The comorbidity of anxiety disorders and physical diseases : an epidemiological approach

Abstract Background: Anxiety disorders are highly comorbid with other mental disorders. This has important implications for individuals’ burden, etiology of the comorbid diseases and treatment. Knowledge about the comorbidity with physical diseases in the community, however, is limited, especially for specific anxiety disorders. This dissertation evaluates the comorbidity of specific anxiety disorders and noncommunicable and communicable physical diseases in the general population. Further, it investigates the association of comorbidity with measures of burden, namely, quality of life and disability. Method: Data of the German Health Interview and Examination Survey (GHS), a representative general population survey from Germany with 4,181 subjects aged 18-65 years, were used. Anxiety disorders were diagnosed using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI), noncommunicable physical diseases were assessed through a self-report questionnaire and a standardized medical interview, and communicable physical diseases through a self-report questionnaire. Results: Both obsessive-compulsive disorder (OCD) and specific phobia were associated with migraine and respiratory diseases. Additionally, subthreshold forms of OCD were associated with specific noncommunicable physical diseases. Agoraphobia, specific phobia, and generalized anxiety disorder were all associated with whooping cough. The documented comorbidity was associated with increased disability and decreased quality of life. Discussion: The detected comorbidity patterns may contribute to a better understanding of the psychobiological pathways of comorbidity. Further, increased burden of individuals affected underlines the need for studies evaluating the effect of treatment in comorbid cases. ------------------------------------------------------------------------------------------------------------------------ Zusammenfassung Hintergrund: Angststörungen weisen eine hohe Komorbidität mit anderen psychischen Störungen auf. Dies hat wichtige Implikationen für die Belastung der Betroffenen, sowie für die Ätiologie und Therapie der komorbiden Störungen. Die Datenlage zur Komorbidität mit körperlichen Erkrankungen in der Bevölkerung ist jedoch für spezifische Angststörungen eingeschränkt. Die vorliegende Dissertation untersucht den Zusammenhang zwischen spezifischen Angststörungen und nichtübertragbaren und übertragbaren körperlichen Erkrankungen in der Bevölkerung. Weiter wird die Assoziation der Komorbidität mit Lebensqualität und Beeinträchtigung untersucht. Methode: Analysiert wurden die Daten des Bundesgesundheitssurvey, einer repräsentativen Bevölkerungsstichprobe Deutschlands mit 4’181 Probanden im Alter von 18-65 Jahren. Angststörungen wurden mit dem DIA-X/M-CIDI Interview erhoben, nichtübertragbare körperliche Erkrankungen mit einem ärztlichen Interview, sowie mit einem Fragebogen und übertragbare körperliche Erkrankungen mit einem Fragebogen. Resultate: Sowohl die Zwangsstörung als auch die Spezifische Phobie traten gehäuft mit Migräne und Atemwegserkrankungen auf. Auch subklinische Formen der Zwangsstörung waren mit spezifischen, nichtübertragbaren körperlichen Erkrankungen assoziiert. Agoraphobie, Spezifische Phobie und Generalisierte Angststörung gingen mit erhöhten Prävalenzraten von Keuchhusten einher. Komorbidität war mit erhöhter Beeinträchtigung und niedrigerer Lebensqualität assoziiert. Diskussion: Die Komorbidiätsmuster können zu einem besseren Verständnis der zugrundeliegenden Mechanismen beitragen. Die assoziierte Belastung unterstreicht die Bedeutung weiterer Forschung zur Wirksamkeit der Therapie bei komorbiden Erkrankungen.

Physical diseases among persons with obsessive compulsive symptoms and disorder: a general population study

Purpose: This study aimed at evaluating the comorbidity between DSM-IV obsessive compulsive disorder (OCD) and subthreshold forms and physical diseases in the general population as well as disability associated with comorbidity. Methods: We used data from the 1998 German Mental Health Survey, a representative survey of the German population. Mental disorders and physical diseases of 4181 subjects (aged 18-65) were cross-sectionally assessed. Mental disorders were diagnosed using the M-CIDI/DIA-X interview. Physical diseases were assessed through a self-report questionnaire and a standardized medical interview. We created three groups of obsessive-compulsive symptoms: (1) no obsessive compulsive symptoms (n=3,571); (2) obsessive compulsive symptoms (OCS, n=371; endorsement of OCS (either obsession or compulsion) without fulfilling any core DSM-IV criteria); (3) subthreshold OCD/OCD (n=239; fulfilling either some or all of the core DSM-IV criteria). Results: In comparison to subjects without OCS, subjects with subthreshold OCD/OCD showed higher prevalence rates of migraine headaches (OR 1.7; 95% CI 1.1-2.5) and respiratory diseases (OR 1.7; 95% CI 1.03-2.7); subjects with OCS showed higher prevalence rates of allergies (OR 1.6; 95% CI 1.1-2.8), migraine headaches (OR 1.9; 95% CI 1.4-2.7) and thyroid disorders (OR 1.4; 95% CI 1.01-2.0). Subjects with both OCS and physical disease reported the highest number of days of disability due to physical or psychological problems during the past 30days compared to subjects with only OCS, only physical disease or neither of them. Conclusions: OCD and subthreshold forms are associated with higher comorbidity rates with specific physical diseases and higher disability than subjects without OCS. Possible etiological pathways should be evaluated in future studies and clinicians in primary care should be aware of these associations

Associations of specific phobia and its subtypes with physical diseases: an adult community study.

