Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T12:06:22.925Z Has data issue: false hasContentIssue false
  • English
  • Français

Implications of comorbidity: lessons from epidemiological studies1

Published online by Cambridge University Press:  11 October 2011

Hans-Ulrich Wittchen
Hans-Ulrich Wittchen*
Affiliation:
Max Planck Institute of Psychiatry (Clinical Institute), Clinical Psychology, Munich, Germany
*
Indirizzo per la corrispondenza: Professor H.U. Wittchen, Max Planck Institute für Psychiatrie, Klinisches Institut, Kraepelinstrasse 10, 80804 München (Germany). Fax +49 - 89-3062.2544
Get access Rights & Permissions [Opens in a new window]

Summary

Objective – The paper discusses conceptual, methodological and clinical issues of comorbidity from the perspective of more recent epidemiological studies. Further the potential causal and pathogenic role of temporally primary disorders for the onset of secondary disorders is evaluated. Results – The available data suggest so far that comorbidity (a) is not an artefact of assessment strategies, sampling or design features, (b) is specific in different disorders, (c) is particularly frequent in anxiety and affective disorders, (d) affects systematically the course of the comorbid conditions and (0 might be related to symptom progression models. Conclusions – Furthermore, evidence is presented that specific forms of primary anxiety disorders affect the risk for secondary depressive disorders, increase the likelihood of non-remission as well as the number of subsequent depressive episodes.

Riassunto

Scopo - Lo studio affronta problemi concettuali, metodologici e clinici della comorbidità, alia luce dei piu recenti studi epidemiologici. Inoltre viene valutata la causa potenziale e il ruolo patogenetico dei disturbi temporaneamente primari per la comparsa dei disturbi secondari. Risultati - I risultati disponibili fino ad oggi suggeriscono che la comorbidità (a) non è un artefatto delle strategic di valutazione, del campionamento o del disegno, (b) è specifica nei differenti disturbi, (c) e particolarmente frequente nei disturbi affettivi e d'ansia, (d) influisce sistematicamente sull'andamento delle condizioni di comorbidita è (f) potrebbe essere correlata con modelli di evoluzione dei sintomi. Conclusioni - È inoltre evidente che forme specifiche di disturbi di ansia primaria comportano il rischio di sviluppare disturbi depressivi. secondari, aumentano la probability di non remissione cosi come il numero di successivi episodi depressivi.

Keywords

comorbiditàprogressione dei sintomiansiadisturbi affettividisturbi da abuso di sostanzeepidemiologiacomorbiditysymptom progressionanxietyaffective and substance disordersepidemiology
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 5 , Issue 2 , August 1996 , pp. 114 - 125
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

Based on IRGASD (Italian Research Group for Affective and Schizophrenic Disorders) lecture, organised by the Institute of Psychiatry of the University of Verona, and delivered in Verona on December 4th 1995. IRGASD activities carried out under the auspices of Dr. Paul Janssen Medical Institute, are supported by Janssen-Cilag.

