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Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview

Published online by Cambridge University Press:  22 October 2007

M. Zimmerman ,
J. B. McGlinchey ,
I. Chelminski  and
D. Young
M. Zimmerman*
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
J. B. McGlinchey
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
I. Chelminski
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
D. Young
Affiliation:
Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
*
*Address for correspondence: M. Zimmerman, M.D., Bayside Medical Center, 235 Plain Street, Providence, RI 02905, USA. (Email: [email protected])
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Abstract

Background

The largest clinical epidemiological surveys of psychiatric disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is the largest clinical epidemiological study using semi-structured interviews assessing a wide range of psychiatric disorders conducted in a general clinical out-patient practice. In the present report we examined the frequency of DSM-IV Axis I diagnostic co-morbidity in psychiatric out-patients.

Method

A total of 2300 out-patients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) upon presentation for treatment.

Results

The mean number of current and lifetime DSM-IV Axis I disorders in the 2300 patients was 1.9 (s.d.=1.5) and 3.0 (s.d.=1.8) respectively. The majority of patients were diagnosed with two or more current disorders, and more than one-third were diagnosed with three or more current disorders. Examination of the most frequent current disorders in the patients with the 12 most common principal diagnoses indicated that the pattern of co-morbidity differed among the disorders. The highest mean number of current co-morbid disorders was found for patients with a principal diagnosis of post-traumatic stress disorder and bipolar disorder.

Conclusions

Clinicians should assume that psychiatric patients presenting for treatment have more than one current diagnosis. The pattern of co-morbidity varies according to the principal diagnosis.

Keywords

Clinical epidemiologyco-morbiditydiagnosis
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 2 , February 2008 , pp. 199 - 210
Copyright
Copyright © Cambridge University Press 2007

