Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition

Abstract

Recent studies emphasize the negative impact of comorbidity on the course of depression. If undiagnosed, depression and comorbidity contribute to high medical utilization. We aimed to assess (1) prevalences of depression alone and with comorbidity (anxiety/somatoform disorders) in primary care, (2) coexistence of anxiety/somatoform disorders in depressive patients, and (3) diagnostic validity of two screeners regarding depression with versus without comorbidity. We examined 394 primary care outpatients using the Composite International Diagnostic Interview (CIDI), the General Health Questionnaire (GHQ-12), and the Well-Being Index (WHO-5). We conducted configurational frequency analyses to identify nonrandom configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners. Point prevalence of any depressive disorder was 22.8%; with at least one comorbid disorder, 15%; and with two comorbid conditions, 6.1%, which significantly exceeded expected percentage (0.9%, P< or =.0001). Depression without comorbidity occurred significantly less often than expected by chance (P< or =.0007). Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio (6.25). The screeners were comparable regarding their diagnostic validity for depression with [GHQ-12: area under the curve (AUC)=0.86; WHO-5: AUC=0.88] and without comorbidity (GHQ-12: AUC=0.84; WHO-5: AUC=0.86). It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected. These results confirm assumptions that the current division between depression and anxiety might be debatable. Validity of screeners tested in our study was not affected by comorbid conditions (e.g., anxiety or somatoform disorders).

Magnitude of depression problem among primary care consumers in Saudi Arabia

“…The rate was lower than that reported in Riyadh (18.8%) and Kuwait (20.5%) [12,13] and higher than in Qatar (13.5%, 2010). [14] Similar studies conducted in European countries revealed a prevalence rate ranging from 16.5% to 22.8%, [15][16][17] indicating that the rates in Gulf Region are comparable with those of Europe.…”

A systematic review of depression and anxiety measures used with individuals with spinal cord injury

“…2 Further, a high comorbidity odds ratio (6.25) between depressive and anxiety disorders was found, leading to the conclusion that depression and anxiety comorbidity occurs more often than expected. 2 For this reason, it is important to assess both depression and anxiety, disorders or symptoms, in tandem. Diagnosis of depression and anxiety disorders is typically conducted through structured interviews based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).…”

“…Despite a conceptual distinction between depression and anxiety, clinically differentiating the two constructs has proven difficult, as people who experience anxiety are often depressed as well. 1,2 In a sample of 394 primary care patients, Mergl et al (2007) found that depression without comorbidity occurred significantly less than expected by chance. 2 Further, a high comorbidity odds ratio (6.25) between depressive and anxiety disorders was found, leading to the conclusion that depression and anxiety comorbidity occurs more often than expected.…”

“…1,2 In a sample of 394 primary care patients, Mergl et al (2007) found that depression without comorbidity occurred significantly less than expected by chance. 2 Further, a high comorbidity odds ratio (6.25) between depressive and anxiety disorders was found, leading to the conclusion that depression and anxiety comorbidity occurs more often than expected. 2 For this reason, it is important to assess both depression and anxiety, disorders or symptoms, in tandem.…”

A hierarchy of distress: Mokken scaling of the GHQ-30

“…As far as it is possible to discern from an online search of the Web of Science using ' GHQ' and 'Mokken ' as search terms and no date restrictions, the GHQ, which is strong psychometrically, has not been subjected to analysis for a hierarchy among its items, although it has been used to validate other scales that have been developed using this procedure (Barkow et al 2001 ;Mergl et al 2007). One hierarchical scale for general health has been developed but does not seem to be widely used (Moorer & Suurmeijer, 1994 ;Moorer et al 2001).…”