Including information about co-morbidity in estimates of disease burden: results from the World Health Organization World Mental Health Surveys
Open accessAbstract
Background: The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles. Method: Face-to-face interviews in 13 countries (six developing, nine developed;n=31 067; response rate=69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. Results: The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24–0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. Conclusions: Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings.
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Even if depression is more a consequence than a cause of chronic physical disorders, as it appears to be for some disorders, comorbid depression is often associated with a worse course of the physical disorder.
“Second, even if depression is more a consequence than a cause of chronic physical disorders, as it appears to be for some disorders, comorbid depression is often associated with a worse course of the physical disorder. 187-190”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [190]
A meta-analysis containing data from more than 1.8 million individuals in 35 countries confirms the presence of a significant association between depression and excess all-cause mortality, although this association may have been overestimated because of publication bias and low study quality.
“A meta-analysis containing data from more than 1.8 million individuals in 35 countries confirms the presence of a significant association between depression and excess all-cause mortality, although this association may have been overestimated because of publication bias and low study quality. 190”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [190]
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- Authors
- Alonso, J., Vilagut, G., Chatterji, S., Heeringa, S., Schoenbaum, M., Bedirhan Üstün, T., Rojas-Farreras, S., Angermeyer, M., Bromet, E., Bruffaerts, R., de Girolamo, G., Gureje, O., Haro, J. M., Karam, A. N., Kovess, V., Levinson, D., Liu, Z., Medina-Mora, M. E., Ormel, J., Posada-Villa, J., Uda, H., & Kessler, R. C.
- Affiliations
- Municipal Institute for Medical Research (ES)
- World Health Organization (CH)
- University of Michigan (US)
- National Institute of Mental Health (US)
- Stony Brook University (US)
- Universitair Ziekenhuis Leuven (BE)
- University College Hospital, Ibadan (NG)
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- University of Balamand (LB)
- Israel Ministry of Health (IL)
- Peking University (CN)
- University Medical Center Groningen (NL)
- Universidad Colegio Mayor de Cundinamarca (CO)
- Osumi Regional Promotion Bureau (JP)
- Harvard University (US)
- Corresponding author
- Kessler, R. C.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2010-06-16
- Volume
- 41
- Issue
- 4
- Pages
- 873-886
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC3045479
- OpenAlex
- W2171960618
- Cited by
- 61
- References
- 70
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 1 · 2017: 5 · 2016: 5 · 2015: 3 · 2014: 6 · 2013: 10 · 2012: 5
- FWCI
- 4.43
- Type
- journal article
- Language
- en
- Open access
- green
- research.rug.nl
- Licence
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Robert Wood Johnson Foundation (044708)
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- John W. Alden Trust
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- European Commission (QLG5–1999-01042, SANCO2004123, 2004123)
- Generalitat de Catalunya (01042)
- Bundesministerium für Gesundheit
- National Insurance Institute of Israel
- Regione Piemonte
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
- Pan American Health Organization
- Instituto de Salud Carlos III (CB06/02/0046, RETICS RD06/0011, RD06/0011, CIBER CB06/02/0046)
- Departament de Salut, Generalitat de Catalunya
- National Institute of Mental Health (R13-MH-066849, R0 1-MH61905, R01‐MH070884, U01-MH-60220, R01MH061905, R01MH059575, MH60220, HHSN271200700030C, U13MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (FIRCA R03TW006481, R03TW006481)
- Cilag
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- disease burden, comorbidities, condition severity, mental illness, chronic physical illness, health perception, visual analogue scale, social burden, insomnia, major depressive disorder, neurological disorders, World Mental Health Surveys
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Analysis of Variance, Mental Disorders, Chronic Disease, Cross-Cultural Comparison, Major Depressive Disorder, Depressive Disorder, Major, Female, Health Policy, Health Status Indicators, Health Surveys, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Nervous System Diseases, Pain Measurement, World Health Organization, Health Care Rationing, Comorbidity, Cost of Illness, Universal Health Insurance, Young Adult
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