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Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries
- J. J. McGrath, C. C. W. Lim, O. Plana-Ripoll, Y. Holtz, E. Agerbo, N. C. Momen, P. B. Mortensen, C. B. Pedersen, J. Abdulmalik, S. Aguilar-Gaxiola, A. Al-Hamzawi, J. Alonso, E. J. Bromet, R. Bruffaerts, B. Bunting, J. M. C. de Almeida, G. de Girolamo, Y. A. De Vries, S. Florescu, O. Gureje, J. M. Haro, M. G. Harris, C. Hu, E. G. Karam, N. Kawakami, A. Kiejna, V. Kovess-Masfety, S. Lee, Z. Mneimneh, F. Navarro-Mateu, R. Orozco, J. Posada-Villa, A. M. Roest, S. Saha, K. M. Scott, J. C. Stagnaro, D. J. Stein, Y. Torres, M. C. Viana, Y. Ziv, R. C. Kessler, P. de Jonge
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 29 / 2020
- Published online by Cambridge University Press:
- 12 August 2020, e153
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Aims
Epidemiological studies indicate that individuals with one type of mental disorder have an increased risk of subsequently developing other types of mental disorders. This study aimed to undertake a comprehensive analysis of pair-wise lifetime comorbidity across a range of common mental disorders based on a diverse range of population-based surveys.
MethodsThe WHO World Mental Health (WMH) surveys assessed 145 990 adult respondents from 27 countries. Based on retrospectively-reported age-of-onset for 24 DSM-IV mental disorders, associations were examined between all 548 logically possible temporally-ordered disorder pairs. Overall and time-dependent hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. Absolute risks were estimated using the product-limit method. Estimates were generated separately for men and women.
ResultsEach prior lifetime mental disorder was associated with an increased risk of subsequent first onset of each other disorder. The median HR was 12.1 (mean = 14.4; range 5.2–110.8, interquartile range = 6.0–19.4). The HRs were most prominent between closely-related mental disorder types and in the first 1–2 years after the onset of the prior disorder. Although HRs declined with time since prior disorder, significantly elevated risk of subsequent comorbidity persisted for at least 15 years. Appreciable absolute risks of secondary disorders were found over time for many pairs.
ConclusionsSurvey data from a range of sites confirms that comorbidity between mental disorders is common. Understanding the risks of temporally secondary disorders may help design practical programs for primary prevention of secondary disorders.
Complementary and alternative medicine contacts by persons with mental disorders in 25 countries: results from the World Mental Health Surveys
- P. de Jonge, K. J. Wardenaar, H. R. Hoenders, S. Evans-Lacko, V. Kovess-Masfety, S. Aguilar-Gaxiola, A. Al-Hamzawi, J. Alonso, L. H. Andrade, C. Benjet, E. J. Bromet, R. Bruffaerts, B. Bunting, J. M. Caldas-de-Almeida, R. V. Dinolova, S. Florescu, G. de Girolamo, O. Gureje, J. M. Haro, C. Hu, Y. Huang, E. G. Karam, G. Karam, S. Lee, J.-P. Lépine, D. Levinson, V. Makanjuola, F. Navarro-Mateu, B.-E. Pennell, J. Posada-Villa, K. Scott, H. Tachimori, D. Williams, B. Wojtyniak, R. C. Kessler, G. Thornicroft
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 27 / Issue 6 / December 2018
- Published online by Cambridge University Press:
- 28 December 2017, pp. 552-567
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Aims.
A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.
Methods.In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18–100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.
Results.An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6–17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.
Conclusions.CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.
Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys
- A. J. Rosellini, H. Liu, M. V. Petukhova, N. A. Sampson, S. Aguilar-Gaxiola, J. Alonso, G. Borges, R. Bruffaerts, E. J. Bromet, G. de Girolamo, P. de Jonge, J. Fayyad, S. Florescu, O. Gureje, J. M. Haro, H. Hinkov, E. G. Karam, N. Kawakami, K. C. Koenen, S. Lee, J. P. Lépine, D. Levinson, F. Navarro-Mateu, B. D. Oladeji, S. O'Neill, B.-E. Pennell, M. Piazza, J. Posada-Villa, K. M. Scott, D. J. Stein, Y. Torres, M. C. Viana, A. M. Zaslavsky, R. C. Kessler
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- Journal:
- Psychological Medicine / Volume 48 / Issue 3 / February 2018
- Published online by Cambridge University Press:
- 19 July 2017, pp. 437-450
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Background
Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.
MethodsThe WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.
Results20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).
