Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Ethnicity and psychiatric comorbidity in a national sample: evidence for latent comorbidity factor invariance and connections with disorder prevalence

Abstract

Purpose

Prevalence rates, and bivariate comorbidity patterns, of many common mental disorders differ significantly across ethnic groups. While studies have examined multivariate comorbidity patterns by gender and age, no studies to our knowledge have examined such patterns by ethnicity. Such an investigation could aid in understanding the nature of ethnicity-related health disparities in mental health and is timely given the likely implementation of multivariate comorbidity structures (i.e., internalizing and externalizing) to frame key parts of DSM-5.

Methods

We investigated whether multivariate comorbidity of 11 common mental disorders, and their associated latent comorbidity factors, differed across five ethnic groups in a large, nationally representative sample (n = 43,093). We conducted confirmatory factor analyses and factorial invariance analyses in White (n = 24,507), Hispanic/Latino (n = 8,308), Black (n = 8,245), Asian/Pacific Islander (n = 1,332), and American Indian/Alaska Native (n = 701) individuals.

Results

Results supported a two-factor internalizing–externalizing comorbidity factor model in both lifetime and 12-month diagnoses. This structure was invariant across ethnicity, but factor means differed significantly across ethnic groups.

Conclusions

These findings, taken together, indicated that observed prevalence rate differences between ethnic groups reflect ethnic differences in latent internalizing and externalizing factor means. We discuss implications for classification (DSM-5 and ICD-11 meta-structure), health disparities research, and treatment.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Blazer DG, Kessler RC, McGonagle KA, Swartz MS (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 151:979–986

  2. 2.

    Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 51:8–19

  3. 3.

    Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR et al (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105

  4. 4.

    Grant BF, Dawson DA, Stinson FS, Chou SP, Dufour MC, Pickering RP (2004) The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug Alcohol Depend 74:223–234

  5. 5.

    Huang B, Grant BF, Dawson DA, Stinson FS, Chou SP, Saha TD et al (2006) Race–ethnicity and the prevalence and co-occurrence of diagnostic and statistical manual of mental disorders, fourth edition, alcohol and drug use disorders and axis I and II disorders: United States, 2001 to 2002. Compr Psychiatry 47:252–257

  6. 6.

    Smith SM, Stinson FS, Dawson DA, Goldstein R, Huang B, Grant BF (2006) Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 36:987–998

  7. 7.

    Hasin DS, Stinson FS, Ogburn E, Grant BF (2007) Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 64(7):830–842

  8. 8.

    Kessler RC, Mickelson KD, Williams DR (1999) The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. J Health Soc Behav 40(3):208–230

  9. 9.

    Krieger N (2000) Discrimination and health. In: Berkman LF, Kawachi I (eds) Social epidemiology. Oxford University Press, New York, pp 36–75

  10. 10.

    Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM (2005) Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med 61(7):1576–1596

  11. 11.

    Williams DR, Jackson PB (2005) Social sources of racial disparities in health. Health Aff 24(2):325–334

  12. 12.

    Dohrenwend BP (2000) The role of adversity and stress in psychopathology: some evidence and its implications for theory and research. J Health Soc Behav 41(1):1–19

  13. 13.

    Meyer IH (1995) Minority stress and mental health in gay men. J Health Soc Behav 36(1):38–56

  14. 14.

    Meyer IH (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 129(5):674–697

  15. 15.

    Breslau J, Aguilar-Gaxiola S, Kendler KS, Su M, Williams D, Kessler RC (2006) Specifying race–ethnic differences in risk for psychiatric disorder in a USA national sample. Psychol Med 36(1):57–68

  16. 16.

    Hasin DS, Goodwin RD, Stinson FS, Grant BF (2005) Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions. Arch Gen Psychiatry 62:1097–1106

  17. 17.

    Williams DR (1999) Race, socioeconomic status, and health: the added effects of racism and discrimination. Ann N Y Acad Sci 896:173–188

  18. 18.

    Williams DR (2001) Racial variations in adult health status: patterns, paradoxes, and prospects. In: Smelser NJ, Wilson WJ, Mitchell F (eds) America becoming: racial trends and their consequences. National Academy Press, Washington, DC, pp 371–409

  19. 19.

