Transdiagnostic development of internalizing psychopathology throughout the life course up to age 45: A World Mental Health Surveys report

Ymkje Anna De Vries, Ali Al-Hamzawi, Jordi Alonso, Laura Helena Andrade, Corina Benjet, Ronny Bruffaerts, Brendan Bunting, Giovanni De Girolamo, Silvia Florescu, Oye Gureje, Josep Maria Haro, Aimee Karam, Elie G. Karam, Norito Kawakami, Viviane Kovess-Masfety, Sing Lee, Zeina Mneimneh, Fernando Navarro-Mateu, Akin Ojagbemi, José Posada-VillaKate Scott, Juan Carlos Stagnaro, Yolanda Torres, Miguel Xavier, Zahari N. Zarkov, Ronald C. Kessler, Peter De Jonge

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Background Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45. Methods We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression. Results The best-fitting LCGA solution identified eight classes: A healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-Average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1-2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001). Conclusions We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.

Original languageEnglish
Pages (from-to)2134 - 2143
JournalPsychological Medicine
Issue number11
Early online date10 Nov 2020
Publication statusPublished - 10 Aug 2022


  • Anxiety disorders
  • depression
  • internalizing disorders
  • latent class growth analysis


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