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References

Alegria, M, Bijl, R, Lin, E, Walters, E, Kessler, R (2000). Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and the Netherlands. Archives of General Psychiatry 57, 383–391.CrossRefGoogle ScholarPubMed
Alonso, J, Lepine, JP (2007). Overview of key data from the European Study of the Epidemiology of Mental Disorders (ESEMeD). Journal of Clinical Psychiatry 68 (Suppl. 2), 3–9.Google ScholarPubMed
Andrews, G, Henderson, S, Hall, W (2001). Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. British Journal of Psychiatry 178, 145–153.CrossRefGoogle ScholarPubMed
Andrews, G, Slade, T, Issakidis, C (2002). Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being. British. Journal of Psychiatry 181, 306–314.CrossRefGoogle Scholar
Barlow, DH, DiNardo, PA, Vermilyea, BB, Vermilyea, J, Blanchard, EB (1986). Co-morbidity and depression among the anxiety disorders: issues in diagnosis and classification. Journal of Nervous and Mental Disease 174, 63–72.CrossRefGoogle ScholarPubMed
Basco, MR, Bostic, JQ, Davies, D, Rush, AJ, Witte, B, Hendrickse, W, Barnett, V (2000). Methods to improve diagnostic accuracy in a community mental health setting. American Journal of Psychiatry 157, 1599–1605.CrossRefGoogle Scholar
Berkson, J (1946). Limitations of the application of fourfold table analysis to hospital data. Biometric Bulletin 2, 47–53.CrossRefGoogle ScholarPubMed
Brown, C, Schulberg, HC, Madonia, MJ, Shear, MK, Houck, PR (1996). Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. American Journal of Psychiatry 153, 1293–1300.Google ScholarPubMed
Brown, TA, Barlow, DH (1992). Comorbidity among anxiety disorders: implications for treatment and DSM-IV. Journal of Consulting and Clinical Psychology 6, 835–844.CrossRefGoogle Scholar
Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585–599.CrossRefGoogle Scholar
Cassano, GB, Perugi, G, Musetti, L (1990). Comorbidity in panic disorder. Psychiatric Annals 20, 517–521.CrossRefGoogle Scholar
Coryell, W, Endicott, J, Andreasen, NC, Keller, MB, Clayton, PJ, Hirschfield, RMA, Scheftner, WA, Winokur, G (1988). Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. American Journal of Psychiatry 145, 293–300.Google ScholarPubMed
Coryell, W, Noyes, R (1988). Placebo response in panic disorder. American Journal of Psychiatry 145, 1138–1140.Google ScholarPubMed
Davidson, J, Smith, R (1993). Traumatic experiences in psychiatric outpatients. Journal of Traumatic Stress 3, 459–475.CrossRefGoogle Scholar
DeRuiter, C, Rijken, H, Garssen, B, VanSchaik, A, Kraaimaat, F (1989). Comorbidity among the anxiety disorders. Journal of Anxiety Disorders 3, 57–68.CrossRefGoogle Scholar
Diniz, J, Rosario-Campos, M, Shavitt, R, Curi, M, Hounie, A, Brotto, S, Miguel, E (2004). Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder. Journal of Clinical Psychiatry 65, 22–27.CrossRefGoogle ScholarPubMed
Fava, M, Rankin, MA, Wright, E, Alpert, JE, Nierenberg, AA, Pava, J, Rosenbaum, JF (2000). Anxiety disorders in major depression. Comprehensive Psychiatry 41, 97–102.CrossRefGoogle ScholarPubMed
Fava, M, Uebelacker, LA, Alpert, JE, Nierenberg, AA, Pava, JA, Rosenbaum, JF (1997). Major depressive subtypes and treatment response. Biological Psychiatry 42, 568–576.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1995). Structured Clinical Interview for DSM-IV Axis I Disorders – Patient Edition (SCID-I/P, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute: New York.Google Scholar
Franklin, C, Sheeran, T, Zimmerman, M (2002). Screening for trauma history, posttraumatic stress disorder, and subthreshold PTSD in psychiatric outpatients. Psychological Assessment 14, 467–471.CrossRefGoogle ScholarPubMed
Gaynes, BN, Magruder, KM, Burns, BJ, Wagner, HR, Yarnall, KSH, Broadhead, WE (1999). Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression? General Hospital Psychiatry 21, 158–167.CrossRefGoogle ScholarPubMed
Goisman, RM, Goldenberg, I, Vasile, RG, Keller, MB (1995). Comorbidity of anxiety disorders in a multicenter anxiety study. Comprehensive Psychiatry 36, 303–311.CrossRefGoogle Scholar
Goodwin, R, Hoven, C, Lyons, J, Stein, M (2002). Mental health service utilization in the United States. The role of personality factors. Social Psychiatry and Psychiatric Epidemiology 37, 561–566.CrossRefGoogle ScholarPubMed
Grant, B, Stinson, F, Dawson, D, Chou, P, Dufour, M, Compton, W, Pickering, R, Kaplan, K (2004). Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders. Archives of General Psychiatry 61, 807–816.CrossRefGoogle ScholarPubMed
Green, BL, Lindy, JD, Grace, MC, Gleser, GD (1989). Multiple diagnoses in posttraumatic stress disorder: the role of war stressors. Journal of Nervous and Mental Disease 177, 329–335.CrossRefGoogle ScholarPubMed