    Hasin D, Carpenter KM, McCloud S, Smith M, Grant BF (1997) The alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability of alcohol and drug modules in a clinical sample. Drug Alcohol Depend 44:133–141

  20. 20.

    Horton J, Compton W, Cottler LB (2000) Reliability of substance use disorder diagnoses among African-Americans and Caucasians. Drug Alcohol Depend 57:203–209

  21. 21.

    Eaton NR, Krueger RF, Markon KE, Keyes KM, Skodol AE, Wall M, Hasin DS, Grant BF (2012) The structure and predictive validity of the internalizing disorders. J Abnorm Psychol. doi:10.1037/a0029598

  22. 22.

    Walton KE, Ormel J, Krueger RF (2011) The dimensional nature of externalizing behaviors in adolescence: evidence from a direct comparison of categorical, dimensional, and hybrid models. J Abnorm Child Psychol 39:553–561

  23. 23.

    Wright AGC, Krueger RF, Hobbs MJ, Markon KE, Eaton NR, Slade T (2012) The structure of psychopathology: toward an expanded quantitative empirical model. J Abnorm Psychol (in press)

  24. 24.

    Eaton NR, South SC, Krueger RF (2010) The meaning of comorbidity among common mental disorders. In: Millon T, Krueger R, Simonsen E (eds) Contemporary directions in psychopathology: scientific foundations of the DSM-V and ICD-11. Guilford Publications, New York, pp 223–241

  25. 25.

    Fergusson DM, Horwood LJ, Lawton JM (1986) The relationships between neuroticism and depressive symptoms. Soc Psychiatry Psychiatr Epidemiol 24:275–281

  26. 26.

    Griffith JW, Zinbarg RE, Craske MG, Mineka S, Rose RD, Waters AM, Sutton JM (2010) Neuroticism as a common dimension in the internalizing disorders. Psychol Med 40:1125–1136

  27. 27.

    Krueger RF (1999) The structure of common mental disorders. Arch Gen Psychiatry 56:921–926

  28. 28.

    Krueger RF, Caspi A, Moffitt TE, Silva PA (1998) The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study. J Abnorm Psychol 108:216–227

  29. 29.

    Krueger RF, Hicks BM, Patrick CJ, Carlson SR, Iacono WG, McGue M (2002) Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. J Abnorm Psychol 111:411–424

  30. 30.

    Krueger RF, Markon KE (2006) Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Ann Rev Clin Psychol 2:111–133

  31. 31.

    Slade T, Watson D (2006) The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychol Med 36:1593–1600

  32. 32.

    Vollebergh WAM, Iedema J, Bijl RV, de Graaf R, Smit F, Ormel J (2001) The structure and stability of common mental disorders. Arch Gen Psychiatry 58:597–603

  33. 33.

    Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ et al (2011) Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Arch Gen Psychiatry 68:90–100

  34. 34.

    Krueger RF, Chentsova-Dutton YE, Markon KE, Goldberg D, Ormel J (2003) A cross-cultural study of the structure of comorbidity among common psychopathological syndromes in the general health care setting. J Abnorm Psychol 112(3):437–447

  35. 35.

    Røysamb E, Kendler KS, Tambs K, Ørstavik RE, Neale MC, Aggen SH, Torgersen S, Reichborn-Kjennerud T (2011) The joint structure of DSM-IV axis I and axis II disorders. J Abnorm Psychol 120:198–209

  36. 36.

    Eaton NR, Keyes KM, Krueger RF, Balsis S, Skodol AE, Markon KE, Grant BF, Hasin DS (2012) An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample. J Abnorm Psychol 121(1):282–288

  37. 37.

    Eaton NR, Krueger RF, Oltmanns TF (2011) Aging and the structure and long-term stability of the internalizing spectrum of personality and psychopathology. Psychol Aging 26(4):987–993

  38. 38.

    Kramer MD, Krueger RF, Hicks BM (2008) Internalizing and externalizing liability factors account for gender differences in the prevalence of common psychopathological syndromes. Psychol Med 38:51–61

  39. 39.

    Andrews G, Goldberg DP, Krueger RF, Carpenter WT Jr, Hyman SE, Sachdev P, Pine DS (2009) Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity? Psychol Med 39:1993–2000

  40. 40.