References

Akiskal, H.S. (1990). Toward a clinical understanding of the relationship of anxiety and depressive disorders. In Comorbidity of Mood and Anxiety Disorders (ed. Maser, J.D. and Cloninger, C.R.). American Psychiatric Press: Washington.Google Scholar
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd. ed.). American Psychiatric Association: Washington DC.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd. ed. revised). American Psychiatric Association: Washington DC.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). American Psychiatric Association: Washington DC.Google Scholar
Andrews, G. (1996). Comorbidity and the general neurotic syndrome. British Journal of Psychiatry 168, Suppl. 30, 67–75.CrossRefGoogle Scholar
Angst, J., Vollrath, M., Merikangas, K.R. & Ernst, C. (1990). Comorbidity of anxiety and depression in the Zurich Cohort Study of young adults. In Comorbidity of Mood and Anxiety Disorders (ed. Maser, J.D. and Cloninger, C.R.), pp 123–153. American Psychiatric Press: Washington DC.Google Scholar
Antony, J.C. & Helzer, J.E. (1991). Syndromes of drug abuse and dependence. In Psychiatric Disorders in America: the Epidemiologic Catchment Area Study (ed. Robins, L.N. and Regier, D.A.), pp 116–154. Free Press: New York.Google Scholar
Boyd, J.H., Burke, J.D., Gruenberg, E. et al. (1984). Exclusion criteria of DSM-III: A study of co-occurrence of hierarchy-free syndromes. Archives of General Psychiatry 41, 983–989.CrossRefGoogle ScholarPubMed
Burke, J.D., Wittchen, H.U., Regier, D.A. & Sartorius, N. (1990). Extracting information from diagnostic interviews on co-occurrence of symptoms of anxiety and depression. In Comorbidity of Mood and Anxiety Disorders (ed. Maser, J.D. and Cloninger, C.R.), pp 649–668. American Psychiatric Press: Washington DC.Google Scholar
Caron, C. & Rutter, M. (1991). Comorbidity in child psychopathology: concepts, issues, and research strategies. Journal of Child Psychology and. Psychiatry 32, 1063–1080.CrossRefGoogle ScholarPubMed
Christie, K.A., Burke, J.D., Regier, D.A., Rae, D.S., Boyd, J.H. & Locke, B.Z. (1988). Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. American Journal of Psychiatry 145, 971–975.Google ScholarPubMed
Cottler, L.B., Compton, W.M., Mager, D., Spitznagel, E.L. & Janca, A. (1992). Posttraumatic stress disorder among substance users from the general population. American Journal of Psychiatry 149, 664–670.Google ScholarPubMed
Dinwiddie, S.H. & Reich, T. (1993) Genetic and family studies of psychiatric illness and alcohol and drug dependence. Journal of Addictive Diseases 12, 17–27.CrossRefGoogle ScholarPubMed
Feinstein, A.R. (1970). The pre-therapeutic classification of comorbidity in chronic disease. Journal of Chronic Diseases 23, 455–468.CrossRefGoogle ScholarPubMed
Goldberg, D. (1996). A dimensional model for common mental disorders. British Journal of Psychiatry 168, Suppl. 30, 35–40.CrossRefGoogle Scholar
Helzer, J.E. & Pryzbeck, T.R. (1988). The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol 49, 219–224.CrossRefGoogle ScholarPubMed
Ingraham, L.J. & Wender, P.H. (1992). Risk for affective disorder and alcohol and other drug abuse in the relatives of affectively ill adoptees. Journal of Affective Disorders 26, 45–52.CrossRefGoogle ScholarPubMed
Kendler, K.S. (1996). Major depression and generalized anxiety disorder. Same genes, (partly) different environment – revisited. British Journal of Psychiatry 168, Suppl. 30, 59–66.CrossRefGoogle Scholar
Kessler, R.C., McGonagle, K.A., Zhao, S., Nelson, C.B., Hughes, M., Eshleman, S., Wittchen, H.U. & Kendler, K.S. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Kessler, R.C., Nelson, C.B., McGonagle, K.A., Liu, J., Swartz, M. & Blazer, D.G. (1996). Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. British Journal of Psychiatry 168, Suppl. 30, 8–21.CrossRefGoogle Scholar
