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Latent class analysis of co-morbidity in the Adult Psychiatric Morbidity Survey in England 2007: implications for DSM-5 and ICD-11

Published online by Cambridge University Press:  04 March 2011

S. Weich ,
O. McBride ,
D. Hussey ,
D. Exeter ,
T. Brugha  and
S. McManus
S. Weich*
Affiliation:
Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
O. McBride
Affiliation:
Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
D. Hussey
Affiliation:
National Centre for Social Research, London, UK
D. Exeter
Affiliation:
National Centre for Social Research, London, UK
T. Brugha
Affiliation:
Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK
S. McManus
Affiliation:
National Centre for Social Research, London, UK
*
*Address for correspondence: S. Weich, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. (Email: S.Weich@warwick.ac.uk)
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Abstract

Background

Psychiatric co-morbidity is complex and ubiquitous. Our aim was to describe the extent, nature and patterning of psychiatric co-morbidity within a representative sample of the adult population of England, using latent class analysis.

Method

Data were used from the 2007 Adult Psychiatric Morbidity Survey, a two-phase national household survey undertaken in 2007 comprising 7325 participants aged 16 years and older living in private households in England. The presence of 15 common mental health and behavioural problems was ascertained using standardized clinical and validated self-report measures, including three anxiety disorders, depressive episode, mixed anxiety depressive disorder, psychosis, antisocial and borderline personality disorders, eating disorders, post-traumatic stress disorder, attention deficit disorder, alcohol and drug dependencies, problem gambling and attempted suicide.

Results

A four-class model provided the most parsimonious and informative explanation of the data. Most participants (81.6%) were assigned to a non-symptomatic or ‘Unaffected’ class. The remainder were classified into three qualitatively different symptomatic classes: ‘Co-thymia’ (12.4%), ‘Highly Co-morbid’ (5.0%) and ‘Addictions’ (1.0%). Classes differed in mean numbers of conditions and impairments in social functioning, and these dimensions were correlated.

Conclusions

Our findings confirm that mental disorders typically co-occur and are concentrated in a relatively small number of individuals. Conditions associated with the highest levels of disability, mortality and cost – psychosis, suicidality and personality disorders – are often co-morbid with more common conditions. This needs to be recognized when planning services and when considering aetiology.

Keywords

Co-morbidityclassificationlatent class analysis
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 10 , October 2011 , pp. 2201 - 2212
Copyright
Copyright © Cambridge University Press 2011

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