A Conceptual Framework of Comorbidity for Investigation in the Context of Psychiatric Disturbance

Comorbidity among people with psychiatric conditions is common and is associated with complicated course, poorer treatment outcomes, higher rates of treatment utilization, and higher risk of mortality. However, research on comorbidity continues to be under-represented in the field. This paper presents the Integrated Framework of Comorbidity to promote and improve research and clinical development in the treatment of comorbidity. The Framework has five domains: I) comorbidity influences, II) comorbid disorders or conditions, III) health care interactions of those with comorbidity, IV) comorbidity outcomes, and V) comorbidity associations. Using the Framework should lead investigators to do the following: 1) examine additional outcomes relevant to their area, 2) consider real-world barriers to the implementation of effective treatments of comorbid conditions, and 3) consider etiological mechanisms carefully when testing the effectiveness of treatments of comorbid conditions. The Framework is meant as a general research and clinical heuristic. Implications of the Framework for research and the development of clinical approaches are also discussed.