ConclusionsWe found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
The cross-national epidemiology of specific phobia in the World Mental Health Surveys
- K. J. Wardenaar, C. C. W. Lim, A. O. Al-Hamzawi, J. Alonso, L. H. Andrade, C. Benjet, B. Bunting, G. de Girolamo, K. Demyttenaere, S. E. Florescu, O. Gureje, T. Hisateru, C. Hu, Y. Huang, E. Karam, A. Kiejna, J. P. Lepine, F. Navarro-Mateu, M. Oakley Browne, M. Piazza, J. Posada-Villa, M. L. ten Have, Y. Torres, M. Xavier, Z. Zarkov, R. C. Kessler, K. M. Scott, P. de Jonge
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- Journal:
- Psychological Medicine / Volume 47 / Issue 10 / July 2017
- Published online by Cambridge University Press:
- 22 February 2017, pp. 1744-1760
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Background
Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries.
MethodData came from 25 representative population-based surveys conducted in 22 countries (2001–2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview.
ResultsThe cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3–21.9% across income groups) and 23.1% reported any treatment (9.6–30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes.
ConclusionsSpecific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.
The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium
- C. Benjet, E. Bromet, E. G. Karam, R. C. Kessler, K. A. McLaughlin, A. M. Ruscio, V. Shahly, D. J. Stein, M. Petukhova, E. Hill, J. Alonso, L. Atwoli, B. Bunting, R. Bruffaerts, J. M. Caldas-de-Almeida, G. de Girolamo, S. Florescu, O. Gureje, Y. Huang, J. P. Lepine, N. Kawakami, Viviane Kovess-Masfety, M. E. Medina-Mora, F. Navarro-Mateu, M. Piazza, J. Posada-Villa, K. M. Scott, A. Shalev, T. Slade, M. ten Have, Y. Torres, M. C. Viana, Z. Zarkov, K. C. Koenen
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- Journal:
- Psychological Medicine / Volume 46 / Issue 2 / January 2016
- Published online by Cambridge University Press:
- 29 October 2015, pp. 327-343
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Background
Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.
MethodGeneral population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.
ResultsOver 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.
ConclusionsGiven the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys
- R. C. Kessler, N. A. Sampson, P. Berglund, M. J. Gruber, A. Al-Hamzawi, L. Andrade, B. Bunting, K. Demyttenaere, S. Florescu, G. de Girolamo, O. Gureje, Y. He, C. Hu, Y. Huang, E. Karam, V. Kovess-Masfety, S Lee, D. Levinson, M. E. Medina Mora, J. Moskalewicz, Y. Nakamura, F. Navarro-Mateu, M. A. Oakley Browne, M. Piazza, J. Posada-Villa, T. Slade, M. ten Have, Y. Torres, G. Vilagut, M. Xavier, Z. Zarkov, V. Shahly, M. A. Wilcox
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 24 / Issue 3 / June 2015
- Published online by Cambridge University Press:
- 27 February 2015, pp. 210-226
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Background.
To examine cross-national patterns and correlates of lifetime and 12-month comorbid DSM-IV anxiety disorders among people with lifetime and 12-month DSM-IV major depressive disorder (MDD).
Method.Nationally or regionally representative epidemiological interviews were administered to 74 045 adults in 27 surveys across 24 countries in the WHO World Mental Health (WMH) Surveys. DSM-IV MDD, a wide range of comorbid DSM-IV anxiety disorders, and a number of correlates were assessed with the WHO Composite International Diagnostic Interview (CIDI).
Results.45.7% of respondents with lifetime MDD (32.0–46.5% inter-quartile range (IQR) across surveys) had one of more lifetime anxiety disorders. A slightly higher proportion of respondents with 12-month MDD had lifetime anxiety disorders (51.7%, 37.8–54.0% IQR) and only slightly lower proportions of respondents with 12-month MDD had 12-month anxiety disorders (41.6%, 29.9–47.2% IQR). Two-thirds (68%) of respondents with lifetime comorbid anxiety disorders and MDD reported an earlier age-of-onset (AOO) of their first anxiety disorder than their MDD, while 13.5% reported an earlier AOO of MDD and the remaining 18.5% reported the same AOO of both disorders. Women and previously married people had consistently elevated rates of lifetime and 12-month MDD as well as comorbid anxiety disorders. Consistently higher proportions of respondents with 12-month anxious than non-anxious MDD reported severe role impairment (64.4 v. 46.0%; χ21 = 187.0, p < 0.001) and suicide ideation (19.5 v. 8.9%; χ21 = 71.6, p < 0.001). Significantly more respondents with 12-month anxious than non-anxious MDD received treatment for their depression in the 12 months before interview, but this difference was more pronounced in high-income countries (68.8 v. 45.4%; χ21 = 108.8, p < 0.001) than low/middle-income countries (30.3 v. 20.6%; χ21 = 11.7, p < 0.001).
