Skip to main content
Log in

Primary prevention of secondary disorders: A proposal and agenda

  • Published:
American Journal of Community Psychology

Abstract

This paper calls for consideration of a new class of preventive interventions designed explicitly to prevent comorbidity of psychiatric disorders. Epidemiologic data show that successful interventions of this type could be extremely valuable, as up to half of lifetime psychiatric disorders and an even larger percent of chronic and seriously impairing disorders occur to people with a prior history of some other disorder. Furthermore, a review of etiologic hypotheses concerning the causes of comorbidity suggests that interventions aimed at primary prevention of secondary disorders might be feasible. However, more basic risk factor research is needed on the causes of comorbidity before we can make a clear assessment of feasibility and discover promising intervention targets. A number of methodological problems arise in carrying out this type of formative research. These problems are reviewed and suggestions are offered for solutions involving innovations in measurement, design, and data analysis.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Abraham, H. D. (1986). Do psychostimulants kindle panic disorder? (letter).American Journal of Psychiatry, 143, 1627.

    PubMed  Google Scholar 

  • Akiskal, H. S. (1991). An integrative perspective on recurrent mood disorders: The mediating role of personality. In J. Becker and A. Kleinman (Eds.),Psychosocial aspects of depression. New Jersey: Lawrence Erlbaum Associates, pp. 215–235.

    Google Scholar 

  • Angst, J., Vollrath, M., Merikangas, K. R., & Ernst C. (1990). Comorbidity of anxiety and depression in the Zurich cohort study of young adults. In J. D. Maser and C. R. Cloninger (Eds.),Comorbidity of mood and anxiety disorders, Washington, D.C.: American Psychiatric Press, pp. 123–138.

    Google Scholar 

  • Aronson, T. A., & Craig, T. J. (1986). Cocaine precipitation of panic disorder.American Journal of Psychiatry, 143, 643–645.

    PubMed  Google Scholar 

  • Berkson, J. (1946). Limitations of the application of the four-fold table analyses to hospital data.Biometrics, 2, 47–53.

    Google Scholar 

  • Bibb, J. L., & Chambless, D. L. (1986). Alcohol use and abuse among diagnosed agoraphobics.Behavior Research Therapy, 24, 49–58.

    Google Scholar 

  • Bohman, M., Cloninger, R., Sigvardsson, S., & von Knorring, A. L. (1981). The genetics of alcoholism and related disorders.Journal of Psychiatric Research, 21, 447–452.

    Google Scholar 

  • Botvin, G. (1986). Substance abuse prevention efforts: Recent developments and future directions.Journal of School Health, 56, 369–374.

    PubMed  Google Scholar 

  • Browne, M. W. (1984). Asymptotically distribution-free methods for the analysis of covariance structures.British Journal of Mathematical and Statistical Psychology, 37, 1–21.

    PubMed  Google Scholar 

  • Bukstein, O. G., Brent, D. A., & Kaminer, Y. (1989). Comorbidity of substance abuse and other psychiatric disorders in adolescents.American Journal of Psychiatry, 146, 1131–1141.

    PubMed  Google Scholar 

  • Cadoret, R., & Gath, A. (1978). Inheritance of alcoholism in adoptees raised apart from alcoholic biological relatives.British Journal of Psychiatry, 132, 252–258.

    Google Scholar 

  • Cadoret, R. J., & Winokur, G. (1974). Depression in alcoholism.Annals of the New York Academy of Science, 233, 34–36.

    Google Scholar 

  • Charney, D. S., Woods, S. W., Goodman, W. K., & Heninger, G. R. (1987). Neurobiological mechanisms of panic anxiety: Biochemical and behavioral correlates of yohimbine-induced panic attacks.American Journal of Psychiatry, 144, 1030–1036.

    PubMed  Google Scholar 

  • Cloninger, R., Bohman, M., & Sigvardsson, S. (1981). Inheritance of alcohol abuse: Cross-fostering analysis of adopted men.Archives of General Psychiatry, 38, 861–867.

    PubMed  Google Scholar 

  • Cox, D. R. (1972). Regression models and life-tables.Journal of the Royal Statistical Society, 34, 187–220.

    Google Scholar 

  • Coyne, J. C. (1976). Depression and the response of others.Journal of Abnormal Psychology, 2, 186–193.

    Google Scholar 

  • Cross-National Collaborative Group (1992). The changing rate of major depression. Cross-national comparisons.Journal of the American Medical Association, 268, 3098–3105.