Specific phobia is the most prevalent anxiety disorder in the community and is associated with substantial impairment. Comorbidity with physical diseases is assumed and has important implications for etiology, treatment, or prevention of the comorbid conditions. However, due to methodological issues data are limited and subtypes of specific phobia have not been investigated yet. We examined the association of specific phobia and its subtypes with physical diseases in a representative community sample with physician-diagnosed physical diseases and diagnostic criteria of specific phobia. Data of the German Mental Health Survey from 4181 subjects aged 18-65 years were used. Specific phobia was diagnosed using M-CIDI/DIA-X interview; physical diseases were assessed through a self-report questionnaire and a medical interview. Logistic regression analyses adjusted for sex were calculated. Specific phobia was associated with cardiac diseases, gastrointestinal diseases, respiratory diseases, arthritic conditions, migraine, and thyroid diseases (odds ratios between 1.49 and 2.53). Among the subtypes, different patterns of associations with physical diseases were established. The findings were partially replicated in the Swiss PsyCoLaus Study. Our analyses show that subjects with specific phobia have an increased probability for specific physical diseases. From these analyses etiological mechanisms of specific phobia and physical disease can be deduced. As subtypes differed in their patterns of associations with physical diseases, different etiological mechanisms may play a role. The findings are highly relevant for public health in terms of prevention and therapy of the comorbid conditions

Physical diseases among persons with obsessive compulsive symptoms and disorder : a general population study

This study aimed at evaluating the comorbidity between DSM-IV obsessive compulsive disorder (OCD) and subthreshold forms and physical diseases in the general population as well as disability associated with comorbidity.; We used data from the 1998 German Mental Health Survey, a representative survey of the German population. Mental disorders and physical diseases of 4181 subjects (aged 18-65) were cross-sectionally assessed. Mental disorders were diagnosed using the M-CIDI/DIA-X interview. Physical diseases were assessed through a self-report questionnaire and a standardized medical interview. We created three groups of obsessive-compulsive symptoms: (1) no obsessive compulsive symptoms (n = 3,571); (2) obsessive compulsive symptoms (OCS, n = 371; endorsement of OCS (either obsession or compulsion) without fulfilling any core DSM-IV criteria); (3) subthreshold OCD/OCD (n = 239; fulfilling either some or all of the core DSM-IV criteria).; In comparison to subjects without OCS, subjects with subthreshold OCD/OCD showed higher prevalence rates of migraine headaches (OR 1.7; 95 % CI 1.1-2.5) and respiratory diseases (OR 1.7; 95 % CI 1.03-2.7); subjects with OCS showed higher prevalence rates of allergies (OR 1.6; 95 % CI 1.1-2.8), migraine headaches (OR 1.9; 95 % CI 1.4-2.7) and thyroid disorders (OR 1.4; 95 % CI 1.01-2.0). Subjects with both OCS and physical disease reported the highest number of days of disability due to physical or psychological problems during the past 30 days compared to subjects with only OCS, only physical disease or neither of them.; OCD and subthreshold forms are associated with higher comorbidity rates with specific physical diseases and higher disability than subjects without OCS. Possible etiological pathways should be evaluated in future studies and clinicians in primary care should be aware of these associations

Day-to-day variations in health behaviors and daily functioning: two intensive longitudinal studies

In two intensive longitudinal studies we examined the daily dynamics in health behaviors and their associations with two important indicators of young adults' daily functioning, namely, affect and academic performance. Over a period of 8 months, university students (Study 1: N = 292; Study 2: N = 304) reported sleep, physical activity, snacking, positive and negative affect, and learning goal achievement. A subsample wore an actigraph to provide an additional measurement of sleep and physical activity and participated in a controlled laboratory snacking situation. Multilevel structural equation models showed that better day-to-day sleep quality or more physical activity than usual, but not snacking, were associated with improved daily functioning, namely, affect and learning goal achievement. Importantly, self-report measurements of health behaviors correlated with behavioral measurements. These findings have the potential to inform health promotion programs aimed at supporting young adults in their daily functioning in good physical and mental health

The importance of physical activity and sleep for affect on stressful days: Two intensive longitudinal studies

We investigated the potential stress-buffering effect of 3 health behaviors-physical activity, sleep quality, and snacking-on affect in the context of everyday life in young adults. In 2 intensive longitudinal studies with up to 65 assessment days over an entire academic year, students (Study 1, N = 292; Study 2, N = 304) reported stress intensity, sleep quality, physical activity, snacking, and positive and negative affect. Data were analyzed using multilevel regression analyses. Stress and positive affect were negatively associated; stress and negative affect were positively associated. The more physically active than usual a person was on a given day, the weaker the association between stress and positive affect (Study 1) and negative affect (Studies 1 and 2). The better than usual a person's sleep quality had been during the previous night, the weaker the association between stress and positive affect (Studies 1 and 2) and negative affect (Study 2). The association between daily stress and positive or negative affect did not differ as a function of daily snacking (Studies 1 and 2). On stressful days, increasing physical activity or ensuring high sleep quality may buffer adverse effects of stress on affect in young adults. These findings suggest potential targets for health-promotion and stress-prevention programs, which could help reduce the negative impact of stress in young adults. (PsycINFO Database Recor

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as "my mood is better when I exercise". This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.; Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.; University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.; Correlations between experiences and behaviours (online data) were small (r = -.12-.14), estimated correlations moderate (r = -.35-.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.; Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy