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Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys
Open accessAbstract
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%; χ 2 1 = 187.0, p < 0.001) and suicide ideation (19.5 v. 8.9%; χ 2 1 = 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%; χ 2 1 = 108.8, p < 0.001) than low/middle-income countries (30.3 v. 20.6%; χ 2 1 = 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.
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“This is in agreement with previous studies, which also reported a higher prevalence of anxiety, stress and depression among women [39].”
From The Prevalence of Depression, Anxiety and Stress and Their Associated Factors in College Students. (2020) · cites this paper as [39]
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“Excessive worry, often as part of an anxiety disorder, is also extremely common in individuals with depressive disorders”
From Intolerance of Uncertainty–Focused Treatment for Adolescents With Excessive Worry: A Pilot Feasibility Study (2020) · cites this paper as Kessler, Sampson, Berglund, & Gruber, 2015
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Klumpp, H., Davey, D. K., & Langenecker, S. A. (2026) · Translational Psychiatry · doi:10.1038/s41398-026-03908-8
Leonhard, C. (2026) · Journal of Forensic and Legal Medicine · doi:10.1016/j.jflm.2026.103114
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Metadata
- Authors
- Kessler, R. C., Sampson, N. A., Berglund, P., Gruber, M. J., Al-Hamzawi, A., Andrade, L., Bunting, B., Demyttenaere, K., Florescu, S., de Girolamo, G., Gureje, O., He, Y., Hu, C., Huang, Y., Karam, E., Kovess-Masfety, V., Lee, S., Levinson, D., Medina Mora, M. E., Moskalewicz, J., Nakamura, Y., Navarro-Mateu, F., Browne, M. A. O., Piazza, M., Posada-Villa, J., Slade, T., ten Have, M., Torres, Y., Vilagut, G., Xavier, M., Zarkov, Z., Shahly, V., & Wilcox, M. A.
- Affiliations
- Harvard University (US)
- University of Michigan (US)
- University of Al-Qadisiyah (IQ)
- Universidade de São Paulo (BR)
- University of Ulster (GB)
- Universitair Ziekenhuis Leuven (BE)
- National School of Public Health, Management and Professional Development (RO)
- University of Ibadan (NG)
- Shanghai Jiao Tong University (CN)
- Shenzhen KangNing Hospital (CN)
- Peking University (CN)
- University of Balamand (LB)
- Chinese University of Hong Kong (HK)
- Israel Ministry of Health (IL)
- Institute of Psychiatry and Neurology (PL)
- Jichi Medical University (JP)
- University of Tasmania (AU)
- Universidad Colegio Mayor de Cundinamarca (CO)
- UNSW Sydney (AU)
- Universidad CES (CO)
- Municipal Institute for Medical Research (ES)
- Universidade Nova de Lisboa (PT)
- National Center of Public Health and Analyses (BG)
- Corresponding author
- Kessler, R. C.
- ORCID
- Venue
- Epidemiology and Psychiatric Sciences
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-02-27
- Volume
- 24
- Issue
- 3
- Pages
- 210-226
- ISSN
- 2045-7960 (ISSN-L)
- 2045-7979
- PMC
- PMC5129607
- OpenAlex
- W1974820251
- Cited by
- 636
- References
- 72
- Citations by year
- 2026: 68 · 2025: 97 · 2024: 100 · 2023: 84 · 2022: 54 · 2021: 57 · 2020: 51 · 2019: 38 · 2018: 32 · 2017: 27 · 2016: 19 · 2015: 9
- FWCI
- 47.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Epidemiology and Psychiatric Sciences (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- HAL (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, other-oa)
- Funders
- Robert Wood Johnson Foundation (044708)
- John W. Alden Trust
- Eli Lilly and Company
- GlaxoSmithKline
- Bundesministerium für Gesundheit
- National Insurance Institute of Israel (H13-SHOGAI-023, H16-KOKORO-013, H14-TOKUBETSU-026)
- Ministry of Health, Labour and Welfare (H16-KOKORO-013, H14-TOKUBETSU-026, H13-SHOGAI-023)
- Ministerstwo Zdrowia
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration (044708)
- Pan American Health Organization
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, R01MH059575, MH60220, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (R03TW006481)
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- major depressive disorder, anxiety disorders, comorbidities, age of onset, suicidal ideation, role impairment, depression treatment, sex differences, marital status, cross-national comparison, income level, World Mental Health Surveys, DSM-IV, Composite International Diagnostic Interview, lifetime prevalence, 12-month prevalence, women's mental health, social determinants of mental health
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