Sex and Informant Effects on Diagnostic Comorbidity in an Adolescent Community Sample

Objective: To investigate sex and informant effects on comorbidity rates for anxiety disorders, depressive disorders, attention-deficit hyperactivity disorder (ADHD), and conduct–oppositional disorder (CD–ODD) in an adolescent community sample. Method: The Diagnostic Interview Schedule for Children-2.25 (DISC-2.25) was administered to 1201 adolescents and their mothers. Results: The highest comorbidity risk found was between ADHD and CD–ODD, with odds ratios (ORs) of 17.6 for adolescent reports and 12.0 for mother reports. The second-highest comorbidity risk, with ORs of 13.2 for adolescent reports and 11.0 for mother reports, was between anxiety and depressive disorders. There was not much overlap between internalizing and externalizing disorders. Adolescent girls had higher rates of coexisting anxiety and depressive disorders, whereas adolescent boys had higher rates of coexisting ADHD and CD–ODD. There was partial support for the hypothesis that adolescent-reported comorbidity rates would exceed mother-reported rates. Conclusions: There is a greater cooccurrence of within-category, compared with between-category, disorders. Adolescent girls are more likely to have coexisting internalizing disorders, while adolescent boys are more likely to have coexisting externalizing disorders. Mothers tend to report more externalizing disorders (that is, ADHD), while adolescents generally report more internalizing disorders.

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Trait and facet-level predictors of first-onset depressive and anxiety disorders in a community sample of adolescent girls

Psychological Medicine ◽

10.1017/s0033291717002719 ◽

2017 ◽

Vol 48 (8) ◽

pp. 1282-1290 ◽

Cited By ~ 12

Author(s):

Brandon L. Goldstein ◽

Roman Kotov ◽

Greg Perlman ◽

David Watson ◽

Daniel N. Klein

Keyword(s):

Anxiety Disorders ◽

Social Phobia ◽

Adolescent Girls ◽

Depressive Disorders ◽

Multivariate Analyses ◽

Community Sample ◽

Internalizing Disorders ◽

Adolescent Females ◽

Diagnostic Interviews ◽

First Onset

AbstractBackgroundIndividual differences in neuroticism, extraversion, and conscientiousness are associated with, and may predict onset of, internalizing disorders. These general traits can be parsed into facets, but there is a surprising paucity of research on facet risk for internalizing disorders. We examined general traits and facets of neuroticism, extraversion, and conscientiousness in predicting first onsets of depressive and anxiety disorders.MethodsA community sample of 550 adolescent females completed general and facet-level personality measures and diagnostic interviews. Interviews were re-administered 18 months later.ResultsFirst onsets of depressive disorders were predicted by neuroticism, extraversion, and conscientiousness. Facets predicting first onset of depression included depressivity (neuroticism facet) and lower positive emotionality and sociability (extraversion facets). First onsets of generalized anxiety disorder (GAD) were predicted by neuroticism, and particularly the facet of anxiousness. First onsets of social phobia were predicted at the facet level by anxiousness. First onsets of specific phobia were predicted by neuroticism, low conscientiousness, and all neuroticism facets. In multivariate analyses, first onsets of depression were uniquely predicted by depressivity, and onsets of GAD and social phobia were uniquely predicted by anxiousness over and above the general trait of neuroticism.ConclusionsGeneral traits predict first onsets of depressive and anxiety disorders. In addition, more specific associations are evident at the facet level. Facets can refine our understanding of the links between personality and psychopathology risk, and provide finer-grained targets for personality-informed interventions.