Grunhaus, L (1988). Clinical and psychobiological characteristics of simultaneous panic disorder and major depression. American Journal of Psychiatry 145, 1214–1221.Google ScholarPubMed
Keller, MB, Klerman, GL, Lavori, PW, Coryell, W, Endicott, J, Taylor, J (1984). Long-term outcomes of episodes of major depression. Journal of the American Medical Association 252, 788–792.CrossRefGoogle ScholarPubMed
Kessler, R, Chiu, W, Demler, O, Walters, E (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshelman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Kessler, RC, Zhao, S, Katz, SJ, Kouzis, AC, Frank, RG, Edlund, M, Leaf, P (1999). Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. American Journal of Psychiatry 156, 115–123.CrossRefGoogle ScholarPubMed
Koenigsberg, HW, Kaplan, RD, Gilmore, MM, Cooper, AM (1985). The relationship between syndrome and personality disorder in DSM-III: experience with 2,462 patients. American Journal of Psychiatry 142, 207–212.Google Scholar
Loranger, AW (1990). The impact of DSM-III on diagnostic practice in a university hospital. Archives of General Psychiatry 47, 672–675.CrossRefGoogle ScholarPubMed
Markowitz, JC, Moran, ME, Kocsis, JH, Frances, AJ (1991). Prevalence and comordibity of dysthymic disorder among psychiatric outpatients. Journal of Affective Disorders 24, 63–71.CrossRefGoogle Scholar
McElroy, S, Altshuler, L, Suppes, T, Keck, P, Frye, M, Denicoff, K, Nolen, W, Kupka, R, Leverich, G, Rochussen, J, Rush, A, Post, R (2001). Axis I psychiatric comorbodity and its relationship to historical illness variables in 288 patients with bipolar disorder. American Journal of Psychiatry 158, 420–426.CrossRefGoogle Scholar
Melartin, TK, Rytsala, HJ, Leskela, US, Lestela-Mielonen, PS, Sokero, TP, Isometsa, ET (2002). Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study. Journal of Clinical Psychiatry 63, 126–134.CrossRefGoogle ScholarPubMed
Mezzich, J, Fabrega, H, Coffman, G, Haley, R (1989). DSM-III disorders in a large sample of psychiatric patients: frequency and specificity of diagnoses. American Journal of Psychiatry 146, 212–219.Google Scholar
Mezzich, JE, Fabrega, H, Coffman, GA (1987). Multiaxial characterization of depressive patients. Journal of Nervous and Mental Disease 175, 339–346.CrossRefGoogle ScholarPubMed
Miller, PR, Dasher, R, Collins, R, Griffiths, P, Brown, F (2001). Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews. Psychiatry Research 105, 255–264.CrossRefGoogle ScholarPubMed
Narrow, WE, Regier, DA, Rae, DS, Manderscheid, RW, Locke, BZ (1993). Use of services by persons with mental and addictive disorders: findings from the National Institute of Mental Health Epidemiologic Catchment Area Program. Archives of General Psychiatry 50, 95–107.CrossRefGoogle ScholarPubMed
Noyes, R, Reich, J, Christiansen, J, Suelzer, M, Pfohl, B, Coryell, WA (1990). Outcome of panic disorder. Archives of General Psychiatry 47, 809–818.CrossRefGoogle ScholarPubMed
Oldham, JM, Skodol, AE (1991). Personality disorders in the public sector. Hospital and Community Psychiatry 42, 481–487.Google ScholarPubMed
Olfson, M, Marcus, SC, Druss, B, Elinson, L, Tanielian, T, Pincus, HA (2002). National trends in the outpatient treatment of depression. Journal of the American Medical Association 287, 203–209.CrossRefGoogle ScholarPubMed
Perugi, G, Toni, C, Frare, F, Travierso, M, Hantouche, E, Akiskal, H (2002). Obsessive-compulsive-bipolar comorbidity: a systematic exploration of clinical features and treatment outcome. Journal of Clinical Psychiatry 63, 1129–1134.CrossRefGoogle ScholarPubMed
Pfohl, B, Blum, N, Zimmerman, M (1997). Structured Interview for DSM-IV Personality. American Psychiatric Press, Inc.: Washington, DC.Google Scholar
Robins, LN, Locke, BZ, Regier, DA (1991). An overview of psychiatric disorders in America. In Psychiatric Disorders in America: The Epidemiologic Catchment Study (ed. Robins, L. N. and Regier, D. A.), pp. 328–386. The Free Press: New York.Google Scholar
Rush, A, Zimmerman, M, Wisniewski, S, Fava, M, Hollon, S, Warden, D, Biggs, M, Shores-Wilson, K, Shelton, R, Luther, J, Thomas, B, Trivedi, M (2005). Comorbid psychiatric disorders in depressed outpatients: demographics and clinical features. Journal of Affective Disorders 87, 43–45.CrossRefGoogle ScholarPubMed
Sanderson, WC, Beck, AT, Beck, J (1990 a). Syndrome comorbidity in patients with major depression or dysthymia: prevalence and temporal relationships. American Journal of Psychiatry 147, 1025–1028.Google ScholarPubMed
Sanderson, WC, DiNardo, PA, Rapee, RM, Barlow, DH (1990 b). Syndrome comorbidity in patients diagnosed with a DSM-III-R anxiety disorder. Journal of Abnormal Psychology 3, 308–312.CrossRefGoogle Scholar
