Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-01-26T07:15:41.103Z Has data issue: false hasContentIssue false
  • English
  • Français

Anxiety Disorders: Similarities and Differences of Comorbidity in Treated and Untreated Groups

Published online by Cambridge University Press:  06 August 2018

Hans-Ulrich Wittchen ,
Cecilia Ahmoi Essau  and
Jürgen-Christian Krieg
Hans-Ulrich Wittchen*
Affiliation:
Max Planck Institute for Psychiatry, Clinical Institute, Kraepelinstr. 10, 8000 Munich 40, Germany
Cecilia Ahmoi Essau
Affiliation:
Max Planck Institute for Psychiatry, Clinical Institute, Kraepelinstr. 10, 8000 Munich 40, Germany
Jürgen-Christian Krieg
Affiliation:
Max Planck Institute for Psychiatry, Clinical Institute, Kraepelinstr. 10, 8000 Munich 40, Germany
*
Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

The similarities and differences of comorbidity in treated and untreated samples with anxiety disorders were examined using data from the Munich Follow-up Study: 133 subjects with anxiety and depressive disorders and 101 former in-patients at the Max Planck Institute for Psychiatry. Diagnoses were based on the DIS, not using the optional DSM—III exclusion rules. In these epidemiological and clinical samples, 69% and 95% respectively had at least two diagnoses. The epidemiological sample was clearly differentiated from the clinical sample by age of onset. The development of both depressive episodes and substance disorders in the two samples was mostly secondary to the development of anxiety problems. The outcome for subjects with both anxiety and depressive disorders tended to be worse than that for those with anxiety alone, regardless of whether a depressive episode was present at the time of the follow-up investigation. The usefulness is underlined of the comorbidity concept based on operationalised diagnosis without the exclusion rules offered by DSM—III and DSM—III—R.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 159 , Issue S12: Anxiety and Serotonin , September 1991 , pp. 23 - 33
Copyright
Copyright © The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Angst, J. & Dobler-Mikola, A. (1985) The Zurich Study V. Anxiety and phobia in young adults. European Archives of Psychiatry and Neurological Science, 234, 408–418.CrossRefGoogle Scholar
Angst, J., Vollrath, M., Merikangas, K., et al (1990) Comorbidity of anxiety and depression in the Zurich Cohort Study of young adults. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 123–137. Washington, DC: American Psychiatric Press.Google Scholar
Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie (1979) Das AMDP-System: Manual zur Dokumentation psychiatrischer Befunde (3. Aufl). Heidelberg: Springer.Google Scholar
Barlow, D. H., Blanchard, E. B., Vermilyea, J. A., et al (1986) Generalized anxiety and generalized disorder: description and reconceptualization. American Journal of Psychiatry, 143, 40–44.Google ScholarPubMed
Bland, R. C., Orn, H. & Newman, S. C. (1988) Lifetime prevalence of psychiatric disorders in Edmonton. Acta Psychiatrica Scandinavica, 77 (suppl. 338 ), 24–32.CrossRefGoogle Scholar
Breier, A., Charney, D. S. & Heninger, G. R. (1984) Major depression in patients with agoraphobia and panic disorder. Archives of General Psychiatry, 41, 1129–1135.CrossRefGoogle ScholarPubMed
Breier, A., Charney, D. S. & Honinger, G. R. (1985) The diagnostic validity of anxiety disorders and their relationship to depressive illness. American Journal of Psychiatry, 142, 787–797.Google ScholarPubMed
Buller, R., Maier, W. & Benkert, O. (1986) Clinical subtypes in panic prospective validity. Journal of Affective Disorders, 11, 105–114.CrossRefGoogle ScholarPubMed
Burke, K. C., Burke, J. D., Regier, D. A., et al (1990a) Age at onset of selected mental disorders in five community populations. Archives of General Psychiatry, 47, 511–518.CrossRefGoogle ScholarPubMed
Burke, J. D., Wittchen, H.-U., Regier, D. A., et al (1990b) Extracting information from diagnostic interviews on cooccurrence of symptoms of anxiety and depression. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 649–669. Washington, DC: American Psychiatric Press.Google Scholar
Canino, G. S., Bird, H. R., Shrout, P. E., et al (1987) The prevalence of specific psychiatric disorders in Puerto Rico. Archives of General Psychiatry, 44, 727–735.CrossRefGoogle ScholarPubMed
Clare, A. W. & Cairns, V. E. (1978) Design, development and use of a standardized interview to assess social maladjustment and dysfunction in community studies. Psychological Medicine, 8, 589–604.CrossRefGoogle ScholarPubMed