Conclusions.Patterns and correlates of comorbid DSM-IV anxiety disorders among people with DSM-IV MDD are similar across WMH countries. The narrow IQR of the proportion of respondents with temporally prior AOO of anxiety disorders than comorbid MDD (69.6–74.7%) is especially noteworthy. However, the fact that these proportions are not higher among respondents with 12-month than lifetime comorbidity means that temporal priority between lifetime anxiety disorders and MDD is not related to MDD persistence among people with anxious MDD. This, in turn, raises complex questions about the relative importance of temporally primary anxiety disorders as risk markers v. causal risk factors for subsequent MDD onset and persistence, including the possibility that anxiety disorders might primarily be risk markers for MDD onset and causal risk factors for MDD persistence.
Contributors
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- By Dag Aarsland, Angelo Antonini, Liana G. Apostolova, Marek Balaz, Roger A. Barker, Oscar Bernal-Pacheco, Mona K. Beyer, Başar Bilgiç, Daniel J. Burdick, Jessica Calleo, K. Ray Chaudhuri, Jeffrey Cummings, Turi O. Dalaker, Christine Daniels, Kathy Dujardin, Sheila R. Eichenseer, Murat Emre, Hubert H. Fernandez, Adam Gerstenecker, Christopher G. Goetz, Haşmet A. Hanağası, Kristina Røkenes Karlsen, Jaime Kulisevsky, Albert F. G. Leentjens, James B. Leverenz, Irene Litvan, Elisabet Londos, Laura Marsh, Saül Martínez-Horta, Pablo Martinez-Martin, Benjamin T. Mast, Brit Mollenhauer, Pouya Movahed, Agneta Nordberg, Javier Pagonabarraga, Irena Rektorova, Per Svenningsson, Alexander I. Tröster, Carolina Villa-Bonomo, Jens Volkmann, Ryan R. Walsh, Daniel Weintraub, Caroline H. Williams-Gray, Henrik Zetterberg
- Edited by Dag Aarsland, Jeffrey Cummings, Daniel Weintraub, University of Pennsylvania, K. Ray Chaudhuri
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- Neuropsychiatric and Cognitive Changes in Parkinson's Disease and Related Movement Disorders
- Published online:
- 05 August 2013
- Print publication:
- 29 August 2013, pp vii-x
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Embarrassment when illness strikes a close relative: a World Mental Health Survey Consortium Multi-Site Study
- B. K. Ahmedani, S. P. Kubiak, R. C. Kessler, R. de Graaf, J. Alonso, R. Bruffaerts, Z. Zarkov, M. C. Viana, Y. Q. Huang, C. Hu, J. A. Posada-Villa, J.-P. Lepine, M. C. Angermeyer, G. de Girolamo, A. N. Karam, M. E. Medina-Mora, O. Gureje, F. Ferry, R. Sagar, J. C. Anthony
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- Journal:
- Psychological Medicine / Volume 43 / Issue 10 / October 2013
- Published online by Cambridge University Press:
- 09 January 2013, pp. 2191-2202
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Background
In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study.
MethodIn 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions.
ResultsThere was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p < 0.001), even with covariate adjustments for age and sex.
ConclusionsThe pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.
Mice infected with the larvae of Taenia crassiceps exhibit a Th2-like immune response with concomitant anergy and downregulation of Th1-associated phenomena
- O. F. Villa, R. E. Kuhn
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- Parasitology / Volume 112 / Issue 6 / June 1996
- Published online by Cambridge University Press:
- 06 April 2009, pp. 561-570
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Infection of intermediate hosts with eggs of taeniid parasites results in a larval infestation known as cysticercosis. A number of studies have indicated that cysticercosis is associated with immunosuppression, although little is known about the mechanisms involved. In the present study, mice infected with the larvae of Taenia crassiceps were found to exhibit a pronounced anergy, which preferentially affected T-cells located anatomically close to the parasite. This anergy was linked to late events in the T cell activation pathway; that is, stimulation through the T cell receptor(TCR)/CD complex by Concanavalin-A, or plate-bound monoclonal antibodies (mAb) to TCRαβ or CD3ε, or combinations of phorbol ester and ionomycin (all of which can bypass early membrane-related events), failed to fully activate T lymphocytes. The relative proximity of T cells to the parasite was directly related to upregulation of IL-4 and downregulation of IL-2 production. In addition, the profiles of parasite-specific Abs showed an exclusive increase of serum IgG1 during infection. Taken together, the data suggest that infection of mice with larvae of T. crassiceps alters the balance of CD4+ Th cells by upregulating Th2 and downregulating Th1 cells located in close proximity to the parasite.