Department of Healthcare Policy, Harvard Medical School, Boston, MA 02115, USA.
Curr Opin Psychiatry. 2011 Jul;24(4):307-12. doi: 10.1097/YCO.0b013e3283477b22.
Although numerous studies have examined the latent structure of internalizing and externalizing mental disorders, the effects of this structure in predicting the development of comorbidity have remained unexamined until recently.
A novel approach to study the effects of latent internalizing and externalizing predispositions to the development of comorbidity was used to analyze data from 14 countries in the WHO World Mental Health Survey Initiative. Pervasive significant positive associations were found between temporally primary and secondary internalizing and externalizing disorders in survival analyses, with time-lagged associations consistently stronger within domains than between domains. The vast majority of these associations were explained by latent internalizing and externalizing variables. Specific phobia and obsessive compulsive disorder were the most important internalizing components and hyperactivity disorder and oppositional-defiant disorder the most important externalizing components. Several intriguing residual time-lagged associations remained significant, though, even after controlling latent predispositions.
The latent variable model suggests that common causal pathways account for most comorbidity among internalizing-externalizing disorders. These pathways should be the focus of future research on the development of comorbidity, although isolation of consistent residual time-lagged associations between certain pairs of primary-secondary disorders is also important in pointing the way to subsequent focused study.
尽管大量研究已经检验了内化和外化精神障碍的潜在结构，但直到最近，这种结构对共病发展的预测作用仍未得到检验。
采用一种新的方法来研究潜在的内化和外化倾向对共病发展的影响，分析了世界卫生组织世界心理健康调查倡议中 14 个国家的数据。在生存分析中，普遍存在原发性和继发性内化和外化障碍之间显著的正相关，且域内的滞后关联始终强于域间。这些关联绝大多数可以用潜在的内化和外化变量来解释。特定恐惧症和强迫症是最重要的内化因素，多动障碍和对立违抗性障碍是最重要的外化因素。然而，尽管控制了潜在的倾向，一些有趣的残余滞后关联仍然显著。
潜在变量模型表明，共同的因果途径可以解释内化-外化障碍之间的大多数共病。这些途径应该是未来共病发展研究的重点，尽管某些原发性-继发性障碍之间存在一致的残余滞后关联的分离也很重要，可以为随后的重点研究指明方向。
