General psychopathology factor and borderline personality disorder : Evidence for substantial overlap from two nationally representative surveys of U.S. adults

A general psychopathology factor reflects an underlying liability for a wide range of mental disorders. There is suggestive evidence that borderline personality disorder (BPD) may be strongly associated with the general psychopathology factor, but there are no detailed data on the degree of overlap between the general psychopathology factor and BPD or its individual symptoms. This study examined the overlap between the general psychopathology factor and BPD using cross-sectional survey data from two nationally representative samples of U.S. adults, the National Comorbidity Survey Replication (N = 5,692) and the National Comorbidity Survey follow-up (N = 5,001). Structural equation modeling was used to fit a bifactor general psychopathology model and to examine the general psychopathology factor's associations with (a) a series of Clusters A, B, and C personality disorder symptoms including BPD symptoms and (b) a latent BPD. Results showed that the shared variance between the general psychopathology factor and a latent BPD was 56% in the National Comorbidity Survey Replication and 71% in the National Comorbidity Survey follow-up. The correlation between the general factor and BPD could be set to unity without worsening model fit, suggesting that BPD closely reflects a general liability to psychopathology. The affective features of BPD were particularly strongly associated with the general psychopathology factor. Findings are discussed with respect to the nosology of BPD and the treatment of mental disorders.Peer reviewe

Alcohol Abuse and Suicide Attempts Among Youth - Correlation or Causation?

This study uses the Youth Risk Behavior Survey (YRBS) and the National Comorbidity Survey (NCS) to explore the causal relationship between alcohol abuse (binge drinking and clinically defined alcohol use disorders) and suicide attempts among youth. We use an empirical approach that allows one to assess the existence and strength of a causal relationship without relying on identifying assumptions. Our results suggest that a causal relationship between binge drinking and suicide attempts is very unlikely. The findings, however, support a causal relationship between clinically defined alcohol use disorders and suicide attempts among girls.

Mental Disorders, Comorbidity, and Suicidal Behavior: Results from the National Comorbidity Survey Replication

Mental disorders are among the strongest predictors of suicide attempts. However, little is known about which disorders are uniquely associated with suicidal behavior due to high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans, and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9,282 US adults. Results revealed that approximately 80% of suicide attempters in the US have a temporally prior mental disorder. Anxiety, mood, impulse-control, and substance disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (odds ratios=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (e.g., PTSD) and poor impulse-control (e.g., conduct disorder, substance disorders) predict which suicide ideators go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.Psycholog

The effects of latent variables in the development of comorbidity among common mental disorders

Background: Although numerous studies have examined the role of latent predispositions to internalizing and externalizing disorders in the structure of comorbidity among common mental disorders, none examined latent predispositions in predicting development of comorbidity. Methods: A novel method was used to study the role of latent variables in the development of comorbidity among lifetime DSM-IV disorders in the National Comorbidity Surveys. Broad preliminary findings are briefly presented to describe the method. The method used survival analysis to estimate time-lagged associations among 18 lifetime DSM-IV anxiety, mood, behavior, and substance disorders. A novel estimation approach examined the extent to which these predictive associations could be explained by latent canonical variables representing internalizing and externalizing disorders. Results: Consistently significant positive associations were found between temporally primary and secondary disorders. Within-domain time-lagged associations were generally stronger than between-domain associations. The vast majority of associations were explained by a model that assumed mediating effects of latent internalizing and externalizing variables, although the complexity of this model differed across samples. A number of intriguing residual associations emerged that warrant further investigation. Conclusions: The good fit of the canonical model suggests that common causal pathways account for most comorbidity among the disorders considered. These common pathways should be the focus of future research on the development of comorbidity. However, the existence of several important residual associations shows that more is involved than simple mediation. The method developed to carry out these analyses provides a unique way to pinpoint these significant residual associations for subsequent focused study. Depression and Anxiety, 2011. (c) 2011 Wiley-Liss, Inc

Mental Disorders and Medical Comorbidity

Presents findings on factors behind the prevalence of patients with both mental and medical conditions; mortality, quality of care, and cost burdens; and evidence-based treatment approaches, including self-management support. Outlines policy implications

The US National Comorbidity Survey: Overview and future directions

This report presents an overview of the results of the US National Comorbidity Survey (NCS) (Kessler et al., 1994) and future directions based on these results. The NCS is a survey that was mandated by the US Congress to study the comorbidity of substance use disorders and nonsubstance psychiatric disorders in the general population of the US. (...

