Department of Economics and Business Economics

Exploring Comorbidity Within Mental Disorders Among a Danish National Population

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Oleguer Plana-Ripoll
  • Carsten Bøcker Pedersen
  • Yan Holtz, Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.
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  • Michael E Benros, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark., University of Copenhagen, Denmark
  • ,
  • Søren Dalsgaard
  • Peter de Jonge, Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical, Center Groningen, Groningen, The Netherlands., Rijksuniversiteit Groningen
  • ,
  • Chun Chieh Fan, Center for Multimodal Imaging and Genetics, School of Medicine, University of California San Diego, La Jolla.
  • ,
  • Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
  • ,
  • Andrea Ganna, The Broad Institute of MIT and Harvard, Cambridge, MA, USA, Massachusetts General Hospital, Boston
  • ,
  • Aja Neergaard Greve
  • Jane Gunn, Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia.
  • ,
  • Kim Moesgaard Iburg
  • Lars Vedel Kessing, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Copenhagen University Hospital - Rigshospitalet
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  • Brian K Lee, Drexel University Philadelphia
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  • Carmen C W Lim, Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Australia, University of Queensland
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  • Ole Mors
  • Merete Nordentoft, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark., University of Copenhagen, Denmark
  • ,
  • Anders Prior
  • Annelieke M Roest, Rijksuniversiteit Groningen, University Medical Center Groningen
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  • Sukanta Saha, Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Australia, University of Queensland
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  • Andrew Schork, Institute of Biological Psychiatry, MHC Sct. Hans, Mental Health Services Copenhagen, Denmark., The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark.
  • ,
  • James G Scott, Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Richlands, Australia, Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia Grant.Ramm@qimrberghofer.edu.au., Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia; School of Public Health, The University of Queensland, Herston, Australia; Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Australia.
  • ,
  • Kate M Scott, Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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  • Terry Stedman, West Moreton Division of Mental Health and Specialised Services, Archerfield, Queensland, Australia.
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  • Holger J Sørensen, The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Copenhagen, Mental Health Centre Copenhagen, University of Copenhagen, Denmark
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  • Thomas Werge, The Lundbeck Foundation Initiative for Integrative Psychiatric Research iPSYCH, Copenhagen, Institute of Biological Psychiatry, MHC Sct. Hans, Mental Health Services Copenhagen, Denmark., University of Copenhagen, Denmark
  • ,
  • Harvey A Whiteford, School of Public Health, University of Queensland, St Lucia, Queensland, Australia., Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4072, Australia.
  • ,
  • Thomas Munk Laursen
  • Esben Agerbo
  • Ronald C Kessler, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
  • ,
  • Preben Bo Mortensen
  • John J McGrath

IMPORTANCE Individuals with mental disorders often develop comorbidityover time. Past studies of comorbidity have often restricted analyses to a subset of disorders and few studies have provided absolute risks of later comorbidity.

OBJECTIVES To undertake a comprehensive study of comorbidity within mental disorders, by providing temporally ordered age-and sex-specific pairwise estimates between the major groups of mental disorders, and to develop an interactive website to visualize all results and guide future research and clinical practice.

DESIGN, SETTING. AND PARTICIPANTS This population-based cohort study included all individuals born in Denmark between January 1, 190 0, and December 31, 2015, and living in the country between January 1, 20 0 0, and December 31, 2016. The analyses were conducted between June 2017 and May 2018.

MAIN OUTCOMES AND MEASURES Danish health registers were used to identify mental disorders, which were examined within the broad 10-level International Statistical Classification of Diseases and Related Health Problems, lOth Revision, subchapter groups (eg, codes F00-F09 and F10-F19). For each temporally ordered pair of disorders, overall and lagged hazard ratios and 95% Cls were calculated using Cox proportional hazards regress on models. Absolute risks were estimated using competing risks survival analyses. Estimates for each sex were generated.

RESULTS A total of 5 940 778 persons were Included in this study (2 958 293 men and 2 982 485 women; mean [SD] age at beginning of follow-up, 32.1[25.4] years). They were followed up for 83.9 million person-years. All mental disorders were associated with an increased risk of all other mental disorders when adjusting for sex, age, and calendar time (hazard ratios ranging from 2.0 [95% CI, 1.7-2.4] for prior intellectual disabilities and later eating disorders to 48.6 [95% Cl, 46.6-50.7] for prior developmental disorders and later intellectual disabilities). The hazard ratios were temporally patterned, with higher estimates during the first year after the onset of the first disorder, but with persistently elevated rates during the entire observation period. Some disorders were associated with substantial absolute risks of developing specific later disorders (eg, 30.6% [95% CI, 29.3%-32.0%] of men and 38.4% [95% CI, 37.5%-39.4%] of women with a diagnosis of mood disorders before age 20 years developed neurotic disorders within the following 5 years).

CONCLUSIONS AND RELEVANCE Comorbidity within mental disorders is pervasive, and the risk persists over time. This study provides disorder-, sex-, and age-specific relative and absolute risks of the comorbidity of mental disorders. Web-based interactive data visualization tools are provided for clinical utility.

Original languageEnglish
JournalJ A M A Psychiatry
Volume76
Issue3
Pages (from-to)259-270
Number of pages12
ISSN0003-990X
DOIs
Publication statusPublished - Mar 2019

    Research areas

  • CO-MORBIDITY, DIAGNOSES, DSM-IV DISORDERS, HEALTH SURVEY, LIFETIME PREVALENCE, RELIABILITY, RISK, SCHIZOPHRENIA, VALIDITY

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