Clancy, J., Noyes, R., Hoenk, P. R., et al (1978) Secondary depression in anxiety neurosis. Journal of Nervous and Mental Disease, 166, 846–850.CrossRefGoogle ScholarPubMed
Coryell, W., Endicott, J., Andreasen, N. C., et al (1988) Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. American Journal of Psychiatry, 145, 293–300.Google ScholarPubMed
Endicott, J., Spitzer, R. L., Fleiss, J. L., et al (1976) A procedure for measuring overall severity of psychiatry disturbance. Archives of General Psychiatry, 33, 766–771.CrossRefGoogle ScholarPubMed
Faltermaier, T., Wittchen, H.-U., Ellman, R., et al (1985) The Social Interview Schedule (SIS): the German version of a standardized interview to assess social maladjustment. Social Psychiatry, 20, 115–124.CrossRefGoogle Scholar
Feinstein, A. R. (1970) The pre-therapeutic classification of comorbidity in chronic disease. Journal of Chronic Disease, 23, 455–468.CrossRefGoogle ScholarPubMed
Feuerlein, W., Küfner, H., Ringer, C., et al (1979) Müunchner Alkoholismustest (MALT). Manual. Weinheim: Beltz.Google Scholar
Hecht, H., Faltermaier, T. & Wittchen, H.-U. (1987) Social Interview Schedule (SIS). Halbstrukturiertes Interview zur Erfassung der aktuellen sozialpsychologischen Situation. Regensburg: Roderer.Google Scholar
Hecht, H., von Zerssen, D., Krieg, C. J., et al (1989) Anxiety and depression: comorbidity, psychopathology, and social functioning. Comprehensive Psychiatry, 30, 420–433.CrossRefGoogle ScholarPubMed
Hollingshead, A. B. & Redlich, F. C. (1958) Social Class and Mental Illness. New York: Wiley.CrossRefGoogle Scholar
Klein, D. F. (1981) Anxiety reconceptualized. In Anxiety: New Research and Changing Concepts (eds Klein, D. F. & Rabkin, J. G.), pp. 235–265. New York: Raven Press.Google Scholar
Leckman, J. F., Weissman, M. M., Merikangas, K. R., et al (1983) Panic disorder increases risk of major depression, alcoholism, panic, and phobic disorders in affectively ill families. Archives of General Psychiatry, 40, 1055–1060.CrossRefGoogle Scholar
Lepine, J. P. (1987) Epidemiologic des attaques de panique et de l'agoraphobie. In L'attaque de panique: un nouveau concept? (ed. Boulenger, J. P.). Chateau de Loir: Goureau.Google Scholar
Lepine, J. P., Wittchen, H.-U. & Essau, C. A. (1991) Lifetime and current comorbidity of anxiety and depressive disorders: results from the International WHO/ADAMHA CIDI field trials. European Archives of Psychiatry and Neurological Sciences (submitted).Google Scholar
Lesser, I. M., Rubin, R. I., Pecknold, J. C., et al (1988) Secondary depression in panic disorder and agoraphobia. Archives of General Psychiatry, 45, 437–443.CrossRefGoogle ScholarPubMed
Marks, I. M. (1987) Fear, Phobias, and Rituals. Panic, Anxiety, and Their Disorders. Oxford: Oxford University Press.Google Scholar
Maser, J. D. & Cloninger, C. R. (eds) (1990) Comorbidity of Mood and Anxiety Disorders. Washington, DC: American Psychiatric Press.Google Scholar
Mavissakalian, M. (1986) Initial depression and response to imipramine in agoraphobia. Journal of Nervous and Mental Disease, 175, 358–361.CrossRefGoogle Scholar
Mavissakalian, M. & Michelson, L. (1986) Agoraphobia: relative and combined effectiveness of therapist-assisted in vivo exposure and imipramine. Journal of Clinical Psychiatry, 47, 117–122.Google ScholarPubMed
Merikangas, K. (1990) Comorbidity for anxiety and depression: review of family and genetic studies. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 331–348. Washington, DC: American Psychiatric Press.Google Scholar
Myers, J. K., Weissman, M. M., Tischler, G. L., et al (1984) Six-month prevalence of psychiatric disorders in three communities. Archives of General Psychiatry, 41, 959–967.CrossRefGoogle ScholarPubMed
Noyes, R. Jr, Clancy, J., Crowe, R., et al (1978) The familial prevalence of anxiety neurosis. Archives of General Psychiatry, 35, 1057–1059.CrossRefGoogle ScholarPubMed
Raskin, M., Pecke, H. V. S., Dickman, W., et al (1982) Panic and generalized anxiety disorder. Archives of General Psychiatry, 39, 687–689.CrossRefGoogle Scholar
Regier, D. A., Meyer, J. K., Kramer, M., et al (1984) The NIMH Epidemiologic Catchment Area (ECA) Program: historical context, major objective, and study population characteristics. Archives of General Psychiatry, 41, 934–941.CrossRefGoogle ScholarPubMed
Regier, D. A., Burke, J. D. & Burke, K. C. (1990) Comorbidity of affective and anxiety disorders in the NIMH Epidemiological Catchment Area Program. In Comorbidity of Mood and Anxiety Disorders (eds Maser, J. D. & Cloninger, C. R.), pp. 113–121. Washington, DC: American Psychiatric Press.Google Scholar
