A Novel Diathesis-Stress Model of Comorbid Early Onset Psychiatric Disorders.

Importance: Psychiatric comorbidity is the norm. Identifying transdiagnostic risk factors will inform our understanding of developmental pathways and early intervention targets. Objective: We recently reported that many psychiatric outcomes are predicted by a three-factor model composed of adolescent externalizing (EXT) behaviors, early life adversity, and dopamine autoreceptor availability. Here, we investigated whether this model could be reproduced in a large population-based sample using functional magnetic resonance imaging (fMRI) instead of positron emission tomography. Design: Data were collected by the IMAGEN consortium beginning in 2010 when cohort members were 14 years old, with follow-up testing at ages 16 and 19. These longitudinal data were used to predict psychiatric disorders by 19 years of age. Setting: Participants were recruited from secondary schools across Europe. Participants: Adolescents (n = 1338) with fMRI, behavioural, diagnostic, and early life trauma data. Main Outcomes and Measures: Binary regression models tested whether a combination of EXT behaviors, childhood trauma, and mesocorticolimbic reward anticipation responses at age 14 or 19 predicted the presence of a disorder by age 19. Results: A total of 1338 participants had the required data (52.4% female). In all models, EXT and adversity scores were significant predictors ( Conclusions and Relevance: The results extend our previous findings, increasing confidence in a novel diathesis-stress model of commonly comorbid early onset psychiatric disorders. The results have implications for diagnostic classification schemes and pleiotropic views of psychiatric disorder etiology.