Reinterpreting Comorbidity: A Model-Based Approach to Understanding and Classifying Psychopathology

Krueger, Robert F.; Markon, Kristian E.

doi:10.1146/annurev.clinpsy.2.022305.095213

Cited by 1,013 publications

(1,105 citation statements)

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“…These findings are consistent with those of Krueger (1999), and they agree with research conducted on other adolescent and adult samples (Krueger and Markon 2006;Lahey et al 2004). Also, the magnitude of the factor loadings for major depressive episode and posttraumatic stress disorder is consistent with the findings of Cox et al (2002) and Slade and Watson (2006), who extended Krueger's dimensional model to include PTSD as part of the internalizing factor.…”

Section: Discussion Summarysupporting

confidence: 89%

“…Between-dimension comorbidity is suggested by the more modest covariance between the two latent dimensions of internalizing and externalizing. Similar findings have been replicated by analyses of data from other large samples (Krueger and Markon 2006;Lahey et al 2004). Confirmatory factor analysis is appropriate to study adolescent psychopathology as pure psychiatric disorders are rare and clusters of disorders often co-occur at rates greater than chance (Angold et al 1999).…”

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confidence: 60%

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A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality, Internalizing, and Externalizing Disorders

Yoder

Longley

Whitbeck

et al. 2007

J Abnorm Child Psychol

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The present study examined associations among dimensions of suicidality and psychopathology in a sample of 428 homeless adolescents (56.3% female). Confirmatory factor analysis results provided support for a three-factor model in which suicidality (measured with lifetime suicidal ideation and suicide attempts), internalizing disorders (assessed with lifetime diagnoses of major depressive episode and post-traumatic stress disorder), and externalizing disorders (indicated by lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse) were positively intercorrelated. The findings illustrate the utility of a dimensional approach that integrates suicidality and psychopathology into one model. KeywordsPsychopathology; Suicidality; Internalizing; Externalizing; Homeless adolescents Dimensions of adolescent suicidality and psychopathology are of increased concern to clinicians and researchers (Bridge et al. 2006;Verona et al. 2004). This interest can be attributed to the relatively high prevalence of adolescent suicidal ideation and suicide attempts (Evans et al. 2005) and to suicide being the third leading cause of death among youths ages 15-24 in the USA (Hoyert et al. 2006). Research also indicates both suicidal ideation and suicide attempts increase the risk for completed suicide (Brown et al. 2000). This pattern of increased liability for suicide risk has led to a broader conceptualization of a suicide spectrum ranging from suicidal ideation to attempted and completed suicide (Lewinsohn et al. 1996).Moreover, psychiatric disorders are among the strongest correlates of adolescent suicidality (Bridge et al. 2006). Mood disorders are robust correlates, but post-traumatic stress disorder, conduct disorder, and substance use disorders are also associated with suicidality (Bridge et al. 2006;Evans et al. 2004). Krueger (1999), informed by the work of Achenbach (Achenbach and McConaughy 1997), developed a dimensional model of psychopathology and clustered psychiatric diagnoses into internalizing and externalizing disorders. As specific psychiatric disorders from both clusters are related to suicidal ideation and attempts, there is interest in linking the suicide spectrum to these broader dimensions of psychopathology (Hills et al. 2005;Verona et al. 2004).Our study expands on this work by including the internalizing and externalizing dimensions of psychopathology in a structural model of adolescent suicidality using a sample of homeless adolescents. Suicidality is measured with lifetime suicidal ideation and suicide attempts, internalizing psychopathology with lifetime diagnoses of major depressive episode and posttraumatic stress disorder, and externalizing psychopathology with lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse. We use confirmatory factor analysis to examine covariances among dimensions of suicidality, internalizing, and externalizing disorders. Internalizing and Externalizing DisordersAchenbach used an empirical approach to derive two broad dimensions (internalizing...

