Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T08:23:51.329Z Has data issue: false hasContentIssue false
  • English
  • Français

Comorbidity and Boundaries of Affective Disorders with Anxiety Disorders and Substance Misuse: Results of an International Task Force

Published online by Cambridge University Press:  06 August 2018

K. R. Merikangas ,
J. Angst ,
W. Eaton ,
G. Canino ,
M. Rubio-Stipec ,
H. Wacker ,
H.-U. Wittchen ,
L. Andrade ,
C. Essau  and
A. Whitaker
...Show all authors
K. R. Merikangas*
Affiliation:
Yale University School of Medicine
J. Angst
Affiliation:
University of Zurich, Lenggstrasse 31, CH-8029, Zurich, Switzerland
W. Eaton
Affiliation:
Johns Hopkins University, 624 North Broadway, Baltimore, MD, USA, 21205-1999
G. Canino
Affiliation:
University of Puerto Rico, Centro Medico, STEA-928, Rio Piedras, PR, USA 00935-0001
M. Rubio-Stipec
Affiliation:
University of Puerto Rico, Centro Medico, STEA-928, Rio Piedras, PR, USA 00935-0001
H. Wacker
Affiliation:
Psychiatrische Universitatsklinik, Petersgraben 4, CH-4031 Basel, Switzerland
H.-U. Wittchen
Affiliation:
Max Planck Institute of Psychiatry, Kraepelinstrasse 2 & 10, D-800, Munich 40, Germany
L. Andrade
Affiliation:
Instituto de Psiquiatria, Hospital de Clinicas, Sao Paulo SP, Brazil, Caixa Postal 8091
C. Essau
Affiliation:
Kinderambulanz, Universität Bremen, Grazer Strasse 2, 28359 Bremen, Germany
A. Whitaker
Affiliation:
Yale University School of Medicine
H. Kraemer
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA 94305
L. N. Robins
Affiliation:
Washington University School of Medicine, 4940 Children's Place, St. Louis, MO, USA 63110-1093
D. J. Kupfer
Affiliation:
University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA, USA 15213
*
Dr K. R. Merikangas, Yale University School of Medicine, Genetic Epidemiology Research Unit, 40 Temple Street, Suite 7B, New Haven, Connecticut 06510-3223, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Associations between affective disorders, anxiety disorders, and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre- or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment ratesacross all sites, confirming Berkson's paradox on an international level.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue S30: Comorbidity of Mood Disorders , June 1996 , pp. 58 - 67
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Andrade, L., Eaton, W. W. & Chilcoat, H. (1994) Lifetime comorbidity of panic attacks and other major depression in a population-based study: symptom profile. British Journal of Psychiatry, 165, 363–369.CrossRefGoogle Scholar
Angst, J. (1990) Depression and anxiety: a review of studies in the community and in primary health care. In Psychological Disorders in General Medical Settings (eds Sartorius, N., Goldberg, D., de Girolamo, G., et al), pp. 60–68. Toronto: Hogrefe & Huber.Google Scholar
Angst, J., Dobler-Mikola, A. & Binder, J. (1984) The Zurich study – a prospective epidemiological study of depressive, neurotic, and psychosomatic syndromes: I. Problem, methodology. European Archives of Psychiatric Neurological Science, 234, 13–20.Google Scholar
Berkson, J. (1946) Limitation of the application of the 4-fold table analysis to hospital data. Biometrics, 2, 47–53.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.Google Scholar
Bronisch, T. & Wittchen, H.-U. (1994) Suicidal ideation and suicide attempts: comorbidity with depression, anxiety disorders, and substance abuse disorder. European Archives of Psychiatry and Clinical Neuroscience, 244, 93–98.CrossRefGoogle ScholarPubMed
Brown, G. W., Harris, T. O. & Eales, M. J. (1993) Aetiology of anxiety and depressive disorders in an inner-city population: 2: comorbidity. Psychological Medicine, 23, 155–165.CrossRefGoogle Scholar
Canino, G. J., Bird, H. R., Shrout, P. E., et al (1987) The prevalence of specific psychiatric disorders in Puerto Rico. Archives of General Psychiatry, 44, 727–735.CrossRefGoogle ScholarPubMed
Caron, C. & Rutter, M. (1991) Comorbidity in child psychopathology: concepts, issues, and research strategies. Journal of Child Psychology and Psychiatry, 32, 1063–1080.Google Scholar
Coryell, W., Endicott, J., Andreasen, N. C., et al (1988) Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. American Journal of Psychiatry, 145, 293–300.Google ScholarPubMed
Derogatis, R. L. (1977) Symptom Checklist 90, R-Version Manual I: Scoring, Administration, and Procedures for the SCL-90. Baltimore: Johns Hopkins University Press.Google Scholar
Eaton, W. W. & Ritter, C. (1988) Distinguishing anxiety and depression with field survey data. Psychological Medicine, 18, 155–166.Google Scholar
Eaton, W. W. & Chilcoat, H. D. (1992) The latent structure of anxiety and depression in treated and untreated samples of two US populations. In Primary Health Care and Psychiatric Epidemiology (eds Cooper, B. & Eastwood, R.), pp. 307–318. London: Routledge.Google Scholar
Feinstein, A. R. (1970) The pre-therapeutic classification of comorbidity in chronic disease. Journal of Chronic Disease, 23, 455–468.CrossRefGoogle ScholarPubMed
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
Kaplan, M. H. & Feinstein, A. R. (1974) The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. Journal of Chronic Disease, 27, 387–404.Google Scholar
