psychopathology: concepts, issues, and research strategies. Journal of Child Psychology and Psychiatry, 32, 1063–1080.Google Scholar
Cloninger, C. R., Martin, R. L., Guze, S. B., et al (1990) The empirical structure of psychiatric comorbidity and its theoretical significance. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J.D. & Cloninger, C. R.), pp. 439–462. Washington, DC: APP.Google Scholar
DiNardo, P. A. & Barlow, D. H. (1990) Syndrome and symptom co-occurrence in the anxiety disorders. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 205–230. Washington, DC: APP.Google Scholar
Feinstein, A. R. (1970) The pre-therapeutic classification of comorbidity in chronic disease. Journal of Chronic Diseases, 23, 455–468.Google Scholar
First, M. B., Spitzer, R. L. & Williams, J. B. W. (1990) Exclusionary principles and the comorbidity of psychiatric diagnoses: a historical review and implications for the future. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 83–112. Washington, DC: APP.Google Scholar
Francis, A., Widinger, T. & Fyer, M. R. (1990) The influence of classification methods on comorbidity. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 41–60. Washington, DC: APP.Google Scholar
Gnutzman, A. (1992) Zeitliche Strukturen bei Komorbidität psychischer Störungen–eine retrospektive Studie. Mannheim: Diplomarbeit.Google Scholar
Kendler, K. S., Neale, M. C., Kessler, R. C., et al (1993) A longitudinal twin study of 1-year prevalence of major depression in women. Archives of General Psychiatry, 50, 843–852.Google Scholar
Kessler, R. C., McGonagle, K. A., Zhao, S., et al (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.Google Scholar
Kessler, R. C., Nelson, C. B., McGonagle, K. A., et al (1996) Comorbidity of DSM–III–R major depressive disorder in the general population: results from the US National Cormorbidity Survey. British Journal of Psychiatry, 168 (Suppl. 30), 17–30.Google Scholar
Klerman, G. L. (1990) Approaches to the phenomena of comorbidity. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 13–40. Washington, DC: APP.Google Scholar
Maier, W., Lichtermann, D. & Minges, J. (1994) The relationship between alcoholism and unipolar depression. A controlled family study. Journal of Psychiatric Research, 28, 303–317.Google Scholar
Maj, M. (1996) Depressive syndromes and symptoms in subjects with human immunodeficiency virus (HIV) infection. British Journal of Psychiatry, 168 (Suppl. 30), 117–122.CrossRefGoogle Scholar
Maser, J. D. & Cloninger, C. R. (eds) (1990) Comorbidity of Mood and Anxiety Disorders. Washington, DC: APP.Google Scholar
Merikangas, K. R. (1990) The genetic epidemiology of alcoholism Psychological Medicine, 20, 11–12.CrossRefGoogle ScholarPubMed
Merikangas, K. R., Risch, N. & Weissman, M. (1994) Comorbidity and co-transmission of affective disorders. Psychological Medicine, 24, 69–80.Google Scholar
Merikangas, K. R., Angst, J., Eaton, W., et al (1996) Comorbidity and boundaries of affective disorders: results of an International Task Force. British Journal of Psychiatry, 168 (Suppl. 30), 58–67.CrossRefGoogle Scholar
Sartorius, N., Üstün, T. B., Lecrubier, Y., et al (1996) Depression comorbid with anxiety: preliminary results from the WHO study on Psychological Disorders in Primary Health Care. British Journal of Psychiatry, 168 (Suppl. 30), 38–43.Google Scholar
Schulte, D. & Wittchen, H.-U. (1988) Wert and Nutzen klassifikatorischer Diagnostik für Psychotherapie. Diagnostica, 34, 85–98.Google Scholar
Spiegel, D. (1996) Cancer and depression. British Journal of Psychiatry, 168 (Suppl. 30), 109–116.Google Scholar
Sullivan, M. A., Weissman, M. M., Bland, R., et al (1996) Co-morbidity of alcoholism and obsessive–compulsive disorder: A cross-national study. American Journal of Psychiatry, (in press).Google Scholar
Van Praag, H. M. (1996) Comorbidity (psycho) analysed. British Journal of Psychiatry, 168 (Suppl. 30), 129–134.Google Scholar
Von Korff, M. & Simon, G. (1996) The relationship between pain and depression. British Journal of Psychiatry, 168 (Suppl. 30), 101–108.Google Scholar
Weissman, M. M., Bland, R., Joyce, P. R., et al (1993) Sex differences in rates of depression: cross-national perspectives. Abstract. Neuropsychopharmacology, 9, 2S.Google Scholar
Weissman, M. M., Bland, R., Canino, G. J., et al (1994) The cross national epidemiology of obsessive–compulsive disorder. Journal of Clinical Psychiatry, 55, 5–10.Google Scholar
Weissman, M. M., Bland, R., Canino, G. J., et al (1996) The cross national epidemiology of major depression and bipolar disorder. Journal of Clinical Psychiatry, in press.CrossRefGoogle 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.Google Scholar
Wittchen, H.-U. (1995) Comorbidity of mood disorders – diagnosis and treatment. Depression, 3, 131–133.Google Scholar
Wittchen, H.-U. & von Zerssen, D. (1988) Verläufe behandelter und unbehandelter Depressionen und Angststörungen – Eine klinisch-psychiatrische und epidemiologische Verlaufsuntersuchung . Berlin: Springer.Google Scholar
Wittchen, H.-U. & Essau, C. A. (1989) Comorbidity of anxiety disorders and depression: does it affect course and outcome? Journal of Psychiatry and Psychobiology, 4, 315–323.Google Scholar
Wittchen, H.-U., Beloch, E., Garzcynski, E., et al (1995) Münchener Composite International Diagnostic Interview (M-CIDI, Paper-pencil 2.2, 2/95). München: Max-Planck-Institut für Psychiatrie, Klinisches Institut (Eigendruck).Google Scholar
Wittchen, H.-U. & Vossen, A. (1995) Implikationen von Komorbidität bei Angststörungen. Ein Kritischer Überblick. Verhaltenstherapie – Praxis, Forschung, Perspektiven, 5, 120–133.Google Scholar
World Health Organization (1990) Composite International Diagnostic Interview (CIDI): (a) CIDI-interview (version 1.0), (b) CIDI-user manual, (c) CIDI-training manual (d) CIDI-computer programs. Geneva: World Health Organization.Google Scholar
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