Cited by 242Mental Health Treatment and AccessMental Health Research TopicsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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12‐Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

The ESEMeD/MHEDEA 2000 investigators, Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., de Girolamo, G., de Graaf, R., Demyttenaere, K., Gasquet, I., Haro, J. M., Katz, S. J., Kessler, R. C., Kovess, V., Lépine, J. P., Ormel, J., Polidori, G., Russo, L. J., Vilagut, G., Almansa, J., Arbabzadeh‐Bouchez, S., Autonell, J., Bernal, M., Buist‐Bouwman, M. A., Codony, M., Domingo‐Salvany, A., Ferrer, M., Joo, S. S., Martínez‐Alonso, M., Matschinger, H., Mazzi, F., Morgan, Z., Morosini, P., Palacín, C., Romera, B., Taub, N., Vollebergh, W. A. M.·2004·Acta Psychiatrica Scandinavica

DOI 10.1111/j.1600-0047.2004.00328.x

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Abstract

Objective: Comorbidity patterns of 12‐month mood, anxiety and alcohol disorders and socio‐demographic factors associated with comorbidity were studied among the general population of six European countries. Method: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross‐sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH‐CIDI). Data are based on 21 425 completed interviews. Results: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse—the disorders with the least functional disabilities. Comorbidity patterns were consistent cross‐nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. Conclusion: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

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Lam, R. W. M., Michalak, E. E., Bond, D. J., Tam, E. M., Axler, A., & Yatham, L. N. (2012) · Depression Research and Treatment · doi:10.1155/2012/630206 · Cited by 71
Potentially traumatic event exposure, posttraumatic stress disorder, and Axis I and II comorbidity in a population-based study of Norwegian young adults
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“This study also demonstrated that PTSD was associated with increased odds of many Axis I conditions [3].”
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Diagnostic co-morbidity in 2300 psychiatric out-patients presenting for treatment evaluated with a semi-structured diagnostic interview
Zimmerman, M. A., McGlinchey, J. B., Chelminski, I., & Young, D. (2007) · Psychological Medicine · doi:10.1017/s0033291707001717 · Cited by 66
Mediterranean diet and depression among older individuals: The multinational MEDIS study
Masana, M. F., Haro, J. M., Mariolis, A. D., Piscopo, S., Valacchi, G., Bountziouka, V., Anastasiou, F., Zeimbekis, A., Tyrovola, D., Gotsis, E., et al. (2018) · Experimental Gerontology · doi:10.1016/j.exger.2018.05.012 · Cited by 68
Self-citation
The Social Phobia Psychotherapy Research Network
Leichsenring, F., Hoyer, J., Beutel, M., Herpertz, S., Hiller, W., Irle, E., Joraschky, P., König, H. H., de Liz, T. M., Nolting, B., et al. (2009) · Psychotherapy and Psychosomatics · doi:10.1159/000162299 · Cited by 59
Is depressed mood in childhood associated with an increased risk for initiation of alcohol use during early adolescence?
Crum, R. M., Storr, C. L., Ialongo, N. S., & Anthony, J. C. (2007) · Addictive Behaviors · doi:10.1016/j.addbeh.2007.05.008 · Cited by 57
“In cross-national surveys among adults, alcohol and depressive disorders have been reported to cooccur (Alonso et al., 2004; Andrade, Walters, Gentil, & Laurenti, 2002; Burns & Teesson, 2002; Helzer & Pryzbeck, 1988; Kessler et al., 1997; Grant & Harford, 1995).”
Background
Efficacy and safety of pregabalin in generalised anxiety disorder: A critical review of the literature
Baldwin, D. S., den Boer, J. A., Lyndon, G. J., Emir, B., Schweizer, E. E., & Haswell, H. (2015) · Journal of Psychopharmacology · doi:10.1177/0269881115598411 · Cited by 60
“…is notable for its high prevalence (lifetime, 1.5–3.1%; Kessler and Wang, 2008; Wittchen and Jacobi, 2005), high degree of chronicity (median duration, >10 years; Bruce et al., 2005) and high degree of co-morbidity, most notably with other anxiety disorders and depression (Alonso et al., 2004).”
BackgroundInfluential
Generalised anxiety disorder
Gale, C. K., & Davidson, O. (2007) · BMJ · doi:10.1136/bmj.39133.559282.be · Cited by 62
Effect of Multimorbidity on Health-Related Quality of Life in Adults Aged 55 Years or Older: Results from the SU.VI.MAX 2 Cohort
Walker, V., Perret‐Guillaume, C., Kesse‐Guyot, E., Agrinier, N., Herçberg, S., Galan, P., Assmann, K. E., Briançon, S., & Rotonda, C. (2016) · PLoS ONE · doi:10.1371/journal.pone.0169282 · Cited by 55
Management of Generalized Anxiety Disorder in Primary Care
Davidson, J. R. T., Feltner, D. E., & Dugar, A. (2010) · The Primary Care Companion to The Journal of Clinical Psychiatry · doi:10.4088/pcc.09r00772blu · Cited by 56
G72 and Its Association With Major Depression and Neuroticism in Large Population-Based Groups From Germany
Rietschel, M., Beckmann, L., Strohmaier, J., Georgi, A., Karpushova, A., Schirmbeck, F. N., Boesshenz, K. V., Schmäl, C., Bürger, C., Jamra, R. A., et al. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07060883 · Cited by 55
Somatic Symptoms in Late-Life Anxiety: Treatment Issues
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Social Factors but Not Stress-Coping Styles Predict Relapse in Detoxified Alcoholics
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“Epidemiological studies from Europe and the United States of America indicate that alcohol dependence will affect many individuals at some time in their lives, with men affected more than women [”
Background
Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis
Boer, K. R., Mahler, C. W., Ünlü, Ç., Lamme, B., Vroom, M. B., Sprangers, M. A. G., Gouma, D. J., Reitsma, J. B., de Borgie, C. A. J. M., & Boermeester, M. A. (2007) · Critical Care · doi:10.1186/cc5710 · Cited by 52
“Compared with these general populations, the proportions of patients from an ICU population with PTSD symptomology, a considerable time after discharge, are high [13,25-28].”
BackgroundResult
High prevalence of mental disorders and comorbidity in the Geneva Gay Men’s Health Study
Wang, J., Häusermann, M., Ajdacic‐Gross, V., Aggleton, P., & Weiss, M. G. (2007) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-007-0190-3 · Cited by 52
The impact of educational status on the clinical features of major depressive disorder among Chinese women
Gan, Z., Li, Y., Xie, D., Shao, C., Yang, F., Shen, Y., Zhang, N., Zhang, G., Tian, T., Yin, A., et al. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.06.046 · Cited by 51
“While higher education was associated with lower rates of mood disorder in a pan-European study (Alonso et al., 2004), and in Holland those with the fewest years of education had the highest morbidity rates (Bijl et al., 1998), in Finland no significant difference between different educational…”
Background
Comorbidity in Anxiety Disorders
Merikangas, K. R., & Swanson, S. A. (2009) · Current topics in behavioral neurosciences · doi:10.1007/7854_2009_32 · Cited by 47
“Alonso et al. (2004) reported a strong degree of concurrence betweenmajor depression and specific anxiety disorders, with odds ratios (OR) ranging from 6.”
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Working conditions and depressive symptoms in the 2003 decennial health survey: the role of the occupational category
Cohidon, C., Santin, G., Imbernon, E., & Goldberg, M. (2009) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-009-0157-7 · Cited by 48
Unmet Need for Mental Healthcare in a Population Sample in Sweden: A Cross-Sectional Study of Inequalities Based on Gender, Education, and Country of Birth
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Prevalence of common mental disorders and their work consequences in France, according to occupational category
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Effectiveness of an internet-delivered intervention for generalized anxiety disorder in routine care: A randomised controlled trial in a student population
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Towards an evidence-based unified psychodynamic protocol for emotional disorders
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Pharmacotherapy for anxiety and comorbid alcohol use disorders
