Question

There were 120 co-morbidities reported out of 1,000 patients. What is the co-morbidity rate?

Answer 1

Ans) Comorbidity: Refers to the presence of two or more illnesses(medical or psychiatric conditions, including alcohol and other drug use disorders-in the same person).

• Comorbidity rates is a problem as-

- Patients with comorbid conditions have significantly different and more negative outcomes than patients with just one diagnosis.

- Comparing demographic, clinical, family history and psychosocial characteristics of three independent groups: MDD without GAD, MDD with GAD, and pure GAD. Found that those with comorbid GAD/MDD had higher suicidal ideation, poorer social functioning, and higher rates of multimorbidity.

- Comorbidity is common among youth and adults and is associated with increased symptom severity, worse impairment, more negative correlates, differential treatment response, and distinct courses.

- Although we know that comorbidity exists, we have little research about it, or about treating it, particularly as most treatment studies exclude individuals with comorbid disorders.

• Comorbidity rates are high because-

>The DSM may be too precise in terms of demarcating boundaries between disorders.

>The DSM may be forcing dimensional disorders into a categorical framework, creating artificial separations of broader symptoms.

>Comorbidity could occur due to chance, particularly as the number of disorders in the DSM increases.
{In order to determine what 'chance' would be for comorbidity of two disorders, multiply the base rates of the disorder (like you would for any probability). This explanation does not cover most comorbidities, which occur at a much greater rate than chance.}

>Symptom co-occurrence: there is an unnecessarily large overlap between symptoms required for diagnosis (consider MDD vs. GAD, ODD vs. ADHD, ADHD vs. Bipolar).

>Diagnostic thresholds may be too low.

>Sampling Bias: cases may be selected from "biased" samples because individuals with more disorders have more opportunities to be selected for various studies

>Population Stratification: we sample from inpatient clinics, low SES groups, etc. and generally get samples with many risk factors (ex. childhood maltreatment, low SES, financial stress, single-parent households) that do not generalize to the greater population - associated liabilities model.