Kendell, R. E. (1989) Clinical validity. Psychological Medicine, 19, 45–55.Google Scholar
Kendler, K. S. & Kessler, R. C. (1993) Major depression and phobias: the genetic and environmental sources of comorbidity. Psychological Medicine, 23, 361–371.Google Scholar
Kendler, K. S., Heath, A. C., Neale, M. C., et al (1993) Alcoholism and major depression in women. Archives of General Psychiatry, 50, 690–698.CrossRefGoogle ScholarPubMed
Kessler, R. C., McGonagle, K. A., Zhao, S., et al (1994) Lifetime and 12-month prevalence of DSM–III–R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8–19.CrossRefGoogle ScholarPubMed
Kraemer, H. (1995) Statistical issues in assessing comorbidity: epidemiological comorbidity and its risk factors. Statistics in Medicine, 19, 721–733.Google Scholar
Lépine, J. P., Wittchen, H.-U. & Essau, C. A. (1993) Lifetime and current comorbidity of anxiety and affective disorders: results from the international WHO/ADAMHA CIDI field trials. International Journal of Methods in Psychiatric Research, 3, 67–77.Google Scholar
Maier, W., Buller, R. & Hallmayer, J. (1988) Comorbidity of panic disorder and major depression: Results from a family study. In Panic and Phobias: Treatments and Variables Affecting Course and Outcome (eds Hand, I. & Wittchen, H.-U.), pp. 180–185. Berlin: Springer-Verlag.Google Scholar
Marks, I. & Lader, M. (1973) Anxiety states (anxiety neurosis): a review. Journal of Nervous and Mental Disorders, 3, 156.Google Scholar
Maser, J. D. & Cloninger, C. R. (1990) Comorbidity of Anxiety and Mood Disorders. Washington, DC: APP.Google Scholar
Merikangas, K. R. (1990) Comorbidity for anxiety and depression: review of family and genetic studies. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 331–348. Washington, DC: APP.Google Scholar
Merikangas, K. R., Risch, N. J., Merikangas, J. R., et al (1988) Migraine and depression: association and familial transmission. Journal of Psychiatric Research, 22, 119–129.CrossRefGoogle ScholarPubMed
Merikangas, K. R. & Gelernter, C. S. (1990) Co-morbidity for alcoholism and depression. Psychiatric Clinics of North America, 13, 613–632.CrossRefGoogle Scholar
Merikangas, K. R., Risch, N. R. & Weissman, M. M. (1994) Comorbidity and co-transmission of alcoholism, anxiety, and depression. Psychological Medicine, 24, 69–80.Google Scholar
Merikangas, K. R. & Angst, J. (1995a) Comorbidity and social phobia. European Archives of Psychiatry and Clinical Neuroscience, 244, 297–303.Google Scholar
Merikangas, K. R. & Angst, J. (1995b) The challenge of depressive disorders in adolescence. In Psychosocial Disturbances in Young People (ed. Rutter, M.). Cambridge: Cambridge University Press.Google Scholar
Regier, D. A., Farmer, M., Rae, D., et al (1990) Comorbidity of mental disorders with alcohol and drug abuse. Journal of the American Medical Association, 264, 2511–2518.Google Scholar
Roberts, R. S., Spitzer, W. G., Elmore, T., et al (1978) An empirical demonstration of Berkson's bias. Journal of Chronic Disease, 31, 119–128.CrossRefGoogle ScholarPubMed
Robins, L. N., Helzer, J. E., Croughan, J. L., et al (1981) National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.Google Scholar
Robins, L. N., Wing, J., Wittchen, H.-U., et al (1988) The Composite International Diagnostic Interview: an epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, 45, 1069–1077.CrossRefGoogle ScholarPubMed
Robins, L. N. & Regier, D. A. (1991) Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press.Google Scholar
Ross, H. E., Glaser, F. B. & Germanson, T. (1988) The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Archives of General Psychiatry, 45, 1023–1031.CrossRefGoogle ScholarPubMed
Schapira, K. K. & Roth, M. (1970) Phobias and affective illness. British Journal of Psychiatry, 117, 25–32.CrossRefGoogle ScholarPubMed
Schneier, F. R. J. & Hornig, C. D. (1992) Social phobia: comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49, 282–288.Google Scholar
Stavrakaki, C. & Vargo, B. (1986) The relationship of anxiety and depression: a review of the literature. British Journal of Psychiatry, 149, 7–16.Google Scholar
Van Ameringen, M., Mancini, C., Styan, G., et al (1991) Relationship of social phobia with other psychiatric illness. Journal of Affective Disorders, 21, 93–99.Google Scholar
Wacker, H. R. M. & Klein, K. H. (1992) Identification of cases of anxiety disorders and affective disorders in the community according to the ICD–10 and DSM–III–R by using the Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 2, 91–100.Google Scholar
Wittchen, H.-U. (1994) Reliability and validity studies of the WHO-CIDI: A critical review. Journal of Psychiatric Research, 28, 57–84.CrossRefGoogle Scholar
Wittchen, H.-U. & Essau, C. A. (1989) Comorbidity of anxiety disorders and depression: does it affect course and outcome? Psychiatry and Psychobiology, 4, 315–323.Google Scholar
Wittchen, H.-U., Robins, L. N., Cottler, L. B., et al and the participants in the Multicentre WHO/ADAMHA Field Trials (1991) Cross-cultural feasibility, reliability, and sources of variance in the Composite International Diagnostic Interview (CIDI). British Journal of Psychiatry, 159, 645–653.CrossRefGoogle ScholarPubMed
Wittchen, H.-U., Essau, C. A., Von Zerssen, D., et al (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.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.