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The Comorbidity of Post-traumatic Stress Disorder (PTSD) and Substance Use Disorders
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Troubles dépressifs et recours aux soins dans la population française à partir des données du Baromètre Santé 2005
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Delays in seeking treatment for mental disorders in the Belgian general population
Bruffaerts, R., Bonnewyn, A., & Demyttenaere, K. (2007) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-007-0239-3 · Cited by 41
“That persons with mental disorder show very low treatment rates is a consistent finding in previous population studies [3, 22, 37], but higher than in treatment settings.”
ResultSelf-citation
Post-traumatic stress disorder: emerging concepts of pharmacotherapy
Baker, D. G., Nievergelt, C. M., & Risbrough, V. B. (2009) · Expert Opinion on Emerging Drugs · doi:10.1517/14728210902972494 · Cited by 39
“PTSD is associated with high levels of impairment across social and occupational domains [41,47].”
Background
Inteligencia emocional percibida, ansiedad y afectos en estudiantes universitarios = Perceived emotional intelligence, anxiety and affect on university students
Cazalla-Luna, N., & López-Barajas, D. M. (2015) · REOP - Revista Española de Orientación y Psicopedagogía · doi:10.5944/reop.vol.25.num.3.2014.13858 · Cited by 37
The level of education is associated with an anxiety-depressive state among men and women – findings from France during the first quarter of the COVID-19 pandemic
Joannès, C., Redmond, N. M., Kelly‐Irving, M., Klinkenberg, J., Guillemot, C., Sordes, F., Delpierre, C., Neufcourt, L., Basson, J.-C., Grégory, B., et al. (2023) · BMC Public Health · doi:10.1186/s12889-023-16280-9 · Cited by 41
Estudios poblacionales en España sobre daños relacionados con el consumo de alcohol
Pulido, J., Indave-Ruiz, B. I., Colell, E., Ruiz-García, M., Bartrolí, M., & Barrio, G. (2014) · Revista Española de Salud Pública · doi:10.4321/s1135-57272014000400005 · Cited by 35
Annual Prevalence and Incidence of Schizophrenia and Similar Psychotic Disorders in the Republic of Korea: A National Health Insurance Data-Based Study
Cho, S., Kim, J.-M., Kang, Y. J., Lee, S. Y., Seo, H. Y., Park, J. E., Kim, H., Kim, K., Lee, J. Y., & Sohn, J. H. (2020) · Psychiatry Investigation · doi:10.30773/pi.2019.0041 · Cited by 37
Understanding the addiction cycle: A complex biology with distinct contributions of genotype vs. sex at each stage
Wilhelm, C., Hashimoto, J. G., Roberts, M. L., Sönmez, K., & Wiren, K. M. (2014) · Neuroscience · doi:10.1016/j.neuroscience.2014.08.041 · Cited by 34
“…consistent studies demonstrating higher mortality, worse outcomes, a distinct psychopathology (Helzer and Pryzbeck, 1988, Brady and Randall, 1999, Alonso et al., 2004, Dawson et al., 2010), and greater sensitivity to the detrimental effects of alcohol among women, future research is warranted…”
Background
Gender Differences in Interpersonal Problems of Alcohol-Dependent Patients and Healthy Controls
Mueller, S. E., Degen, B., Petitjean, S. A., Wiesbeck, G. A., & Walter, M. (2009) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph6123010 · Cited by 34
“Women with drinking problems report more depression, more psychiatric problems and are more likely to drink to relieve negative affect [18], which is supported by an European epidemiological study showing that alcohol-dependent women have a higher overall rate of co-morbid psychiatric disorders than men, especially af…”
BackgroundResult
Association of chronic disease prevalence and quality of life with suicide-related ideation and suicide attempt among Korean adults
Lee, S., Joshi, P., & Song, H.-B. (2017) · Indian Journal of Psychiatry · doi:10.4103/psychiatry.indianjpsychiatry_282_16 · Cited by 34
“consistence with other studies, lower education attainment was found associated with chronic disease.[36,37] Occupation”
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Depression and anxiety in later COVID-19 waves across Europe: New evidence from the European COvid Survey (ECOS)
Hajek, A., Neumann‐Böhme, S., Sabat, I., Torbica, A., Schreyögg, J., Barros, P. P., Stargardt, T., & König, H. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114902 · Cited by 32
Source imaging of P300 auditory evoked potentials and clinical correlations in patients with posttraumatic stress disorder
Bae, K., Kim, D.-W., Im, C., & Lee, S. (2011) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2011.08.002 · Cited by 31
“Previous studies have found that the lifetime prevalence rate of PTSD ranges from 5% to 10%, and that the 12-month prevalence rate is about 2–5% (Alonso et al., 2004a, b, c; Kessler et al., 2005; Wittchen and Jacobi, 2005).”
Background
Factores de riesgo psicosociales y ambientales asociados a trastornos mentales
Arredondo, N. H. L., Marín, C. A., Juárez, F., Sañudo, J. E. P., Muñiz, O. A., Escobar, B., Herrón, I., Agudelo, D., Lemos, M., Isaza, B. E. T., et al. (2010) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) · doi:10.14349/sumapsi2010.458 · Cited by 31
Multiple Co-occurring Behaviours among Gamblers in Treatment: Implications and Assessment
Westphal, J. R., & Johnson, L. J. (2007) · International Gambling Studies · doi:10.1080/14459790601157905 · Cited by 33
“…national mental health epidemiological studies in Asia (Kawakami et al., 2004) and Europe (Kringlen et al., 2001) and a six nation European study (Alonso et al., 2004) found similar patterns of co-occurrence as studies in the USA (Kessler et al., 1994; Kessler et al., 2005) despite differences…”
Result
Factors influencing depression endpoints research (FINDER): Study design and population characteristics
Garcia-Cebrian, A., Bauer, M., Montejo, A. L., Dantchev, N., Demyttenaere, K., Gandhi, P., Grassi, L. G., Monz, B. U., David, P., Quail, D., et al. (2007) · European Psychiatry · doi:10.1016/j.eurpsy.2007.10.002 · Cited by 30
Self-citation
Behavioural effects of rapid intravenous administration of meta-chlorophenylpiperazine (m-CPP) in patients with generalized social anxiety disorder, panic disorder and healthy controls
Veen, J. F. V., van der Wee, N. J. A., Fiselier, J., van Vliet, I. M., & Westenberg, H. G. M. (2007) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2007.03.005 · Cited by 29
“Generalized social anxiety disorder (gSAD) and panic disorder (PD) are among the most prevalent anxiety disorders, with reported lifetime prevalences in Europe of 2.4% for SAD and of 2.1% for PD (Alonso et al., 2004a).”
BackgroundInfluential
Marital satisfaction, conflict communication, attachment style and psychological distress in couples with a hospitalized depressed patient
Lemmens, G., Buysse, A., Heene, E., Eisler, I., & Demyttenaere, K. (2007) · Acta Neuropsychiatrica · doi:10.1111/j.1601-5215.2006.00168.x · Cited by 36
Self-citation

