Adolescent depression and externalizing problems: testing two models of comorbidity in an inpatient sample

Differentiating between additive (quantitative) and interactive (qualitative) effects of comorbidity has important treatment implications. This study illustrates the heuristic superiority of a multifactorial approach over simple group comparisons in testing quantitative versus qualitative models of comorbidity. Analysis of variance was used to compare 266 adolescent inpatients identified as depressed, externalizing, both, or neither on self-report measures of personality, school problems, and substance abuse. The results support quantitative rather than qualitative models of comorbidity. Depressed status related most strongly to group differences in interpersonal and self-critical concerns. Externalizing status related most strongly to group differences in school problems and drug use. Main effects for the two statuses together explained especially elevated levels of reactance and alcohol abuse among the comorbid adolescents.