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Section: Discussion Summarysupporting

confidence: 89%

mentioning

confidence: 60%

A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality, Internalizing, and Externalizing Disorders

Yoder

Longley

Whitbeck

et al. 2007

J Abnorm Child Psychol

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“…The symptoms of posttraumatic stress disorder (PTSD) often co-occur with other psychiatric disorders, such as depression, generalized anxiety disorder, social phobia, simple phobia and panic disorder (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Krueger & Markon, 2006). Empirical findings have demonstrated a high rate of comorbidity between PTSD and depressive symptoms (O’Donnell, Creamer, & Pattison, 2004; Tekin et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake

Cheng

Liang

et al. 2018

European Journal of Psychotraumatology

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Background: Many studies have reported the comorbidity of posttraumatic stress disorder (PTSD) and depression in children. However, the underlying relationship between PTSD and depression remains unclear.Objective: This study examines the relationship between PTSD and depressive symptoms in children who survived the Wenchuan earthquake in China.Methods: In total, 301 children were assessed at four months and then followed up at 29, 40 and 52 months after the disaster. The ages of the children ranged from 9.6–14.6 years old, and the sample included 157 males and 144 females. The children were assessed by using the University of California at Los Angeles PTSD reaction index for DSM-IV for PTSD symptoms and the Children’s Depression Inventory for depressive symptoms.Results: Comorbid PTSD and depressive symptoms were prevalent in 4.0, 3.3, 3.7 and 5.1% of the participants at times 1, 2, 3 and 4, respectively. The cross-lagged analysis indicated that PTSD symptoms at time 1 predicted depressive symptoms at time 2; depressive symptoms at time 1 predicted PTSD symptoms at time 2; depressive symptoms at time 2 predicted PTSD symptoms at time 3; and depressive symptoms at time 3 predicted PTSD symptoms at time 4. The findings also showed that being female, poor parental relationships and trauma exposure were risk factors for PTSD or depressive symptoms.Conclusions: The results suggest that the causal relationship between PTSD and depressive symptoms changes over time; the effects of PTSD symptoms tend to decrease, while those of depressive symptoms tend to increase. Two stages of the relationship between PTSD and depressive symptoms were observed, namely, that PTSD and depressive symptoms first influenced each other and then that depressive symptoms predicted PTSD. The results of our study also suggest that females with poor parental relationships and a high degree of trauma exposure are more likely to require intervention.

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“…Indeed, given that PTSD is characterized by high rates of comorbidity (Brady, Killeen, Brewerton, & Lucerini, 2000), some have suggested that the disorder may be better conceptualized within a dimensional rather than categorical framework (Krueger & Markon, 2006a). Previous efforts to apply an internalizing/externalizing model of psychopathology to the presentation of patients with PTSD have most commonly utilized a categorical approach based on cluster analytic methods to identify subgroups of patients who are higher or lower Van Voorhees et al Page 3 Aggress Behav.…”

Section: Introductionmentioning

confidence: 99%

Personality Assessment Inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: Associations with aggression

Voorhees

Dennis

Elbogen

et al. 2014

Aggressive Behavior

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Posttraumatic stress disorder (PTSD) is associated with aggressive behavior in veterans, and difficulty controlling aggressive urges has been identified as a primary postdeployment readjustment concern. Yet only a fraction of veterans with PTSD commit violent acts. The goals of this study were to (1) examine the higher-order factor structure of Personality Assessment Inventory (PAI) scales in a sample of U.S. military veterans seeking treatment for PTSD; and (2) to evaluate the incremental validity of higher-order latent factors of the PAI over PTSD symptom severity in modeling aggression. The study sample included male U.S. Vietnam (n = 433) and Iraq/Afghanistan (n = 165) veterans who were seeking treatment for PTSD at an outpatient Veterans Affairs (VA) clinic. Measures included the Clinician Administered PTSD Scale, the PAI, and the Conflict Tactics Scale. The sample was randomly split into two equal subsamples (n's = 299) to allow for cross-validation of statistically derived factors. Parallel analysis, variable clustering analysis, and confirmatory factor analyses were used to evaluate the factor structure, and regression was used to examine the association of factor scores with self-reports of aggression over the past year. Three factors were identified: internalizing, externalizing, and substance abuse. Externalizing explained unique variance in aggression beyond PTSD symptom severity and demographic factors, while internalizing and substance abuse did not. Service era was unrelated to reports of aggression. The constructs of internalizing versus externalizing dimensions of PTSD may have utility in identifying characteristics of combat veterans in the greatest need of treatment to help manage aggressive urges.

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Reinterpreting Comorbidity: A Model-Based Approach to Understanding and Classifying Psychopathology

Cited by 1,013 publications

References 64 publications

A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality, Internalizing, and Externalizing Disorders

A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality, Internalizing, and Externalizing Disorders

Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake

Personality Assessment Inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: Associations with aggression

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