Authors: The ESEMeD/MHEDEA 2000 investigators, Alonso, J., Angermeyer, M. C., Bernert, S., Bruffaerts, R., Brugha, T. S., Bryson, H., de Girolamo, G., de Graaf, R., Demyttenaere, K., Gasquet, I., Haro, J. M., Katz, S. J., Kessler, R. C., Kovess, V., Lépine, J. P., Ormel, J., Polidori, G., Russo, L. J., Vilagut, G., Almansa, J., Arbabzadeh‐Bouchez, S., Autonell, J., Bernal, M., Buist‐Bouwman, M. A., Codony, M., Domingo‐Salvany, A., Ferrer, M., Joo, S. S., Martínez‐Alonso, M., Matschinger, H., Mazzi, F., Morgan, Z., Morosini, P., Palacín, C., Romera, B., Taub, N., & Vollebergh, W. A. M.
Affiliations: University of Leicester (GB)
Leipzig University (DE)
KU Leuven (BE)
GlaxoSmithKline (United Kingdom) (GB)
Centro San Giovanni di Dio Fatebenefratelli (IT)
Hôpital Paul-Brousse (FR)
Universitat de Barcelona (ES)
Harvard University (US)
Mutuelle Générale de l'Éducation Nationale (FR)
University of Groningen (NL)
Istituto Superiore di Sanità (IT)
Institut Municipal d'Assistència Sanitària (ES)
Assistance Publique – Hôpitaux de Paris (FR)
Trimbos Institute (NL)
University of Modena and Reggio Emilia (IT)
ORCID: Alonso, J.
Bernert, S.
Bruffaerts, R.
Brugha, T. S.
Bryson, H.
Demyttenaere, K.
Haro, J. M.
Katz, S. J.
Kessler, R. C.
Ormel, J.
Russo, L. J.
Vilagut, G.
Almansa, J.
Domingo‐Salvany, A.
Ferrer, M.
Martínez‐Alonso, M.
Matschinger, H.
Taub, N.
Vollebergh, W. A. M.
Venue: Acta Psychiatrica Scandinavica
Publisher: Wiley
Published: 2004-06
Volume: 109
Issue: s420
Pages: 28-37
ISSN: 0001-690X (ISSN-L)
1600-0447
DOI: 10.1111/j.1600-0047.2004.00328.x
OpenAlex: W1978533844
Cited by: 242
References: 35
Citations by year: 2025: 2 · 2024: 1 · 2023: 5 · 2022: 7 · 2021: 5 · 2020: 8 · 2019: 7 · 2018: 10 · 2017: 15 · 2016: 9 · 2015: 12 · 2014: 23 · 2013: 14 · 2012: 12
FWCI: 21.79
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 13 d)
Locations: Acta Psychiatrica Scandinavica (publishedVersion)
PubMed (publishedVersion)
Leicester Research Archive (University of Leicester) (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Funders: GlaxoSmithKline
European Commission
Instituto de Salud Carlos III
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: psychiatric comorbidity, mood disorders, anxiety disorders, alcoholism, specific phobia, alcohol abuse, sociodemographic risk factors, cross-national comparison, mental health burden, early intervention
MeSH terms: Adolescent, Adult, Aged, Alcoholism, Anxiety, Cross-Sectional Studies, Demography, Europe, Female, Humans, International Cooperation, Male, Middle Aged, Psychology, Comorbidity, Prevalence, Mood Disorders

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12‐Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project

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