2004b. 12-Month comorbidity patterns and associated factors in Europe: Results from the European Study of 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

ABSTRACT 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, 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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    • "Other studies have found that past-year prevalence in a national sample of young adults was 3.1%, with roughly 76% of reported cases being moderate to severe (Kessler et al., 2006). Additionally , several studies have found that GAD is strongly associated with alcohol use (Alonso et al., 2004; Grant et al., 2005). One causal explanation for the etiology of comorbidity is that anxiety disorders (or anxiety symptoms per se) serve to promote direct use of alcohol and/or other drugs. "
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    ABSTRACT: Objective: Alcohol use disorders and anxiety disorders often co-occur; moreover, lesbian and bisexual women appear at higher risk for both alcohol and anxiety disorders. Although research among college student samples has found direct effects of increased use of protective behavioral strategies on decreasing alcohol use and alcoholrelated negative consequences, this has yet to be demonstrated among lesbian and bisexual women. Furthermore, it is unclear whether generalized anxiety influences the use of such strategies, which in turn predict alcohol consumption and related negative consequences. The primary objective of the present study was to examine the mediating role of protective behavioral strategies on the relationships between generalized anxiety and alcohol consumption and related negative consequences among a young adult sample of lesbian and bisexual women. Method: A national sample of 1,083 lesbian and bisexual women between the ages of 18 and 25 years completed an online survey that assessed the constructs of interest. Results: Results showed support for mediation such that lesbian and bisexual women who reported having higher levels of generalized anxiety were less likely to use drinking protective behavioral strategies, which in turn led to higher levels of alcohol consumption as well as negative alcohol-related consequences. Conclusions: These findings highlight the importance of examining who is at risk for alcohol use disorders as well as why they are at risk. Results indicate that interventions for high-risk drinking among younger lesbian and bisexual women may need to specifically address factors such as affect management or coping with anxiety, at least for the proportion of women who are endorsing significant symptoms of anxiety. (J. Stud. Alcohol Drugs, 74, 168-174, 2013).
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