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The Structure and Stability of Common Mental Disorders
The NEMESIS Study
Wilma A. M. Vollebergh, PhD;
Jurjen Iedema, PhD;
Rob V. Bijl, PhD;
Ron de Graaf, PhD;
Filip Smit, MSc;
Johan Ormel, PhD
Arch Gen Psychiatry. 2001;58:597-603.
Background We analyzed the underlying latent structure of 12-month DSM-III-R diagnoses of 9 common disorders for the general population
in the Netherlands. In addition, we sought to establish (1) the stability
of the latent structure underlying mental disorders across a 1-year period
(structural stability) and (2) the stability of individual differences in
mental disorders at the level of the latent dimensions (differential stability).
Methods Data were obtained from the first and second measurement of the Netherlands
Mental Health Survey and Incidence Study (NEMESIS) (response rate at baseline:
69.7%, n = 7076; 1 year later, 79.4%, n = 5618). Nine common DSM-III-R diagnoses were assessed twice with the Composite International
Diagnostic Interview with a time lapse of 1 year. Using structural equation
modeling, the number of latent dimensions underlying these diagnoses was determined,
and the structural and differential stability were assessed.
Results A 3-dimensional model was established as having the best fit: a first
dimension underlying substance use disorders (alcohol dependence, drug dependence);
a second dimension for mood disorders (major depression, dysthymia), including
generalized anxiety disorder; and a third dimension underlying anxiety disorders
(simple phobia, social phobia, agoraphobia, and panic disorder). The structural
stability of this model during a 1-year period was substantial, and the differential
stability of the 3 latent dimensions was considerable.
Conclusions Our results confirm the 3-dimensional model for 12-month prevalence
of mental disorders. Results underline the argument for focusing on core psychopathological
processes rather than on their manifestation as distinguished disorders in
future population studies on common mental disorders.
From the Trimbos-Institute, Netherlands Institute of Mental Health
and Addiction, Utrecht (Drs Vollebergh, Bijl, and de Graaf and Mr Smit); the
Social and Cultural Planning Office, The Hague (Dr Iedema); and the Department
of Social Psychiatry, University of Groningen, Groningen (Dr Ormal), the Netherlands.
Corresponding author and reprints: Wilma A. M. Vollebergh, PhD, Trimbos-Institute,
PO Box 725, 3500 AS Utrecht, The Netherlands.
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