Comorbidity and Disease Burden in the National Comorbidity Survey Replication (Ncs-R)

Abstract

Background Disease burden estimates rarely consider comorbidity. Using a recently developed methodology for integrating information about comorbidity into disease burden estimates, we examined the comparative burdens of 9 mental and 10 chronic physical disorders in the National Comorbidity Survey Replication (NCS-R). Methods Face-to-face interviews in a national household sample (n = 5,692) assessed associations of disorders with scores on a visual analog scale (VAS) of perceived health. Multiple regression analysis with interactions for comorbidity was used to estimate these associations. Simulation was used to estimate incremental disorder-specific effects adjusting for comorbidity. Results 74.9% of respondents reported one or more disorders. 73.8–98.2% of respondents with disorders reported having at least one other disorder. The best-fitting model to predict VAS scores included disorder main effects and interactions for number of disorders. Adjustment for comorbidity reduced individual-level disorder-specific burden estimates substantially, but with considerable between-disorder variation (.07–.69 ratios of disorder-specific estimates with and without adjustment for comorbidity). Four of the five most burdensome disorders at the individual level were mental disorders based on bivariate analyses (panic/agoraphobia, bipolar disorder, PTSD, major depression) but only two based on multivariate analyses, adjusting for comorbidity (panic/agoraphobia, major depression). Neurological disorders, chronic pain conditions, and diabetes were the other most burdensome individual-level disorders. Chronic pain conditions, cardiovascular disorders, arthritis, insomnia, and major depression were the most burdensome societal-level disorders. Conclusions Adjustments for comorbidity substantially influence estimates of disease burden, especially those of mental disorders, underlining the importance of including information about comorbidity in studies of mental disorders.

Prevalence and correlates of DSM-IV-TR major depressive disorder, self-reported diagnosed depression and current depressive symptoms among adults in Germany

“…In the USA in the NCS-R study, associations between CIDI-MDD and having a higher number of somatic comorbidities were reported for the overall study population (Gadermann et al, 2012;Kessler et al, 2010). In our data, an association with a higher number of somatic comorbidities was found in men, but not in women suggesting that physical and mental health may be more closely aligned in men than women and highlight the importance of sex-specific analyses.…”

ApoE2 Exaggerates PTSD-Related Behavioral, Cognitive, and Neuroendocrine Alterations

“…The detrimental effects of PTSD are often magnified by accelerated development of stress-related medical conditions, and PTSD displays a high comorbidity rate with anxiety and depressive disorders (Gadermann et al, 2012). Following a traumatic event, many people experience traumatic stress symptoms, but rates appear to diminish quickly over the course of a few months (Rubin et al, 2005;Galea et al, 2003).…”

Blockade of the GLT-1 Transporter in the Central Nucleus of the Amygdala Induces both Anxiety and Depressive-Like Symptoms

“…Individuals who experience comorbid GAD and MDD have greater severity of illness including increased suicidal ideation and higher levels of pathological worry (Zimmerman and Chelminski, 2003). Furthermore, depression with comorbid anxiety is not well treated by standard treatments, creating a population of individuals who are categorized as treatment resistant (Newman et al, 2010;Gadermann et al, 2012). High rates of comorbidity, symptom overlap (Brown et al, 1995;Zbozinek et al, 2012), and common underlying brain abnormalities between anxiety and depressive disorders have lead to novel insights into networks that may regulate both anhedonia and anxiogenesis.…”