Psychiatric Disorders and Labor Market Outcomes: Evidence from the National Comorbidity Survey - Replication

This paper uses the National Comorbidity Survey – Replication to estimate the effects of recent psychiatric disorder on employment, hours worked, and earnings. We employ methods proposed in Altonji, Elder and Taber (2005) which use selection on observable traits to provide information regarding selection along unobservable factors. Among males, disorder is associated with reductions of 13-17 percentage points in labor force participation and employment, depending on the sample and the model. Among females, we find smaller, less consistent associations between disorder and labor force participation and employment. There are no effects of disorder on earnings or hours worked among employed individuals.

The structure of feared social situations among race-ethnic minorities and Whites with social anxiety disorder in the United States

We investigated feared social situations in individuals with social anxiety disorder from different racial and ethnic groups in the United States. The sample included 247 African Americans, 158 Latinos, and 533 non-Latino Whites diagnosed with social anxiety disorder within the past 12 months from the integrated Collaborative Psychiatric Epidemiology Studies data set. After randomly splitting the full sample, we conducted an exploratory factor analysis with half of the sample to determine the structure of feared social situations in a more diverse sample than has been used in previous studies. We found evidence for a model consisting of three feared social domains: performance/public speaking, social interaction, and observational. We then conducted a confirmatory factor analysis on the remaining half of the sample to examine whether this factor structure varied significantly between the race-ethnic groups. Analyses revealed an adequate fit of this model across all three race-ethnic groups, suggesting invariance of the factor structure between the study groups. Broader cultural contexts within which these findings are relevant are discussed, along with important implications for comprehensive, culturally sensitive assessment of social anxiety.R01 MH078308 - NIMH NIH HHS; R01 MH081116 - NIMH NIH HHS; MH-081116 - NIMH NIH HHS; K23 MH096029 - NIMH NIH HHS; MH-078308 - NIMH NIH HH

Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

An overview is presented of the design and field procedures of the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a US face-to-face household survey of the prevalence and correlates of DSM-IV mental disorders. The survey was based on a dual-frame design that included 904 adolescent residents of the households that participated in the US National Comorbidity Survey Replication (85.9% response rate) and 9244 adolescent students selected from a nationally representative sample of 320 schools (74.7% response rate). After expositing the logic of dual-frame designs, comparisons are presented of sample and population distributions on Census socio-demographic variables and, in the school sample, school characteristics. These document only minor differences between the samples and the population. The results of statistical analysis of the bias-efficiency trade-off in weight trimming are then presented. These show that modest trimming meaningfully reduces mean squared error. Analysis of comparative sample efficiency shows that the household sample is more efficient than the school sample, leading to the household sample getting a higher weight relative to its size in the consolidated sample relative to the school sample. Taken together, these results show that the NCS-A is an efficient sample of the target population with good representativeness on a range of socio-demographic and geographic variables. Copyright © 2009 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63040/1/279_ftp.pd

Disparities in Child and Adolescent Mental Health and Mental Health Services in the U.S.

This is one of a series of five papers outlining the particular domains and dimensions of inequality where new research may yield a better understanding of responses to this growing issue.Mental health is recognized as a central determinant of individual well-being, family relationships, and engagement in society, yet there are considerable variations in mental health and mental health care according to race and ethnicity among youth in the U.S.In their report, Margarita Alegría and colleagues investigate disparities in mental health and mental health services for minority youth. Taking a developmental perspective, the authors explore four areas that may give rise to inequalities in mental health outcomes, highlight specific protective factors and barriers to care, and, finally, outline an agenda for future research