A Hierarchical Integration of Person-Centered Comorbidity Models: Structure, Stability, and Transition Over Time

Abstract

Person-centered analyses of mental disorder comorbidity typically identify a single optimal latent group structure. We took an alternate approach, modeling every estimable comorbidity class model in a nationally representative sample ( N = 34,653) and integrating them into a single overarching hierarchy, providing a full multilevel accounting of various person-centered comorbidity structures. We then investigated the structural stability of this hierarchy across two waves of data collection, and the stability of, and transition between, comorbidity classes over time using latent transition analysis. Findings suggested that comorbidity classes were structured into an interpretable hierarchy. Evidence for robust structural stability of the hierarchy over time was found, regardless of assessment time points and diagnostic time frames used. Latent transition analysis provided evidence for both continuity and change of comorbidity group membership. We discuss how person- and variable-centered models provide complementary perspectives toward empirically supported classification.

Developmental stability of general and specific factors of psychopathology from early childhood to adolescence: dynamic mutualism or p‐differentiation?

“…For example, person-centered studies have identified unique classes that describe patterns of co-occurring symptomatology both cross-sectionally (Vaidyanathan, Patrick, & Iacono, 2011) and longitudinally through childhood (Patalay, Moulton, Goodman, & Ploubidis, 2017). Recent research investigating transitions between these cross-sectional classes over time indicate that transitions between 'pure' psychopathological classes (e.g., predominantly internalizing or externalizing) and comorbid classes are relatively common, with transitions more often observed to and from comorbid and predominantly externalizing classes (Basten et al, 2016;Kim & Eaton, 2017;McElroy, Shevlin, & Murphy, 2017;Willner, Gatzke-Kopp, & Bray, 2016). The findings of the present variable-centered study mirror these results; externalizing and p demonstrated stronger reciprocal relationships over time than internalizing and p. Indeed, it appears that those who score high on p initially could potentially develop more specific psychopathology in any of the three specific domains.…”

Changes in General and Specific Psychopathology Factors Over a Psychosocial Intervention

“…A strength of our multi-level modeling approach is that changes in general and specific psychopathology factors were analyzed at the within-person level. Most, but not all, 54 bifactor studies have modeled these factors at the between-person level. Therefore, while there is growing evidence that the average levels of symptoms co-occur between individuals [8][9][10][11][12][13][14][15] , it was unknown whether symptoms positively co-occur within a given individual.…”

A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research

“…For example, deviation on multiple dimensions may yield discontinuous cutpoints (cf. Kim & Eaton, 2017). In short, the HiTOP framework is a work in progress and researchers are encouraged to consult the consortium website for updates or to apply for membership in the consortium and contribute to improving the model.…”