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Psychiatric comorbidity in the Baltimore ECA follow-up study: the matrix approach

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Abstract

Background

Psychiatric comorbidity is defined as the joint occurrence of two or more mental or substance use disorders. Widespread psychiatric comorbidity has been reported in treatment and population-based studies. The aim of this study was to measure the extent and impact of psychiatric comorbidity in a cohort of the Baltimore Epidemiologic Catchment Area study.

Methods

We examined the comorbidity burden of 16 mental disorders in a cohort of 847 participants using both established and novel analytical approaches The Comorbidity to Diagnosis Inflation Ratio (CDIR), is a statistical instrument that quantifies impact of pairwise comorbid associations, both on the whole sample, as well as on each specific disorder.

Results

Most anxiety disorders had substantial co-occurrence with each other, as well as with Major Depressive Disorder (MDD). In addition, mood disorders had a high degree of comorbidity with Alcohol Dependence (AD). The CDIR for the whole sample was 1.32, indicating a ratio of 132 comorbidities per 100 diagnoses. The conditions with high sample prevalence were relatively less comorbid than the low prevalence conditions. Obsessive Compulsive Disorder had a comorbidity burden that was 89% greater than the overall sample.

Conclusion

Anxiety disorders are highly interrelated, as well as highly comorbid with depression. The comorbidity phenomenon is linked to the differential prevalence of the analyzed conditions. Comorbidity frequency (most prevalent comorbid condition) appears mutually exclusive to comorbidity burden (most widely interrelated condition). While AD and MDD were the most frequently diagnosed disorders; low prevalence conditions as OCD and GAD were the most widely interrelated.

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Acknowledgements

The authors want to thank Mayra Tisminetzky, MD PhD, Robert Goldberg, PhD, and Charles Flexner, MD for their feedback and comments.

Funding

This work was supported by: NIA grant U01AG052445 (Dr Eaton), NIMH grant MH50616 (Dr. Nestadt).

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 624 North Broadway, Baltimore, MD, 21205, USA

    Ruben Miozzo, William Eaton, O. Joseph Bienvenu, Jack Samuels & Gerald Nestadt

  2. Graduate Training Program in Clinic Investigation, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA

    Ruben Miozzo & O. Joseph Bienvenu

  3. Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21205, USA

    William Eaton, O. Joseph Bienvenu, Jack Samuels & Gerald Nestadt

  4. Meyers Primary Care Institute, Worcester, MA, 01605, USA

    Ruben Miozzo

  5. Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA

    Ruben Miozzo

Authors
  1. Ruben Miozzo
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  2. William Eaton
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  3. O. Joseph Bienvenu
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  4. Jack Samuels
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  5. Gerald Nestadt
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Contributions

Study concept and design: Drs. RM and GN. Participants selection and interviewing: Drs WE, OJB, and GN. Data analysis: Dr RM. Data interpretation: Drs RM, WE, OJB, JS, and GN. Preparation of manuscript: Drs GM and GN. Critical revision of manuscript: Drs RM, WE, OJB, JS, and GN.

Corresponding author

Correspondence to Ruben Miozzo.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

All participants of the ECA study have given their written informed consent and that the study protocol was approved by the Institutional Review Board of Johns Hopkins Medical Institutions.

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Miozzo, R., Eaton, W., Bienvenu, O.J. et al. Psychiatric comorbidity in the Baltimore ECA follow-up study: the matrix approach. Soc Psychiatry Psychiatr Epidemiol 58, 141–151 (2023). https://doi.org/10.1007/s00127-021-02184-9

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  • DOI: https://doi.org/10.1007/s00127-021-02184-9

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