Abstract
IMPORTANCE: Mental disorders predict future occurrences of both the same disorder (homotypic continuity) and other disorders (heterotypic continuity). Heterotypic continuity is inconsistent with a view of mental disorders as fixed entities. In contrast, hierarchical-dimensional conceptualizations of psychopathology, in which each form of psychopathology is hypothesized to have both unique and broadly shared etiologies and mechanisms, predict both homotypic and heterotypic continuity. OBJECTIVE: To test predictions derived from a hierarchical-dimensional model of psychopathology that (1) heterotypic continuity is widespread, even controlling for homotypic continuity, and that (2) the relative magnitudes of heterotypic continuities recapitulate the relative magnitudes of cross-sectional correlations among diagnoses at baseline. DESIGN, SETTING, AND PARTICIPANTS: Ten prevalent diagnoses were assessed in the same person twice (ie, in 2 waves separated by 3 years). We used a representative sample of adults in the United States (i.e., 28,958 participants 18-64 years of age in the National Epidemiologic Study of Alcohol and Related Conditions who were assessed in both waves). MAIN OUTCOMES AND MEASURES: Diagnoses from reliable and valid structured interviews. RESULTS: Adjusting for sex and age, we found that bivariate associations of all pairs of diagnoses from wave 1 to wave 2 exceeded chance levels (P < .05) for all homotypic (median tetrachoric correlation of ρ = 0.54 [range, 0.41-0.79]) and for nearly all heterotypic continuities (median tetrachoric correlation of ρ = 0.28 [range, 0.07-0.50]). Significant heterotypic continuity was widespread even when all wave 1 diagnoses (including the same diagnosis) were simultaneous predictors of each wave 2 diagnosis. The rank correlation between age- and sex-adjusted tetrachoric correlation for cross-sectional associations among wave 1 diagnoses and for heterotypic associations from wave 1 to wave 2 diagnoses was ρ = 0.86 (P < .001). CONCLUSIONS AND RELEVANCE: For these prevalent mental disorders, heterotypic continuity was nearly universal and not an artifact of failure to control for homotypic continuity. Furthermore, the relative magnitudes of heterotypic continuity closely mirrored the relative magnitudes of cross-sectional associations among these disorders, consistent with the hypothesis that both sets of associations reflect the same factors. Mental disorders are not fixed and independent entities. Rather, each diagnosis is robustly related to other diagnoses in a correlational structure that is manifested both concurrently and in patterns of heterotypic continuity across time.