| | Domain | Directions |
| | Conceptual | (i) Carve valid next steps with integrated input from clinicians, researchers, taxometricians, psychometricians, and patients.
(ii) Develop complex conceptual models that capture the complexity of comorbidities while moving away from mind-body, organ system dichotomies.
(iii) Conceptualize comorbidities in a manner that encourages investigation of both biological and social etiologies of comorbidities and outcomes.
(iv) Keep the patient at the center of all conceptualization endeavors.
(v) Build the science from both epidemiological and etiological perspectives in tandem. |
| | Research | (i) Design rigorous longitudinal comorbidity mapping projects that also collect comprehensive data on sociodemographics, lifestyle factors, environmental factors, biomarkers, and outcomes.
(ii) Commit resources and funding (directed RFAs and supplements from major research agencies and across institutes).
(iii) Bridge gaps in understanding of physical and psychiatric morbidities.
(iv) Leverage epidemiological and statistical approaches to move comorbidity science from atheoretical to theoretical; that is, model various sources of uncertainty (e.g., multiple bias modeling), amplify data through simulation (Monte Carlo techniques), and improve understanding of relationships among variables (e.g., using Hybrid Structural Equation modeling techniques combining observed and latent variable analysis).
(v) Interpret carefully findings within the limitations of an emerging science rather than as biological realities or “scientific givens”.
(vi) Educate clinicians, researchers, and policymakers about the risks of atheoretical approaches to understanding comorbidities including diagnostic proliferation, polypharmacy, and cost.
(vii) Include populations such as minorities, poor, uninsured/underinsured, elderly, cognitively impaired, and those with complex morbidities who are disproportionately excluded from comorbidity research. |
| | Measurement | (i) Characterize and minimize potential sources of erroneous inference.
(ii) Develop measures that capture complex and dynamic nature of comorbidities beyond numbers and severity of diseases.
(iii) Incorporate a discussion on nontraditional measurement approaches such as clinimetrics in conceptualizing measurement (e.g., approaching comorbidities using a battery of psychometric and clinimetric instruments that address different dimensions of the phenomenon such as types, severity, trajectory of diseases or symptoms, and rates of progression, clinical states such as functional capacity, and other aspects of health such as well-being and distress).
(iv) Develop measures that combine physical and psychological morbidities. |
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