Cited by 541Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional Development

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Depression Comorbid with Anxiety: Results from the WHO Study on Psychological Disorders in Primary Health Care

Sartorius, Nornam, Üstün, T. Bedirhan, Lecrubier, Yves, Wittchen, Hans-Ulrich·1996·British Journal of Psychiatry

DOI 10.1192/s0007125000298395

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Abstract

The World Health Organization collaborative study on “Psychological Problems in General Health Care” investigated the form, frequency, course and outcome of common psychological problems in primary care settings at 15 international sites. The research employed a two-stage case-finding procedure. GHQ–12 was administered to 25 916 adults who consulted health-care services. The second-stage assessment (n=5438) consisted of the Composite International Diagnostic Interview (GDI), the Social Disability Schedule, and questionnaires. Possible cases or borderline cases of mental disorder, and a sample of known cases, were followed up at three months and one year. Using standard diagnostic algorithms (ICD–10), prevalence rates were calculated for current disorder (one-month) and lifetime experience disorder. Well-defined psychological problems are frequent in all the general health-care settings examined (median 24.0%). Among the most common were depression, anxiety, alcohol misuse, somatoform disorders, and neurasthenia. Nine per cent of patients suffered from a “subthreshold condition” that did not meet diagnostic criteria but had clinically significant symptoms and functional impairment. The most common co-occurrence was depression and anxiety. Comorbidity increases the likelihood of recognition of mental disorders in general health care, and the likelihood of receiving treatment.

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Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results From the National Comorbidity Survey
Kessler, R. C. (1994) · Archives of General Psychiatry · doi:10.1001/archpsyc.1994.03950010008002 · Cited by 12,370