Schwalberg, MD, Barlow, DH, Alger, SA, Howard, LJ (1992). Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders. Journal of Abnormal Psychology 101, 675–681.CrossRefGoogle ScholarPubMed
Shear, MK, Greeno, C, Kang, J, Ludewig, D, Frank, E, Swartz, HA, Hanekamp, M (2000). Diagnosis of nonpsychotic patients in community clinics. American Journal of Psychiatry 157, 581–587.CrossRefGoogle ScholarPubMed
Sherbourne, CD, Wells, KB (1997). Course of depression in patients with comorbid anxiety disorders. Journal of Affective Disorders 43, 245–250.CrossRefGoogle ScholarPubMed
Sierles, FS, Chen, JJ, McFarland, RE, Taylor, MA (1983). Posttraumatic stress disorder and concurrent psychiatric illness: a preliminary report. American Journal of Psychiatry 140, 1177–1179.Google ScholarPubMed
Stangler, RS, Printz, AM (1979). DSM-III: psychiatric diagnosis in a university population. American Journal of Psychiatry 137, 937–940.Google Scholar
The ESEMeD/MHEDEA 2000 investigators (2004). 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica 109 (Suppl. 420), 28–37.CrossRefGoogle Scholar
Trivedi, M, Rush, A, Wisniewski, S, Nierenberg, A, Warden, D, Ritz, L, Norquist, G, Howland, R, Lebowitz, B, McGrath, P, Shores-Wilson, K, Biggs, M, Balasubramani, G, Fava, M, STAR*D Study, Team (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D implications for clinical practice. American Journal of Psychiatry 163, 28–40.CrossRefGoogle ScholarPubMed
Turner, SM, Beidel, DC, Borden, JW, Stanley, MA, Jacob, RG (1991). Social phobia: Axis I and II correlates. Journal of Abnormal Psychology 100, 102–106.CrossRefGoogle ScholarPubMed
Van Valkenburg, C, Winokur, G, Behar, D, Lowry, M (1984). Depressed women with panic attacks. Journal of Clinical Psychiatry 45, 367–369.Google ScholarPubMed
Wilfley, D, Friedman, M, Dounchis, J, Stein, R, Welch, R, Ball, S (2000). Comorbid psychopathology in binge eating disorder: relation to eating disorder severity at baseline and following treatment. Journal of Consultng and Clinical Psychology 68, 641–649.CrossRefGoogle ScholarPubMed
Zimmerman, M (2003). Integrating the assessment methods of researchers in routine clinical practice: the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. In Standardized Evaluation in Clinical Practice (ed. First, M.), pp. 29–74. American Psychiatric Publishing, Inc: Washington, DC.Google Scholar
Zimmerman, M, Chelminski, I (2006). A scale to screen for Axis I disorders in psychiatric outpatients: performance of the Psychiatric Diagnostic Screening Questionnaire. Psychological Medicine 36, 1601–1611.CrossRefGoogle ScholarPubMed
Zimmerman, M, Chelminski, I, McDermut, W (2002). Major depressive disorder and Axis I diagnostic comorbidity. Journal of Clinical Psychiatry 63, 187–193.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (1999 a). Psychiatric diagnosis in clinical practice: is comorbidity being missed? Comprehensive Psychiatry 40, 182–191.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (1999 b). Differences between clinical and research practice in diagnosing borderline personality disorder. American Journal of Psychiatry 156, 1570–1574.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (1999 c). Is posttraumatic stress disorder underdiagnosed in routine clinical settings? Journal of Nervous and Mental Disease 187, 420–428.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (1999 d). The reliability and validity of a screening questionnaire for 14 DSM-IV Axis I disorder (The Psychiatric Diagnostic Screening Questionnaire). Journal of Clinical Psychiatry 60, 677–683.CrossRefGoogle Scholar
Zimmerman, M, Mattia, JI (2000). Principal and additional DSM-IV disorders for which outpatients seek treatment. Psychiatric Services 51, 1299–1304.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (2001 a). The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity. Comprehensive Psychiatry 42, 175–189.CrossRefGoogle ScholarPubMed
Zimmerman, M, Mattia, JI (2001 b). A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Archives of General Psychiatry 58, 787–794.CrossRefGoogle Scholar
Zimmerman, M, Posternak, M, Attiullah, N, Friedman, M, Boland, R, Baymiller, S, Berlowitz, S, Uy, K, Singer, S, Chelminski, I (2005). Why isn't Bupropion the most frequently prescribed antidepressant? Journal of Clinical Psychiatry 66, 603–610.CrossRefGoogle ScholarPubMed
Zimmerman, M, Posternak, M, Friedman, M, Attiullah, N, Baymiller, S, Boland, R, Berlowitz, S, Rahman, S, Uy, K, Singer, S (2004). Which factors influence psychiatrists' selection of an antidepressant? American Journal of Psychiatry 161, 1285–1289.CrossRefGoogle Scholar
Zimmerman, M, Sheeran, T (2003). Screening for principal versus comorbid conditions in psychiatric outpatients with the Psychiatric Screening Questionnaire. Psychological Assessment 15, 110–114.CrossRefGoogle Scholar