Kessler, R.C., Nelson, C.B., McGonagle, K.A., Edlund, M.J., Frank, R.G. & Leaf, P.J. (in press). The epidemiology of co-occurring mental disorders and substance use disorders in the National Comorbidity Survey: Implications for prevention and service utilisation. American Journal of Orthopsychiatry.Google Scholar
Kessler, R.C., Edlund, M.J., Frank, R.G., Kendler, K.S., Leaf, P.J., Nelson, C.B. & Wittchen, H.U. (submitted for publication). Comorbidity of DSM-III-R mental disorders and substance disorders in the National Comorbidity Survey. Bulletin of the Menninger Clinic.Google Scholar
Klein, D.F. (1981). Anxiety reconceptualized. In Anxiety.- New Research and Changing Concepts (ed. Klein, D.F. and Rabkin, J.G.). Raven Press: New York.Google Scholar
Klein, D.F., Ross, D.C. & Cohen, P. (1987). Panic and avoidance in agoraphobia. Archives of General Psychiatry 44, 377–385.CrossRefGoogle ScholarPubMed
Klerman, G.L. (1990) Approaches to the phenomena of comorbidity. In Comorbidity of Mood and Anxiety Disorders, (ed. Maser, J.D. and Cloninger, C.R.), pp. 13–40. American Psychiatric Press: Washington DC.Google Scholar
Kushner, M.G., Sher, K.J. & Beitman, B.D. (1990). The relation between alcohol problems and the anxiety disorders. American Journal of Psychiatry 147, 685–695.Google ScholarPubMed
Luthar, S.S., Anton, S.F., Merikangas, K.R. & Rounsaville, B.J. (1992). Vulnerability to substance abuse and psychopathology Rabkin). among siblings of opioid abusers. Journal of Nervous and Mental Disease 180, 153–161.CrossRefGoogle Scholar
Magee, W.J., Eaton, W.W., Wittchen, H.U., McGonagle, K.A. & Kessler, R.C. (1996). Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Archives of General Psychiatry 53, 159–168.CrossRefGoogle ScholarPubMed
Maier, W., Lichtermann, D. & Minges, J. (1994). The relationship between alcoholism and unipolar depression. A controlled family study. Journal of Psychiatric Research 28, 303–317.CrossRefGoogle ScholarPubMed
Marks, I.M. (1985). Behavioral psychotherapy for anxiety disorders. In The Psychiatric Clinics in North America: Anxiety Disorders (ed. Curtis, G.C., Thyer, A. and Rainey, J.M.). Saunders: Philadelphia.Google Scholar
Maser, J.D. & Cloninger, C.R. (ed.) (1990). Comorbidity of Mood and Anxiety Disorders. American Psychiatric Press: Washington DC.,Google Scholar
Merikangas, K.R. (1990). The genetic epidemiology of alcoholism. Psychological Medicine 20, 11–12.CrossRefGoogle ScholarPubMed
Merikangas, K.R., Rounsaville, B.J. & Prusoff, B.A. (1992). Familial factors in vulnerability to substance abuse. In Vulnerability to Drug Abuse (ed. Glantz, M.D. and Pickens, R.), pp 75–97. American Psychological Association: Washington DC.CrossRefGoogle Scholar
Merikangas, K.R., Angst, J., Eaton, W.W., Canino, G., Rubio-Stipec, M., Wacker, H., Wittchen, H.U., Andrade, L., Essau, C.A., Kraemer, H., Robins, L.N. & Kupfer, D.J. (1996). Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. British Journal of Psychiatry 168, Suppl. 30, 49–58.CrossRefGoogle Scholar
Nace, E.P., Davis, C.W. & Gaspari, J.P. (1991). Axis Il comorbidity in substance abusers. American Journal of Psychiatry 148, 118–120.Google Scholar
National Institute of Mental Health (1993). The prevention of mental disorders: A National Research Agenda (unpublished report).Google Scholar
Regier, D.A., Burke, J.D. & Burke, K.C. (1990). Comorbidity of Affective and Anxiety Disorders in the NIMH Epidemiologic Catchment Area Program. American Psychiatric Press: Washington DC.Google Scholar
