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Examining heterotypic continuity of psychopathology: a prospective national study

Published online by Cambridge University Press:  12 April 2017

C. Blanco ,
M. M. Wall ,
S. Wang  and
M. Olfson
C. Blanco
Affiliation:
Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse (NIDA), Bethesda, MD, USA
M. M. Wall
Affiliation:
Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
S. Wang
Affiliation:
Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
M. Olfson*
Affiliation:
Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
*
*Address for correspondence: M. Olfson, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA. (Email: mo49@cumc.columbia.edu)
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Abstract

Background

Individuals with one psychiatric disorder are at increased risk for incidence and recurrence of other disorders. We characterize whether the magnitude of such heterotypic continuity varies based on whether the first disorder remits or persists over time.

Method

Cohorts were selected from participants in the National Epidemiologic Survey on Alcohol and Related Conditions wave 1 (2001–2002) and wave 2 (2004–2005) surveys with ⩾1 mood, anxiety, or substance use disorder at wave 1. Among respondents remitting (n = 6719) or not remitting (n = 3435) from ⩾1 of disorder at wave 2, the analyses compared the odds of developing new disorders.

Results

As compared with adults whose disorders persisted from wave 1 to wave 2, those with ⩾1 remission had lower odds of incidence or recurrence of another disorder. Remission from alcohol dependence [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.3–0.5] and drug dependence (OR 0.4, 95% CI 0.3–0.6) were associated with the lowest odds of incidence of another disorder. Social anxiety disorder was associated with the lowest adjusted odds of recurrence (adjusted OR = 0.2, 95% CI 0.1–0.6). Remission of disorders within one class (mood, anxiety, substance use) was consistently associated with lower odds of incidence or recurrence of disorders from the same class than with developing disorders from the other classes.

Conclusions

Remission from common psychiatric disorders tends to decrease the risk for incidence or recurrence of disorders and this effect is stronger within than across disorder classes. These results do not support the concept of heterotypic continuity as a substitution of one disorder for another.

Keywords

Heterotypic continuityhomotypic continuitysymptom substitutionNESARCcourse of psychiatric disorders.
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 12 , September 2017 , pp. 2097 - 2106
Copyright
Copyright © Cambridge University Press 2017 

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