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Epidemiologic Reviews Advance Access published online on July 10, 2008
Epidemiologic Reviews, doi:10.1093/epirev/mxn003
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Epidemiologic Reviews © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Article

Comorbid Forms of Psychopathology: Key Patterns and Future Research Directions

Magdalena Cerdá1,2,3, Aditi Sagdeo2 and Sandro Galea2,3,4

1 Robert Wood Johnson Foundation Health and Society Scholars Program, Department of Epidemiology, University of Michigan, Ann Arbor, MI
2 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
3 Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY
4 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY

Correspondence to Dr. Magdalena Cerdá, Department of Epidemiology, School of Public Health, University of Michigan, 109 South Observatory, 3639 SPH Tower, Ann Arbor, MI 48109-2029 (e-mail: mcerda{at}umich.edu or mcerda{at}nyam.org).

accepted for publication April 29, 2008.

The purpose of this review is to systematically appraise the peer-reviewed literature about clustered forms of psychopathology and to present a framework that can be useful for studying comorbid psychiatric disorders. The review focuses on four of the most prevalent types of mental health problems: anxiety, depression, conduct disorder, and substance abuse. The authors summarize existing empirical research on the distribution of concurrent and sequential comorbidity in children and adolescents and in adults, and they review existing knowledge about exogenous risk factors that influence comorbidity. The authors include articles that used a longitudinal study design and used psychiatric definitions of the disorders. A total of 58 articles met the inclusion criteria and were assessed. Current evidence demonstrates a reciprocal, sequential relation between most comorbid pairs, although the mechanisms that mediate such links remain to be explained. Methodological concerns include the inconsistency of measurement of the disorders across studies, small sample sizes, and restricted follow-up times. Given the significant mental health burden placed by comorbid disorders, and their high prevalence across populations, research on the key risk factors for clustering of psychopathology is needed.

anxiety • comorbidity • conduct disorder • depression • social conditions • substance-related disorders


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