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Title: The cross-national structure of mental disorders: results from the World Mental Health Surveys
Authors: de Jonge, Peter
Wardenaar, Klaas J
Lim, Carmen C W
Aguilar-Gaxiola, Sergio
Alonso, Jordi
Andrade, Laura Helena
Bunting, Brendan
Chatterji, Somnath
Ciutan, Marius
Gureje, Oye
Karam, Elie
Lee, Sing
Medina-Mora, Maria Elena
Moskalewicz, Jacek
Navarro-Mateu, Fernando
Pennell, Beth-Ellen
Piazza, Marina
Posada-Villa, José
Torres, Yolanda
Kessler, Ronald C
Scott, Kate
Affiliations: Faculty of Medicine 
Keywords: Comorbidity
Mental disorders
Psychiatric disorders
Issue Date: 2018
Publisher: National Library of Medicine
Part of: Psychological Medicine
Volume: 48
Issue: 12
Start page: 2073
End page: 2084
The patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data is available on the placement of eating disorders, bipolar disorder and psychotic experiences in this structure.

We evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six psychotic experiences. Respondents (n=5,478–15,499) were included from 10 high, middle and lower-middle income countries across the world aged 18 years or older. Confirmatory Factor Analyses (CFA) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. measurement invariance was evaluated with multigroup CFA (MG-CFA).

A second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and psychotic experiences with a separate factor.

These results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders.
ISSN: 00332917
DOI: 10.1017/S0033291717003610
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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