    Google Scholar 

  • Duncan, O. D. (1975).Introduction to structural equation models. New York: Academic Press.

    Google Scholar 

  • Eaton, W. W., Dryman, A., & Weissman, M. M. (1991). Panic and Phobia. In L. N. Robins and D. A. Regier (Eds.),Psychiatric disorders in America. New York: Free Press, pp. 155–179.

    Google Scholar 

  • Falloon, I. R. H., Boyd J. L., & McGill C. W. (1984).Family care of schizophrenia. New York: Guilford.

    Google Scholar 

  • Finlay-Jones, R. (1989). Anxiety. In G. W. Brown and T. O. Harris (Eds.), Life events and illness. New York: Guilford, pp. 95–112

    Google Scholar 

  • Gillelman, R., Mannuzza, S., Shenker, R., & Bonagura, N. (1985). Hyperactive boys almost grown up. I. Psychiatric status.Archives of General Psychiatry, 42, 937–947.

    PubMed  Google Scholar 

  • Goddard, G. V., Mclntyre, D. C., & Leech, C. K. (1969). A permanent change in brain function resulting from daily electrical stimulation.Experimental Neurology, 25, 295–330.

    PubMed  Google Scholar 

  • Gomez, R. L., Janowsky, M. D., Zetin, M., Huey, L., & Clopton, P. L. (1981). Adult psychiatric diagnosis and symptoms compatible with the hyperactive child syndrome: A retrospective study.Journal of Clinical Psychiatry, 42, 389–394.

    PubMed  Google Scholar 

  • Gordon, R. S. (1987). An operational classification of disease prevention. In J. A. Steinberg and M. M. Silverman (Eds.),Preventing mental disorders: A research perspective. Rockville, MD: NIMH, pp. 20–26.

    Google Scholar 

  • Hagnell, O., & Grasbeck A. (1990). Comorbidity of anxiety and depression in the Lundby 25-year prospective study: The pattern of subsequent episodes. In J. D. Maser and C. R. Cloninger (Eds.),Comorbidity of mood and anxiety disorders. Washington, D.C.: American Psychiatric Press, pp. 139–152.

    Google Scholar 

  • Heath, A. C., Kessler, R. C., Neale, M. C., Hewitt, J. K., Eaves, L. J., & Kendler, K. S. (1993). Testing hypotheses about direction of causation using cross-sectional family data.Behavior Genetics, 23, 29–50.

    PubMed  Google Scholar 

  • Helzer, J. E., & Pryzbeck, T. R. (1988). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment.Journal of Studies on Alcohol, 49, 219–224.

    PubMed  Google Scholar 

  • Hesselbrock, M. N. (1986). Childhood behavior problems and adult antisocial personality disorder in alcoholism. In R. E. Meyer (Ed.),Psychopathology and addictive disorders. New York: Guilford Press, pp. 78–94.

    Google Scholar 

  • Hesselbrock, M. N., Hesselbrock, V. M., Tennen, H., Meyer, R. E., & Workman, K. L. (1983). Methodological considerations in the assessment of depression in alcoholics.Journal of Consulting Clinical Psychology, 51, 399–405.

    Google Scholar 

  • Hesselbrock, V. M., Hesselbrock, M. N., & Workman-Daniels, K. L. (1986). Effect of major depression and antisocial personality on alcoholism: Course and motivational patterns.Journal of Studies on Alcohol, 47, 207–212.

    PubMed  Google Scholar 

  • Jaffe, J. H., & Ciraulo, D. A. (1986). Alcoholism and depression. In R.E. Meyer (Ed.),Psychopathology and addictive disorders. New York: Guilford Press, pp. 293–320

    Google Scholar 

  • Joreskog, K. G., & Sorbom, D. (1989). LISREL 7 user's reference guide. Mooresville, IN: Scientific Software.

    Google Scholar 

  • Kaplan, H. I., & Sadock, B. J. (1988).Synopsis of psychiatry: Behavioral sciences clinical psychiatry (5th ed.). Baltimore: Williams and Wilkins.

    Google Scholar 

  • Keeler, M. H., Taylor, C. I., & Miller, W. C. (1979). Are all recently detoxified alcoholics depressed?American Journal of Psychiatry, 136, 586–588.

    PubMed  Google Scholar 

  • Kendler, K. S., Neale, M. C., Kessler, R. C., Heath, A. C., & Eaves, L. J. (1992a). A population based twin-study of major depression in women: The impact of varying definitions of illnesses.Archives of General Psychiatry, 49, 257–266.