Robins, L. N., Helzer, J. E., Ratcliff, K. S., et al (1982) Validity of the Diagnostic Interview Schedule, version II: DSM–III diagnoses. Psychological Medicine, 12, 855–870.CrossRefGoogle ScholarPubMed
Robins, L. N., Helzer, J. E., Weissman, M. M., et al (1984) Lifetime prevalence of psychiatric disorders at three sites. Archives of General Psychiatry, 41, 949–959.CrossRefGoogle Scholar
van Valkenburg, C., Akiskal, H. S., Puzantian, V., et al (1984) Anxious depressions: clinical, family history, and naturalistic outcome – comparisons with panic and major depressive disorders. Journal of Affective Disorders, 6, 67–82.CrossRefGoogle ScholarPubMed
von Zerssen, D. (1986) Clinical Self-Rating Scales (CSRS) of the Munich Psychiatric Information System (PSYCHIS München). In Assessment of Depression (eds Sartorius, N. & Ban, T. A.), pp. 270–303. Berlin: Springer.CrossRefGoogle Scholar
von Zerssen, D., unter Mitarbeit von Koeller, D.-M. (1976) Klinische Selbstbeurleilungs – Skalen (KSb-S) aus dem Müncher Psychiatrischen Informationssystem (PSYCHIS München). Manuale. a) Allgemeiner Teil. b) Paranoid-Depressivitätsskala. c) Befind-lichkeitsskala. d) Beschwerden-Liste. Weinheim: Beltz Test.Google Scholar
Weissman, M. M., Leckman, J. F., Merikangas, K. R., et al (1984) Depressive and anxiety disorders in parents and children. Archives of General Psychiatry, 41, 845–852.CrossRefGoogle ScholarPubMed
Wittchen, H.-U. (1984) The German Version of the Diagnostic Interview Schedule (DIS Version 2) – Reliability and Results from a General Population Survey. Report to the Division of Biometry and Epidemiology, NIMH. Bethesda: NIMH.Google Scholar
Wittchen, H.-U. (1986) Epidemiology of panic attacks and panic disorders. In Panic and Phobias – Empirical Evidence of Theoretical Models and Longterm Effects of Behavioral Treatments (eds Hand, I. & Wittchen, H.-U.), pp. 18–28. Heidelberg: Springer.Google Scholar
Wittchen, H.-U. (1987) Chronic difficulties and life events in the long term course of affective and anxiety disorders: result from the Munich Follow-up Study. In From Social Class to Social Stress – New Developments in Psychiatric Epidemiology in From Social Class to Social Stress – New Developments in Psychiatric Epidemiology (ed. Angermeyer, C.), pp. 176–196. Heidelberg: Springer.Google Scholar
Wittchen, H.-U. (1988) Natural course and spontaneous remissions of untreated anxiety disorders: results of the Munich Follow-up Study (MFS). In Panic and Phobias 2. Treatments and Variables Affecting Course and Outcome in Panic and Phobias 2. Treatments and Variables Affecting Course and Outcome (eds Hand, I. & Wittchen, H.-U.), pp. 3–17. Heidelberg: Springer.Google Scholar
Wittchen, H.-U., Semler, G. & von Zerssen, D. (1985) A comparison of two diagnostic methods – clinical ICD diagnosis versus DSM–III and Research Diagnostic Criteria using the Diagnostic Interview Schedule (Version 2). Archives of General Psychiatry, 42, 677–684.CrossRefGoogle Scholar
Wittchen, H.-U. & von Zerssen, D. (eds) (1988) Verläufe behandelter und unbehandelter Depressionen und Angststörungen. Heidelberg: Springer.CrossRefGoogle Scholar
Wittchen, H.-U., Burke, J. D., Semler, G., et al (1989a) Recall and dating reliability of psychiatric symptoms – test–retest reliability of time related symptom questions in a standardized psychiatric interview (CIDI/DIS). Archives of General Psychiatry, 46, 437–443.CrossRefGoogle Scholar
Wittchen, H.-U., Hand, J. & Hecht, H. (1989b) Prävalenz, Komorbidität und Schweregrad von Angstörnngen. Zeitschrift für Klinische Psychologic 18, 117–133.Google Scholar
Wittchen, H.-U. & Essau, C. A. (1989) Comorbidity of anxiety disorders and depression: does it affect course and outcome? Journal of Psychiatry and Psychobiology, 4, 315–323.CrossRefGoogle Scholar
Wittchen, H.-U. & Bronish, T. (1991) Use, abuse, and dependence of alcohol in West Germany – Lifetime and six-month prevalence in the Munich Follow-up Study. In Cross-National Comparison of Rates of Alcoholism (eds Helzer, J. & Canino, G.). Oxford: Oxford University Press.Google Scholar
Zitrin, C. M., Klein, D. F., Woerner, M. G. (1980) Treatment of agoraphobia with group exposure in vivo and imipramine. Archives of General Psychiatry, 37, 63–72.CrossRefGoogle ScholarPubMed
Zitrin, C. M., Klein, D. F., Woerner, M. G. et al (1983) Treatment of phobias: comparison of imipramine hydrochloride and placebo. Archives of General Psychiatry, 40, 125–138.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.