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The prevalence and co-morbidity of subthreshold psychiatric conditions

Psychological Medicine ◽

10.1017/s0033291703001466 ◽

2004 ◽

Vol 34 (4) ◽

pp. 613-622 ◽

Cited By ~ 156

Author(s):

PETER M. LEWINSOHN ◽

STEWART A. SHANKMAN ◽

JEFFREY M. GAU ◽

DANIEL N. KLEIN

Keyword(s):

Clinical Practice ◽

Adolescent Depression ◽

Internalizing Disorders ◽

Externalizing Disorders ◽

Diagnostic Interview ◽

Future Research ◽

Co Morbidity ◽

Psychiatric Conditions ◽

Dsm Iv ◽

Males And Females

Background. In previous studies of subthreshold conditions, co-morbidity has been largely ignored. The purpose was to examine rates of co-morbidity among subthreshold disorders and between subthreshold and full-syndrome disorders for the major non-psychotic classes of disorders from DSM-IV.Method. Participants came from the Oregon Adolescent Depression Project (mean age=16·6 years; females=52·1%). On the basis of a diagnostic interview (K-SADS), participants were assigned to eight subthreshold disorders (MDD, bipolar, eating, anxiety, alcohol use, substance use, conduct, ADHD).Results. Of the 1704 adolescents in the analyses, 52·5% had at least one subthreshood disorder. Of those, 40·0% had also experienced a co-morbid subthreshold condition, and 29·9% of those had a second co-morbid subthreshold condition. Of those with a subthreshold, 36·4% also had a full syndrome. The subthreshold forms of externalizing disorders were co-morbid with each other. As expected, subthreshold anxiety was co-morbid with subthreshold MDD but subthreshold anxiety was also co-morbid with subthreshold alcohol, conduct, and ADHD. The pattern of co-morbidities was nearly identical for males and females.Conclusions. The hypotheses that externalizing disorders would be co-morbid with other externalizing disorders and that internalizing disorders would be co-morbid with other internalizing disorders was partially supported. Co-morbidities between subthreshold disorders and between subthreshold disorders and full syndrome should impact future research and clinical practice. The assessment of subthreshold disorders needs to include the assessment of other subthreshold and full-syndrome conditions.

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Psychiatric Comorbidity of Internet Addiction in College Students: An Interview Study

CNS Spectrums ◽

10.1017/s1092852900016308 ◽

2008 ◽

Vol 13 (2) ◽

pp. 147-153 ◽

Cited By ~ 148

Author(s):

Chih-Hung Ko ◽

Ju-Yu Yen ◽

Cheng-Sheng Chen ◽

Cheng-Chung Chen ◽

Cheng-Fang Yen

Keyword(s):

College Students ◽

Depressive Disorder ◽

Social Phobia ◽

Internet Addiction ◽

Adult Adhd ◽

Depressive Disorders ◽

Psychiatric Comorbidity ◽

Diagnostic Interview ◽

Dysthymic Disorder ◽

Hyperactivity Disorder

ABSTRACTObjective:This study was aimed to evaluate the association between Internet addiction and depressive disorder, social phobia and adult attention-deficit/hyperactivity disorder (ADHD) in a sample of Taiwanese college students; and examine gender differences in the psychiatric comorbidity of Internet addiction in this student population.Methods:Two hundred sixteen college students (132 males, 84 females) were recruited. Internet addiction, major depressive disorder, dysthymic disorder, social phobia, and adult ADHD of all participants were diagnosed based on psychiatric diagnostic interview.Results:This study revealed that adult ADHD and depressive disorders were associated with Internet addiction among college students. However, depressive disorders were associated with Internet addiction in the males but not the females.Conclusion:With these results, it seems reasonable to suggest that effective evaluation of, and treatment for, adult ADHD and depressive disorders is required for college students with Internet addiction.

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Recurrent brief depressive disorder reinvestigated: a community sample of adolescents and young adults

Psychological Medicine ◽

10.1017/s0033291702006967 ◽

2003 ◽

Vol 33 (3) ◽

pp. 407-418 ◽

Cited By ~ 23

Author(s):

L. PEZAWAS ◽

H.-U. WITTCHEN ◽

H. PFISTER ◽

J. ANGST ◽

R. LIEB ◽

...