    PubMed  Google Scholar 

  • Kendler, K. S., Neale M. C., Kessler, R. C., Heath, A. C., Eaves, L. J. (1992b). Major depression and generalized anxiety disorder: same genes (partly) different environments?Archives of General Psychiatry, 49, 716–722.

    PubMed  Google Scholar 

  • Kessier, R. C. (1987). The interplay of research design strategies and data analysis procedures in evaluating the effects of stress on health. In S. V. Kasl and C. L. Cooper (Eds.),Stress and health: Issues in research methodology. New York: John Wiley & Sons, pp. 113–140.

    Google Scholar 

  • Kessler, R. C., Kendler, K. S., Heath, A., Neale, M. C., & Eaves, L. J. (in press a). Perceived support and adjustment to stress in a general population sample of female twins.Psychological Medicine.

  • Kessler, R. C., & Magee, W. J. (in press). The disaggregation to vulnerability as a function of the determinants of onset and recurrence. In W. R. Avison & I. A. Gotlib (Eds.),Stress and mental health: Contemporary issues and prospects for the future. New York: Plenum.

  • Kessler, R. C., McGonagle, K. A., Carnelley, K. B., Nelson, C. B., Farmer, M. E., & Regier, D. A. (in press b). Comorbidity of mental disorders and substance use disorders: Review and agenda for future research.Research in Community and Mental Health.

  • Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., Wittchen, H.-U., & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders among persons aged 15–54 in the united states: Results from the national comorbidity survey.Archives of General Psychiatry, 51, 8–91.

    PubMed  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., & Nelson, C. B. (submitted for publication). Post-traumatic Stress Disorder in the National Comorbidity Survey.

  • Klein, D. F., Ross, D. C., & Cohen, P. (1987). Panic and avoidance in agoraphobia.Archives of General Psychiatry, 44, 377–385.

    PubMed  Google Scholar 

  • Kranzler, H. R., & Liebowitz, N. R. (1988). Anxiety and depression in substance abuse: Clinical implications.Medical Clinics of North America, 72, 867–885.

    PubMed  Google Scholar 

  • Leavell, H. R., & Clark, E. G. (Eds.) (1953).Textbook of preventive medicine. New York: McGraw-Hill.

    Google Scholar 

  • Lewis, C. E., Rice, J., Andreasen, N., Endicott, J., & Hartman, A. (1986). Clinical and familial correlates of alcoholism in men with unipolar major depression.Alcoholism: Clinical and Experimental Research, 10, 657–662.

    Google Scholar 

  • Liebowitz, M. R., Fryer, M. R., Gorman, J., Dillon, D., Appleby, I. L., Levy, G., Anderson, S., Levitt, M., Palij, M., Davies, S. O., & Klein, D. F. (1984). Lactate provocation of panic attacks, I: Clinical and behavioral findings.Archives of General Psychiatry, 41, 764–770.

    PubMed  Google Scholar 

  • Loftus, E. F., Smith, K. D., Klinger, M. R., & Fiedler, J. (1992). Memory and mismemory for health events. In J. M. Tanur (Ed.),Questions about questions: Inquiries into the cognitive bases of surveys. New York: Russell Sage Foundation, pp. 102–137.

    Google Scholar 

  • Loney, J. (1980). The Iowa theory of substance abuse among hyperactive adolescents. In D. J. Lettieri, M. Sayers, and H. W. Pearson (Eds.),Theories on drug abuse: NIDA Research Monograph Series 30. Washington, D.C.: U.S. Department of Health and Human Services, pp. 132–136.

    Google Scholar 

  • Maser, J. D., & Cloninger C. R. (1990).Comorbidity of mood and anxiety disorders. Washington, D.C.: American Psychiatric Press.

    Google Scholar 

  • Mendlewicz, J., & Baron, M. (1981). Morbidity risks in subtypes of unipolar depressive illness: Differences between early and late onset forms.British Journal of Psychiatry, 139, 463–466.

    PubMed  Google Scholar 

  • Merikangas, K. R., Risch, N. J., & Weissman, M. M. (in press). Comorbidity and co-transmission of alcoholism, anxiety and depression.Psychological Medicine.

  • Meyer, R. E. (1986).Psychopathological and addictive disorder. New York: Guilford.

    Google Scholar 

  • National Institute of Mental Health (1993). The Prevention of Mental Disorders: A National Research Agenda, Unpublished report.