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Poverty and mental health among migrants: When is ingroup exposure more protective than social ties?
Tulin, M., & Smith, S. (2020) · SSM - Population Health · doi:10.1016/j.ssmph.2020.100599 · Cited by 3
Vitamin D status was not associated with anxiety, depression, or health-related quality of life in Middle Eastern and African-born immigrants in Sweden
Granlund, L., Ramnemark, A., Andersson, C., Lindkvist, M., Norberg, M., & Fhärm, E. (2020) · Nutrition Research · doi:10.1016/j.nutres.2020.02.006 · Cited by 5
MENTAL ILL-HEALTH AND HEART FAILURE COMORBIDITY
Ahmed, M., Morrissey, H., & Ball, P. (2019) · International Journal of Current Pharmaceutical Research · doi:10.22159/ijcpr.2019v11i4.34931 · Cited by 3
“The mixed anxiety-depressive disorder is also common in primary care; where the patient exhibits broadly equal amounts of anxiety and depressive symptoms [25].”
Background
[Is there room for improvement in the Spanish version of the scaled General Health Questionnaire (GHQ-28)?].
Balsategui, A. R., & Rodríguez, J. (2011) · Atención Primaria · doi:10.1016/j.aprim.2010.11.011 · Cited by 3
Experience of Trained Primary Health Care Workers in Mental Health Service Delivery across Ogun State Nigeria
Timothy, A., Onofa, L. E. U., Ighoroje, M., Gater, R. A., Adegboyega, O., Niran, O., Ogundele, A. T., Samuel, O., Funmilayo, O., Modupe, O., et al. (2017) · Clinical Psychiatry · doi:10.21767/2471-9854.100035 · Cited by 2
“This result is quite contrary to several other studies that reported mild-moderate depression, dysthymia, anxiety, somatoform and alcohol use disorders as the most common disorders in primary mental health care delivery [25,27-29].”
Result
[(Expected) Consultation length, mental (co-)morbidity and patient satisfaction in the family practice encounter].
Klement, A., Oemler, M., Wienke, A., Richter, M., & Wolfradt, U. (2015) · Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen · doi:10.1016/j.zefq.2015.08.005 · Cited by 3
Cultural Applicability of Screening Tools for Measuring Symptoms of Depression
Roy, T., & Lloyd, C. (2013) · Springer eBooks · doi:10.1007/978-0-85729-751-8_4 · Cited by 3
Are Anxiety and Depression Two Sides of the Same Coin?
Jones, J. E. (2008) · Elsevier eBooks · doi:10.1016/b978-0-12-374006-9.00007-2 · Cited by 4
Psychiatric services as seen by GPs: A survey among primary care physicians in two Finnish cities
Kaltiala-Heino, R., Korkeila, J., Tuori, T., & Isohanni, M. (1998) · doi:10.1080/08039489850139427 · Cited by 3
Evidence for the anxiolytic- and antidepressant-like effects of three semi-synthetic derivatives of xylopic acid in mice
Benneh, C., Abotsi, W. M., Mante, P., Biney, R., Fetse, J. P., Abeka, M. K., Adongo, D. W., & Woode, E. (2025) · Naunyn-Schmiedeberg's Archives of Pharmacology · doi:10.1007/s00210-025-03814-8 · Cited by 2
“Concurrent treatment of both disorders positively affects the outcome of therapy (Bakish 1999; Rivas-Vazquez et al. 2004; Sartorius et al. 1996).”
What’s in a Face? Amygdalar Sensitivity to an Emotional Threatening Faces Task and Transdiagnostic Internalizing Disorder Symptoms in Participants Receiving Attention Bias Modification Training
Rengasamy, M. L., Woody, M. L., Kovats, T., Siegle, G. J., & Price, R. B. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10205-9 · Cited by 2
“Because anxiety and depression are highly comorbid conditions, anxious patients may also exhibit reductions in their comorbid depressive symptoms following ABM (Sartorius et al. 1996).”
Background
Chest pain following the use of fluvoxamine in depression
Pang, T., & Gudi, A. (2018) · Proceedings of Singapore Healthcare · doi:10.1177/2010105818802993 · Cited by 2
Ethnic differences in the Prevalence of Thyroid disorders among population of Far Western Region of Nepal
Pandeya, D. R., Bhatt, M. P., Bhatta, M. P., & Bhattarai, J. P. (2017) · Medical Journal of Shree Birendra Hospital · doi:10.3126/mjsbh.v16i2.18544 · Cited by 2
The effects of depression and anxiety levels on the status of recovery in patients with idiopathic sudden sensorineural hearing loss
Mert, D. G., Durmuş, K., Kelleci, M., Karataş, T. D., & Altuntaş, E. (2016) · doi:10.2399/jmu.2016002011 · Cited by 2
“As the literature shows a high level of comorbidity between depression and anxiety,([9,10]) it may be necessary to evaluate anxiety while studying the effects of depression on recovery from a physical illness.”
Background
Relationship between Alcohol Dependence and Depression of Alcohol Dependent Inpatients
Choi, B.-Y., & Jeong, H.-C. (2015) · Bio-Science and Bio-Technology · doi:10.14257/ijbsbt.2015.7.5.37 · Cited by 2
“According to a report by the WHO, the social and economic burden due to depression is increasing continuously and is expected to rank second among all diseases by 2020 [9].”
Background
Clinical characteristics and patterns of referral to a primary mental health team: A retrospective study
Jespersen, S., Chong, T., Gray, K., Carrin, D., Morton, L., Robinson, T., & Inglis, S. (2009) · Asia-Pacific Psychiatry · doi:10.1111/j.1758-5872.2009.00020.x · Cited by 2
“A large study of primary care settings found that 25% of patients had a depressive or anxiety disorder, and only half of these were detected by the primary care physician (Sartorius et al. 1996).”
Background
War psychiatry
Wessely, S. (2008) · British Journal of Psychiatry · doi:10.1192/bjp.192.3.177 · Cited by 2
The role of psychiatry in U.S. Air Force primary care: research-based models for clinical consultation and education.
Higgins, M. J., & Lacy, T. (2006) · Military Medicine · doi:10.7205/milmed.171.11.1117 · Cited by 2
Depression and Anxiety Observed In Parents of Children Diagnosed with Chronic Neurological Diseases
Yenici, A., Aydınlı, N., & Çalışkan, M. (2019) · Tuberculin Skin Test in Children · doi:10.5222/j.child.2019.87094 · Cited by 2
Diagnosing Mental Health Disorders in Primary Care: Evaluation of a New Training Tool
Satter, R. M., & Kinnier, R. T. (2012) · PsycEXTRA Dataset · doi:10.1037/e646542012-001 · Cited by 2
“The choice avatar group did not outperform the text-based training group.”
Background
Hausärztliche Arbeitsmethodik – Strukturierte Anamnese
Mühlenfeld, H.-M. (2026) · Allgemeinmedizin up2date · doi:10.1055/a-2507-0757 · Cited by 1
Respiratory Sinus Arrhythmia—Common and Distinct Mechanisms of Emotional Adjustment in the Depressive and Anxiety Disorders Spectrum?
Adolph, D., Zhang, X. C., Teismann, T., Wannemüller, A., & Margraf, J. (2025) · Psychophysiology · doi:10.1111/psyp.70079 · Cited by 2
“Although current nosologic systems list depressive and anxiety disorders as distinct disorder categories, they are highly comorbid (Gorman 1996; Kessler et al. 2005; Sartorius et al. 1996) and share a considerable amount of symptomatology (Clark and Watson 1991).”
Independent and joint trajectories of depression and anxiety symptoms among Chinese male sailors throughout a prolonged non-24-h rotating shift schedule at sea: a parallel-process growth mixture modeling approach
Tu, Z., Tian, F., He, J., Wang, C., Tian, J., & Shen, X. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05389-1 · Cited by 1
“What is more, few studies paid attention to the co-existence of depression and anxiety symptoms in the study field of shift work, although numerous studies have shown that the comorbid states of depression and anxiety are common [19– 21].”
Background
Hematochezia caused by tandospirone in a patient with major depressive disorder and anxious distress: a case report
Jiang, X., Ma, Z., Li, Z., Ou, Y., Luo, Z., & Li, Z. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1209354 · Cited by 1
Coexistence of mental and somatic diseases and difficulties in diagnosis and working with mentally ill people
Janeczek, P. (2022) · Journal of Education, Health and Sport · doi:10.12775/jehs.2022.12.07.065 · Cited by 1
“Similar population-based studies in other countries have demonstrated a similar magnitude of the phenomenon [24, 25, 26].”
Result
The Global Epidemiology of Mental and Substance Use Disorders
Heslin, K. C. (2019) · Springer eBooks · doi:10.1007/978-3-030-18435-3_2 · Cited by 2
Investigating the relationship between plasma neuropeptide-S levels and clinical depression
Baykan, H., Durmaz, O., Baykan, O., Can, M. Ş., Kara, H., Hişmioğullari, A., & Karlıdere, T. (2018) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2018.1444088 · Cited by 1
“Clinical trials showed that anxiety and related symptoms, as well as anxiety spectrum disorders, were associated with high comorbidity in major depressive disorder [17,18].”
Background