Regier, D.A., Farmer, M.E. & Goodwin, F.K. (1993). Comorbidity of mental and substance abuse disorders. In Psychiatry (ed. Michel, R., Cooper, A.M., Guze, S.B., Judd, L.L., Solnit, A.J., Stunkard, A.J., Weissman, M.M. and Wilner, P.J.), pp. 1–23. Lippincott: Philadephia.Google Scholar
Robins, L.N., Helzer, J.E., Ratcliff, K.S. & Seyfried, W. (1982). Validity of the Diagnostic Interview Schedule, version II: DSMIII diagnoses. Psychological Medicine 12, 855–870.CrossRefGoogle ScholarPubMed
Rosen, M.I. & Kosten, T. (1994). Cocaine-associated panic attacks in methadone-maintained patients. American Journal of Drug and Alcohol Abuse 18, 57–62.CrossRefGoogle Scholar
Russell, J.M., Newman, S.C. & Bland, R.C. (1994). Drug abuse and dependence. Acta Psychiatrica Scandinavica, Supplementum No. 376, 54–62.CrossRefGoogle Scholar
Stockwell, T., Smail, P., Hodgson, R. & Canter, S. (1983). Alcohol dependence and phobic anxiety states II: retrospective study. British Journal of Psychiatry 144, 58–63.CrossRefGoogle Scholar
VanPraag, H.M. (1996). Comorbidity (psycho)analysed. British Journal of Psychiatry 168, Suppl. 30, 120–125.Google Scholar
Weissman, M.M., Klerman, G.L., Markowitz, J.S. & Quellette, M. (1989). Suicidal ideation and suicide attempts in panic disorder and attacks. New England Journal of Medicine 321, 1209–1214.CrossRefGoogle ScholarPubMed
Wesner, R.B. (1990). Alcohol use and abuse secondary to anxiety. Psychiatric Clinics of North America 13, 699–713.CrossRefGoogle ScholarPubMed
Wittchen, H.U. (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): A critical review. Journal of Psychiatric Research 28, 57–84.CrossRefGoogle ScholarPubMed
Wittchen, H.U. (1996). Critical issues in the evaluation of comorbidity. British Journal of Psychiatry 168, Suppl. 30, 126–132.CrossRefGoogle Scholar
Wittchen, H.U. & Beloch, E. (submitted for publication). The impact of social phobia on quality of life. Clinical Psychopharmacology.Google Scholar
Wittchen, H.U. & Essau, C.A. (1989). Comorbidity of anxiety disorders and depression: does it affect course and outcome? Journal of Psychiatry and Psychobiology 4, 315–323.CrossRefGoogle Scholar
Wittchen, H.U. & Perkonigg, A. (submitted for publication). Epidemiologie psychischer Störungen. Grundlagen, Häufigkeit, Risikofaktoren und Konsequenzen. In Enzyklopädie der Psychologie (ed. Hahlweg, K. und A, A. Ehlers). Hogrefe: Gottingen.Google Scholar
Wittchen, H.U. & von Zerssen, D. (ed.) (1987). Verläufe behandelter und unbehandelter Depressionen und Angststörungen. Eine klinisch-psychiatrische und epidemiologische Verlaufsuntersuchung. Springer: Berlin.Google Scholar
Wittchen, H.U. & Vossen, A. (1995). Implikationen von Komorbiditat bei Angststörungen. Ein kritischer Überblick. Verhaltensther Prax Forsch Perspekt 5, 120–133.Google Scholar
Wittchen, H.U., Essau, C.A. & Krieg, J.C. (1991). Anxiety disorders: Similarities and differences of comorbidity in treated and untreated groups. British Journal of Psychiatry 159, Suppl. 12, 23–33.CrossRefGoogle Scholar
Wittchen, H.U., Essau, C.A., von Zerssen, D., Krieg, C.J. & Zaudig, M. (1992). Lifetime and six-month prevalence of mental disorders in the Munich Follow-up Study. European Archives of Psychiatry and Clinical Neuroscience 241, 247–258.CrossRefGoogle ScholarPubMed
Wittchen, H.U., Perkonigg, A. & Reed, V. (1996). Comorbidity of mental disorders and substance use disorders. European Addiction Research 2, 36–48.CrossRefGoogle Scholar
World Health Organization (1991). ICD-10, Chapter V, Mental and Behavioral Disorders (Including Disorders of Psychological Development). Diagnostic Criteria for Research, Draft for Field Trials. World Health Organization: Geneva.Google Scholar