    Regier DA, Narrow WE, Kuhl EA, Kupfer DJ (eds) (2011) The conceptual evolution of DSM-5. American Psychiatric Publishing, Inc., Arlington

  41. 41.

    Slade T (2007) The descriptive epidemiology of internalizing and externalizing psychiatric dimensions. Soc Psychiatry Psychiatr Epidemiol 42:554–560

  42. 42.

    Kendler KS, Prescott CA, Myers J, Neale MC (2003) The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry 60:929–937

  43. 43.

    Kendler KS, Aggen SH, Knudsen GP, Røysamb E, Neale MC, Reichborn-Kjennerud T (2011) The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. Am J Psychiatry 168:29–39

  44. 44.

    Lahey BB, Van Hulle CA, Singh AL, Waldman ID, Rathouz PJ (2011) Higher-order genetic and environmental structure of prevalent forms of child and adolescent psychopathology. Arch Gen Psychiatry 68:181–189

  45. 45.

    Grant BF, Dawson DA (2006) Introduction to the national epidemiologic survey on alcohol and related conditions. Alcohol Res Health 29(2):74–78

  46. 46.

    Grant BF, Harford TC, Dawson DA, Chou PS, Pickering RP (1995) The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS): reliability of alcohol and drug modules in a general population sample. Drug Alcohol Depend 39:37–44

  47. 47.

    Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R (2003) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71:7–16

  48. 48.

    Wittchen H-U (1994) Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 28:57–84

  49. 49.

    Muthén LK, Muthén BO (2010) Mplus user’s guide. Author, Los Angeles

  50. 50.

    Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model 6:1–55

  51. 51.

    Cheung GW, Rensvold RB (2002) Evaluating goodness-of-fit indexes for testing measurement invariance. Struct Equ Model 9:233–255

  52. 52.

    Keyes KM, Eaton NR, Krueger RF, McLaughlin K, Wall MM, Grant BF, Hasin DS (2012) Childhood adversities and the structure of common psychiatric disorders. Br J Psychiatry 200(2):107–115

  53. 53.

    Brown T (2003) Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification. J Health Soc Behav 44(3):292–301

  54. 54.

    Jones CP (2000) Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health 90(8):1212–1215

  55. 55.

    Kendrick L, Anderson NLR, Benjamin M (2007) Perceptions of depression among young African American men. Family Commun Health 30(1):63–73

  56. 56.

    Mabry JB, Kiecold KJ (2005) Anger in black and white: race, alienation, and anger. J Health Soc Behav 46(1):85–101

  57. 57.

    Goldberg D, Simms LJ, Gater R, Krueger RF (2011) Integration of dimensional spectra for depression and anxiety into categorical diagnoses for general medical practice. In: Regier DA, Narrow WE, Kuhl EA, Kupfer DJ (eds) The conceptual evolution of DSM-5. American Psychiatric Publishing, Inc., Arlington, pp 19–35

  58. 58.

    Tang TZ, DeRubeis RJ, Hollon SD, Amsterdam J, Shelton R, Schalet B (2009) Personality change during depression treatment: a placebo-controlled trial. Arch Gen Psychiatry 66:1322–1330

  59. 59.

    Nathan PE, Gorman JM (2007) A guide to treatments that work, 3rd edn. Oxford University Press, Inc., New York

  60. 60.

    Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, Ehrenreich-May J (2011) Unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. Oxford University Press, New York

  61. 61.

    Markon KE (2010) Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders. Psychol Med 40:273–288

Download references

Acknowledgments

U01AA018111, R01DA018652, and K05AA014223 (Hasin). The National Epidemiologic Survey on Alcohol and Related Conditions was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and funded, in part, by the Intramural Program, NIAAA, National Institutes of Health, with additional support from the National Institute on Drug Abuse.

Conflict of interest

None.

Author information

Correspondence to Nicholas R. Eaton.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Eaton, N.R., Keyes, K.M., Krueger, R.F. et al. Ethnicity and psychiatric comorbidity in a national sample: evidence for latent comorbidity factor invariance and connections with disorder prevalence. Soc Psychiatry Psychiatr Epidemiol 48, 701–710 (2013). https://doi.org/10.1007/s00127-012-0595-5

Download citation

Keywords

  • Comorbidity
  • Ethnicity
  • Internalizing
  • Externalizing
  • Prevalence
  • Disparities