Authors: Sartorius, N., Üstün, T. B., Lecrubier, Y., & Wittchen, H.-U.
Affiliations: University of Geneva (CH)
World Health Organization (CH)
Inserm (FR)
Corresponding author: Üstün, T. Bedirhan
Venue: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
Published: 1996-06
Volume: 168
Issue: S30
Pages: 38-43
ISSN: 0007-1250 (ISSN-L)
1472-1465
DOI: 10.1192/s0007125000298395
OpenAlex: W2765030473
Cited by: 541
References: 0
Citations by year: 2026: 7 · 2025: 11 · 2024: 6 · 2023: 23 · 2022: 13 · 2021: 19 · 2020: 28 · 2019: 26 · 2018: 21 · 2017: 17 · 2016: 17 · 2015: 21 · 2014: 18 · 2013: 17 · 2012: 24
FWCI: 18.96
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified, 8101 d)
Locations: The British Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Max Planck Institute for Plasma Physics (submittedVersion)
MPG.PuRe (Max Planck Society) (submittedVersion)
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
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords: depression, anxiety, comorbidities, primary care, mental illness, prevalence, mental disorder recognition, treatment seeking, alcohol abuse, somatoform disorders, neurasthenia
MeSH terms: Adolescent, Adult, Aged, Antidepressive Agents, Anxiety Disorders, Chronic Disease, Depressive Disorder, Female, Humans, Male, Middle Aged, Primary Health Care, Professional Impairment, Psychotropic Drugs, Sampling Studies, World Health Organization, Comorbidity, Prevalence, Odds Ratio

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Depression Comorbid with Anxiety: Results from the WHO Study on Psychological Disorders in Primary Health Care

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