Keyword(s):

Young Adults ◽

Depressive Disorder ◽

Depressive Disorders ◽

Suicide Attempts ◽

Community Sample ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Co Morbidity ◽

Course Stability ◽

Clinically Significant

Background. This article presents prospective lower bound estimations of findings on prevalence, incidence, clinical correlates, severity markers, co-morbidity and course stability of threshold and subthreshold recurrent brief depressive disorder (RBD) and other mood disorders in a community sample of 3021 adolescents.Method. Data were collected at baseline (age 14–17) and at two follow-up interviews within an observation period of 42 months. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI).Results. Our data suggest that RBD is a prevalent (2·6%) clinical condition among depressive disorders (21·3%) being at least as prevalent as dysthymia (2·3%) in young adults over lifetime. Furthermore, RBD is associated with significant clinical impairment sharing many features with major depressive disorder (MDD). Suicide attempts were reported in 7·8% of RBD patients, which was similar to MDD (11·9%). However, other features, like gender distribution or co-morbidity patterns, differ essentially from MDD. Furthermore, the lifetime co-occurrence of MDD and RBD or combined depression represents a severe psychiatric condition.Conclusions. This study provides further independent support for RBD as a clinically significant syndrome that could not be significantly explained as a prodrome or residual of major affective disorders.

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Diagnostic outcome of self-reported hallucinations in a community sample of adolescents

Psychological Medicine ◽

10.1017/s003329170200555x ◽

2002 ◽

Vol 32 (4) ◽

pp. 619-627 ◽

Cited By ~ 129

Author(s):

D. DHOSSCHE ◽

R. FERDINAND ◽

J. VAN DER ENDE ◽

M. B. HOFSTRA ◽

F. VERHULST

Keyword(s):

Depressive Disorders ◽

Psychotic Disorders ◽

Community Sample ◽

Age Groups ◽

Participation Rate ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Self Report ◽

Diagnostic Outcome

Objective. We aimed to assess the diagnostic outcome of self-reported hallucinations in adolescents from the general population.Method. The sample consisted of 914 adolescents between ages 11–18 participating in an ongoing longitudinal study. The participation rate from the original sample was 70%. Responses on the Youth Self-Report questionnaire were used to ascertain hallucinations in adolescents. Eight years later, Axis 1 DSM-IV diagnoses were assessed using the 12-month version Composite International Diagnostic Interview in 783 (86%) of 914 study subjects. No subjects were diagnosed with schizophreniform disorders or schizophrenia.Results. Hallucinations were reported by 6% of adolescents and 3% of young adults. Self-reported hallucinations were associated with concurrent non-psychotic psychiatric problems in both age groups. Adolescents who reported auditory, but not visual, hallucinations, had higher rates of depressive disorders and substance use disorders, but not psychotic disorders, at follow-up, compared to controls.Conclusions. Self-reported auditory hallucinations in adolescents are markers of concurrent and future psychiatric impairment due to non-psychotic Axis 1 disorders and possibly Axis 2 disorders. It cannot be excluded that there was selective attrition of children and adolescents who developed Schizophrenic or other psychotic disorders later in life.

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Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents

Psychological Medicine ◽

10.1017/s0033291799008454 ◽

1999 ◽

Vol 29 (3) ◽

pp. 655-668 ◽

Cited By ~ 80

Author(s):

A. J. OLDEHINKEL ◽

H.-U. WITTCHEN ◽

P. SCHUSTER

Keyword(s):

