Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project. (2004) 12-Month co-morbidity patterns and associated factors in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

Acta psychiatrica Scandinavica. Supplementum 02/2004; 109(420):28-37. DOI: 10.1111/j.1600-0047.2004.00328.x
Source: PubMed


Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries.
Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews.
In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both.
High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

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Available from: Johan Ormel, Dec 22, 2013
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    • "In Europe the lifetime prevalence of GAD has been estimated at 4.3 to 5.9%, with a 12-month prevalence of 1.2 to 1.9%, yet only a very small percentage seek treatment [7]. GAD, like other mental health disorders, often presents with comorbidity - principally mood disorders or other types of anxiety disorder [4,8]. GAD is associated with significant deleterious effects: economic, personal, intrapersonal and societal [9,10], which can cause significant impairment and reduced quality of life for an individual and their family [11]. "
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    ABSTRACT: Worldwide prevalence of generalized anxiety disorder (GAD) is considered high; in Europe lifetime prevalence has been estimated at 4.3 to 5.9%. High levels of anxiety disorders have been reported in university students, affecting 25 to 30% of the population. Young adults are some of the most vulnerable for the onset of mental health disorders and any stressors may act as a catalyst for their onset. The absence of resources can often mean that many do not seek treatment. Other factors that impede access to resources include such things as a lack of trained professionals, personal stigma, and waiting lists. Anxiety disorders can be treated successfully; indeed brief forms of cognitive-behavior therapy have been recommended. One potential avenue for research and development is that of delivering low-intensity interventions online for students with GAD. Therefore, the current study seeks to investigate the potential effectiveness for a low-intensity online CBT-based treatment for GAD in a service-based setting; implemented as one step in a stepped-care model. The research is a service-based effectiveness study utilizing a randomized waiting-list controlled design. The active intervention consists of six weekly modules of online CBT. Participants are assigned a supporter who provides weekly post-session feedback on progress and exercises. Participants will complete the GAD-7 as the primary outcome measure. Secondary outcomes include pathological worry, depression and measures of well-being. At three-months follow-up data will be collected using the GAD-7, BDI-II, PSWQ, ED-Q5 and WSAS. Post-session data will be collected on significant in-session events in treatment (HAT). A satisfaction with treatment measure will be administered post-treatment (SAT). The study will be a contribution to the potential for a low-intensity internet-delivered program implemented in a service-based setting; implemented as one step in a stepped-care model. The study will be a contribution to the already established work in online treatments for anxiety worldwide. The study will assess the utility of an innovative digital health solution (SilverCloud) to deliver such interventions.Trial registration: Current Controlled Trials ISRCTN16303842.
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    • "In Europe, anxiety disorders have an estimated 12-month prevalence of nearly 14 percent (Alonso et al., 2004b; Wittchen et al., 2011). Comorbidity across different anxiety and mood disorders is high in the general population (Alonso et al., 2004a) and the occurrence of an additional Axis-I diagnosis is even higher in individuals seeking treatment for their anxiety in primary care centers for treatment of stress, anxiety and related disorders (Brown, Campbell, Lehman, Grisham, & Mancill, 2001). The most common comorbid disorder for individuals with one anxiety disorder is a mood disorder or another anxiety disorder. "
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    ABSTRACT: A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7–10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities.
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    • "Of the variables associated to a greater prevalence of depression in PC, gender was that which has shown to be more consistent throughout the literature, with greater prevalence in women in comparison to men (Aragonés, Piñol, Labad, Folch, & Melich, 2004; Serrano-Blanco et al., 2010). This result is similar to that found in the general population (Alonso et al., 2004b) and has been replicated in studies conducted in different countries. Thus, for example, no differences were found with respect to this proportion among the 15 countries of 4 continents where the WHO study " Psychological Problems in General Health Care " was carried out (Sartorius et al., 1993), for which, it is probable that the greater prevalence of depression in women in comparison to men may be more influenced by biological and/or psychological-type factors than cultural factors. "
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    ABSTRACT: Major depression is currently one of the most prevalent and most disabling mental disorders. A large number of people with depression seek treatment from primary care (PC) providers. We present a critical review of the literature focused on the prevalence, diagnosis and treatment of depression in PC, giving special emphasis to studies carried out in Spain. Results indicate that Spain's 12-month prevalence for depression in PC is between 9.6% and 20.2%. In addition, depression is highly comorbid with other physical and psychological conditions. In spite of its elevated prevalence, patients suffering from depression are often misdiagnosed and rarely receive minimally adequate treatment. This leads to higher drop-out and relapse rates together with an elevated cost burden. The need for scientifically-based treatments in PC is discussed, given the fact that they have shown higher efficacy rates when compared to treatment as usual and may help to reduce social and health-care costs.
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