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, 64, 107-13

A Dimensional Liability Model of Age Differences in Mental Disorder Prevalence: Evidence From a National Sample


A Dimensional Liability Model of Age Differences in Mental Disorder Prevalence: Evidence From a National Sample

Nicolas Hoertel et al. J Psychiatr Res.


Recent theories have proposed a metastructure that organizes related mental disorders into broad dimensions of psychopathology (i.e., internalizing and externalizing dimensions). Prevalence rates of most mental disorders, when examined independently, are substantially lower in older than in younger adults, which may affect this metastructure. Within a nationally representative sample, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093), we developed a dimensional liability model of common psychiatric disorders to clarify whether aging affects specific disorders or general dimensions of psychopathology. Significant age differences existed across age groups (18-24, 25-34, 35-44, 45-54, 55-64, 65-75 and 75+), such that older adults showed lower prevalence rates of most disorders compared to younger adults. We next investigated patterns of disorder comorbidity for past-year psychiatric disorders and found that a distress-fear-externalizing liability model fit the data well. This model was age-group invariant and indicated that the observed lower prevalence of mental disorders with advancing age originates from lower average means on externalizing and internalizing liability dimensions. This unifying dimensional liability model of age and mental disorder comorbidity can help inform the role of aging on mental disorder prevalence for research and intervention efforts, and service planning for the impending crisis in geriatric mental health.

Keywords: Age differences; Age invariance; Comorbidity; Elderly; Internalizing-externalizing; Mental disorders; Older adults; Psychiatric disorders.

Conflict of interest statement

Conflicts of interest: none


Figure 1
Figure 1. Age groups invariant (constrained) model of the latent structure of psychiatric disorders
Ellipses are used to denote latent constructs; rectangles are used to denote the observed variables measuring these constructs. All factor loadings and covariance measures are standardized and significant (two-sided p < .005). Values separated by slashes are respectively for participants 18-24, 25-34, 35-44, 45-54, 55-64, 65-75 and >75 years of age. Values differ slightly across age groups due to standardization. All disorders were assessed on a 12-month basis except for antisocial personality disorder which was assessed on a lifetime basis. MDE: major depressive episode, GAD: generalized anxiety disorder, SAD: social anxiety disorder, ASPD: antisocial personality disorder.

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