  • Neale, M. C., & Cardon, L. R. (Eds.) (1992).Methodology for genetic studies of twins and families. Kluwer Academic Press: Dodrecht, Netherlands.

    Google Scholar 

  • Parrella, D. P., & Filstead, W. J. (1987). Definition of onset in the development of onset-based alcoholism typologies.Journal of Studies on Alcohol, 49, 85–92.

    Google Scholar 

  • Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, B. J., Judd, L. L., & Goodwin, F. K. (1990). Comorbidity of mental health disorders with alcohol and other drug abuse.Journal of American Medical Association, 264, 2511–2518.

    Google Scholar 

  • Ries, R. K., & Ellingson, E. (1990). A pilot assessment at one month of 17 dual diagnosis patients.Hospital and Community Psychiatry, 41, 1230–1233.

    PubMed  Google Scholar 

  • Robins, L. N., Locke, B. Z., & Regier, D. A. (1991). An overview of psychiatric disorders in America. In L. N. Robins, & D. A. Regier (Eds.),Psychiatric Disorders in America. New York: Free Press, pp. 328–366.

    Google Scholar 

  • Robins, L. N., & Przybeck, T. R. (1985). Age of onset of drug use as a factor in drug and other disorders.National Institute on Drug Abuse: Research Monograph Series, 56, 178–192.

    Google Scholar 

  • Robins, L. N., Wing, J., Wittchen, H. -U., Helzer, J. E., Babor, T. F., Burke, J., Farmer, A., Jablenski, A., Pickens, R., Regier, D. A., Sartorius, N., & Towle, L. H. (1988). The Composite International Diagnostic Interview: An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures.Archives of General Psychiatry, 45, 1069–1077.

    PubMed  Google Scholar 

  • Rotheram-Borus, M. J. (1988). Assertiveness training with children. In R. H. Price, E. L. Cowen, R. P. Lorion, & J. Ramos-McKay (Eds.),14 ounces of prevention: A casebook for practitioners. Washington, D.C. American Psychological Association, pp. 83–97.

    Google Scholar 

  • Rounsaville, B. J., Kosten, T. R., Weissman, M. M., Prusoff, B., Pauls, D., Anton, S. F., & Merikangas, K. (1991). Psychiatric disorders in relatives of probands with opiate addiction.Archives of General Psychiatry, 48, 33–42.

    PubMed  Google Scholar 

  • Roy, A., DeJong, J., Lamparski, D., Adinoff, B., George, T., Moore, V., Garnett, D., Kerich, M., & Linnoila, M. (1991). Mental disorders among alcoholics: Relationship to age of onset and cerebrospinal fluid neuropeptides.Archives of General Psychiatry, 48, 423–427.

    PubMed  Google Scholar 

  • Schuckit, M. A., Irwin, M., Howard, T., & Smith, T. (1988). A structured diagnostic interview for identification of primary alcoholism: A preliminary evaluation.Journal of Studies on Alcohol, 49, 93–99.

    PubMed  Google Scholar 

  • Smith, C. (1976). Statistical resolution of genetic heterogeneity in familial disease.Annals of Human Genetics, 39, 281–290.

    PubMed  Google Scholar 

  • Tarter, R. E., Hegedus, A. M., & Gavaler, J. S. (1985). Hyperactivity in sons of alcoholics.Journal of Studies on Alcohol, 46, 259–261.

    PubMed  Google Scholar 

  • Weiss, R. D., Mirin, S. M., & Griffin, M. L. (1988). Psychopathology in cocaine abusers: Changing trends.The Journal of Nervous and Mental Disease, 176, 719–725.

    PubMed  Google Scholar 

  • Wolf, A. W., Schubert, D. S. P., Patterson, M. B., Grande, T. P., Brocco, K. J., & Pendelton, L. (1988). Associations among major psychiatric diagnoses.Journal of Consulting and Clinical Psychology, 56, 292–294.

    PubMed  Google Scholar 

  • Woodruff, R. A., Guze, S. B., Clayton, P. J., & Carr, D. (1979). Alcoholism and depression. In D. W. Goodwin and C. K. Erikson (Eds.),Alcoholism and affective disorders. New York: SP Medical and Scientific Books, pp. 39–48.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kessler, R.C., Price, R.H. Primary prevention of secondary disorders: A proposal and agenda. Am J Commun Psychol 21, 607–633 (1993). https://doi.org/10.1007/BF00942174

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00942174

Key words

Navigation