Depressive Disorder ◽

Depressive Disorders ◽

Remission Rate ◽

Community Sample ◽

Population Sample ◽

Composite International Diagnostic Interview ◽

Diagnostic Interview ◽

Depressive Episodes ◽

Prospective Longitudinal

Background. This article presents prospective longitudinal findings on prevalence, incidence, patterns of change and stability of depressive disorders in a community sample of 1228 adolescents.Methods. Data were collected at baseline and follow-up (20 months later) in a representative population sample of 1228 adolescents, aged 14–17 at baseline. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI).Results. The overall cumulative lifetime incidence of any depressive condition was 20·0% (major depressive disorder (MDD), 12·2%; dysthymia, 3·5%; subthreshold MDD, 6·3%), of which about one-third were incident depressions in the period between baseline and follow-up. Depressive disorders rarely started before the age of 13. Females were about twice as likely as males to develop a depressive disorder. Overall, the 20-month outcome of baseline depression was unfavourable. Dysthymia had the poorest outcome of all, with a complete remission rate of only 33% versus 43% for MDD and 54% for subthreshold MDD. Dysthymia also had the highest number of depressive episodes, and most psychosocial impairment and suicidal behavioural during follow-up. Treatment rates were low (8–23%). Subthreshold MDD associated with considerable impairment had an almost identical course and outcome as threshold MDD.Conclusions. DSM-IV MDD and dysthymia are rare before the age of 13, but frequent during adolescence, with an estimated lifetime cumulative incidence of 14%. Only a minority of these disorders in adolescence is treated, and more than half of them persist or remit only partly.

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Familial confounding of the association between maternal smoking during pregnancy and internalizing disorders in offspring

Psychological Medicine ◽

10.1017/s0033291716003627 ◽

2017 ◽

Vol 47 (8) ◽

pp. 1417-1426 ◽

Cited By ~ 8

Author(s):

S. M. Meier ◽

K. J. Plessen ◽

F. Verhulst ◽

O. Mors ◽

P. B. Mortensen ◽

...

Keyword(s):

Anxiety Disorders ◽

Maternal Smoking ◽

Depressive Disorders ◽

Cox Regression ◽

Severe Depression ◽

Internalizing Disorders ◽

Externalizing Disorders ◽

Smoking During Pregnancy ◽

Increased Risk ◽

Maternal Smoking During Pregnancy

BackgroundMaternal smoking has consistently been associated with multiple adverse childhood outcomes including externalizing disorders. In contrast the association between maternal smoking during pregnancy (MSDP) and internalizing (anxiety and depressive) disorders in offspring has received less investigation.MethodWe conducted a nationwide cohort study including 957635 individuals born in Denmark between 1991 and 2007. Data on MSDP and diagnoses of depression or anxiety disorders were derived from national registers and patients were followed up from the age of 5 years to the end of 2012. Hazard rate ratios (HRRs) were estimated using stratified Cox regression models. Sibling data were used to disentangle individual- and familial-level effects of MSDP and to control for unmeasured familial confounding.ResultsAt the population level, offspring exposed to MSDP were at increased risk for both severe depression [HRR 1.29, 95% confidence interval (CI) 1.22–1.36] and severe anxiety disorders (HRR 1.26, 95% CI 1.20–1.32) even when controlling for maternal and paternal traits. However, there was no association between MSDP and internalizing disorders when controlling for the mother's propensity for MSDP (depression: HRR 1.11, 95% CI 0.94–1.30; anxiety disorders: HRR 0.94, 95% CI 0.80–1.11) or comparing differentially exposed siblings (depression: HRR 1.18, 95% CI 0.75–1.89; anxiety disorders: HRR 0.87, 95% CI 0.55–1.36).ConclusionsThe results suggest that familial background factors account for the association between MSDP and severe internalizing disorders not the specific exposure to MSDP.

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Sources of covariation among the child-externalizing disorders: informant effects and the shared environment

Psychological Medicine ◽

10.1017/s0033291705004770 ◽

2005 ◽

Vol 35 (8) ◽

pp. 1133-1144 ◽

Cited By ~ 54

Author(s):

S. ALEXANDRA BURT ◽

MATT McGUE ◽

ROBERT F. KRUEGER ◽

WILLIAM G. IACONO

Keyword(s):

