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Implications of comorbidity: lessons from epidemiological studies1

Published online by Cambridge University Press:  11 October 2011

Hans-Ulrich Wittchen
Hans-Ulrich Wittchen*
Affiliation:
Max Planck Institute of Psychiatry (Clinical Institute), Clinical Psychology, Munich, Germany
*
Indirizzo per la corrispondenza: Professor H.U. Wittchen, Max Planck Institute für Psychiatrie, Klinisches Institut, Kraepelinstrasse 10, 80804 München (Germany). Fax +49 - 89-3062.2544
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Summary

Objective – The paper discusses conceptual, methodological and clinical issues of comorbidity from the perspective of more recent epidemiological studies. Further the potential causal and pathogenic role of temporally primary disorders for the onset of secondary disorders is evaluated. Results – The available data suggest so far that comorbidity (a) is not an artefact of assessment strategies, sampling or design features, (b) is specific in different disorders, (c) is particularly frequent in anxiety and affective disorders, (d) affects systematically the course of the comorbid conditions and (0 might be related to symptom progression models. Conclusions – Furthermore, evidence is presented that specific forms of primary anxiety disorders affect the risk for secondary depressive disorders, increase the likelihood of non-remission as well as the number of subsequent depressive episodes.

Riassunto

Scopo - Lo studio affronta problemi concettuali, metodologici e clinici della comorbidità, alia luce dei piu recenti studi epidemiologici. Inoltre viene valutata la causa potenziale e il ruolo patogenetico dei disturbi temporaneamente primari per la comparsa dei disturbi secondari. Risultati - I risultati disponibili fino ad oggi suggeriscono che la comorbidità (a) non è un artefatto delle strategic di valutazione, del campionamento o del disegno, (b) è specifica nei differenti disturbi, (c) e particolarmente frequente nei disturbi affettivi e d'ansia, (d) influisce sistematicamente sull'andamento delle condizioni di comorbidita è (f) potrebbe essere correlata con modelli di evoluzione dei sintomi. Conclusioni - È inoltre evidente che forme specifiche di disturbi di ansia primaria comportano il rischio di sviluppare disturbi depressivi. secondari, aumentano la probability di non remissione cosi come il numero di successivi episodi depressivi.

Keywords

comorbiditàprogressione dei sintomiansiadisturbi affettividisturbi da abuso di sostanzeepidemiologiacomorbiditysymptom progressionanxietyaffective and substance disordersepidemiology
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 5 , Issue 2 , August 1996 , pp. 114 - 125
Copyright
Copyright © Cambridge University Press 1996

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Footnotes

1

Based on IRGASD (Italian Research Group for Affective and Schizophrenic Disorders) lecture, organised by the Institute of Psychiatry of the University of Verona, and delivered in Verona on December 4th 1995. IRGASD activities carried out under the auspices of Dr. Paul Janssen Medical Institute, are supported by Janssen-Cilag.

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