Environmental Factors ◽

Genetic Factors ◽

Family Members ◽

Relative Weight ◽

Externalizing Disorders ◽

Shared Environment ◽

Hyperactivity Disorder ◽

Oppositional Defiant ◽

Co Morbidity ◽

Informant Effects

Background. Research has documented high levels of co-morbidity among childhood externalizing disorders, but its etiology remains in dispute. Specifically, although all behavior genetic studies of the etiology of the co-occurrence of attention deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) agree that genetic factors are important, differences exist across studies in the relative weight assigned to genetic, shared environmental factors (i.e. factors that increase similarity among family members), and non-shared environmental factors (i.e. factors that decrease similarity among family members). Because heritability estimates can vary across informants, we used a biometric informant-effects model to determine whether these discrepancies were a function of systematic differences in maternal and child informant reports of ADHD, CD, and ODD.Method. We studied 1782 11-year-old twins from the Minnesota Twin Family Study. Symptom counts for each disorder were obtained from interviews administered to twins and their mothers. We fit a model that allowed us to examine, both across and within informants, the genetic and environmental contributions to the co-occurrence among ADHD, CD, and ODD.Results. The results revealed that the co-occurrence among the disorders common to maternal and child informant reports was influenced largely by shared environmental forces. Genetic factors also contributed, though their impact was only marginally significant. In contrast, the co-occurrence unique to each informant was influenced exclusively by either genetic or non-shared environmental factors.Conclusions. Such findings offer additional evidence that shared environmental factors are important to the co-morbidity among ADHD, CD, and ODD, and highlight the necessity of considering informant effects when drawing conclusions about the origins of co-morbidity from analyses of genetically informative data.

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Emotion Dysregulation and Externalizing Spectrum Disorders

The Oxford Handbook of Emotion Dysregulation ◽

10.1093/oxfordhb/9780190689285.013.17 ◽

2019 ◽

pp. 236-247

Author(s):

Tiffany M. Shader ◽

Theodore P. Beauchaine

Keyword(s):

Emotion Dysregulation ◽

Externalizing Disorders ◽

Developmental Model ◽

Peer Influences ◽

Neighborhood Violence ◽

Number Of Children ◽

Hyperactivity Disorder ◽

Oppositional Defiant ◽

Trait Impulsivity ◽

And Function

As described in the literature for many years, a sizable number of children with hyperactive-impulsive and combined subtypes/presentations of attention-deficit/hyperactivity disorder (ADHD)—especially males—progress to more serious externalizing syndromes across development. Such outcomes include oppositional defiant disorder, conduct problems, delinquency, substance use disorders, and in some cases antisocial personality disorder, incarceration, and recidivism. This chapter summarizes a developmental model that emphasizes different contributions of trait impulsivity, a highly heritable, subcortically mediated vulnerability, versus emotion dysregulation, a highly socialized, cortically mediated vulnerability, to externalizing progression. According to this perspective, trait impulsivity confers vulnerability to all externalizing disorders, but this vulnerability is unlikely to progress beyond ADHD in protective environments. In contrast, for children who are reared under conditions of adversity—including poverty, family violence, deviant peer influences, and neighborhood violence/criminality—neurodevelopment of prefrontal cortex structure and function is compromised, resulting in failures to achieve age-expected gains in emotion regulation and other forms of executive control. For these children, subcortical vulnerabilities to trait impulsivity are amplified by deficient cortical modulation, which facilitates progression along the externalizing spectrum.

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Using the 11-item Version of the RCADS to Identify Anxiety and Depressive Disorders in Adolescents

Research on Child and Adolescent Psychopathology ◽

10.1007/s10802-021-00817-w ◽

2021 ◽

Author(s):

Jerica Radez ◽

Polly Waite ◽

Bruce Chorpita ◽

Cathy Creswell ◽

Faith Orchard ◽

...

Keyword(s):

Suicidal Ideation ◽

Depressive Disorders ◽

Community Sample ◽

Depression Scale ◽

Parent Report ◽

Depression Symptoms ◽

Adolescent Report ◽

Two Samples ◽

Sensitivity Specificity ◽

Anxiety Depression

AbstractThe purpose of this study was to identify items from the Revised Children’s Anxiety and Depression Scale – RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire – MFQ- C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire – SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. We compared two samples of adolescents and their parents – a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P. Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the RCADS-47-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not. The 11 RCADS items accurately discriminated between the community and clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.

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