Disclosure: Dr. Kessler has been a consultant for GlaxoSmithKline Inc., Sanofi-Aventis, Kaiser Permanente, Merck & Co., Inc., Ortho-McNeil Janssen Scientific Affairs, Pfizer Inc., Shire Pharmaceuticals, SRA International, Takeda Global Research & Development, Transcept Pharmaceuticals, Inc., Wyeth-Ayerst, Plus One Health Management; has served on advisory boards for Eli Lilly & Company, Mindsite, Wyeth-Ayerst, Appliance Computing II, Ortho-McNeil Janssen Scientific Affairs, and Plus One Health Management; and has had research support for his epidemiological studies from Analysis Group, Inc., Bristol-Myers Squibb, Eli Lilly & Company, EPI-Q, Ortho-McNeil Janssen Scientific Affairs, Pfizer, Inc., Sanofi-Aventis Gruoupe, Shire US, Inc., GlaxoSmithKline, and Walgreens Co. He owns stock in Datastat, Inc. The remaining authors declare that no competing interests exist.
COMORBIDITY AND DISEASE BURDEN IN THE NATIONAL COMORBIDITY SURVEY REPLICATION (NCS-R)
Article first published online: 14 MAY 2012
© 2012 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 29, Issue 9, pages 797–806, September 2012
How to Cite
Gadermann, A. M., Alonso, J., Vilagut, G., Zaslavsky, A. M. and Kessler, R. C. (2012), COMORBIDITY AND DISEASE BURDEN IN THE NATIONAL COMORBIDITY SURVEY REPLICATION (NCS-R). Depress. Anxiety, 29: 797–806. doi: 10.1002/da.21924
- Issue published online: 4 SEP 2012
- Article first published online: 14 MAY 2012
- Manuscript Accepted: 28 JAN 2012
- Manuscript Revised: 13 JAN 2012
- Manuscript Received: 1 SEP 2011
- burden of illness;
- confounding factors;
- cost of illness;
- global burden of disease;
- health valuation;
- visual analog scale (VAS)
Disease burden estimates rarely consider comorbidity. Using a recently developed methodology for integrating information about comorbidity into disease burden estimates, we examined the comparative burdens of nine mental and 10 chronic physical disorders in the National Comorbidity Survey Replication (NCS-R).
Face-to-face interviews in a national household sample (n = 5,692) assessed associations of disorders with scores on a visual analog scale (VAS) of perceived health. Multiple regression analysis with interactions for comorbidity was used to estimate these associations. Simulation was used to estimate incremental disorder-specific effects adjusting for comorbidity.
The majority of respondents (74.9%) reported one or more disorders. Of respondents with disorders, 73.8–98.2% reported having at least one other disorder. The best-fitting model to predict VAS scores included disorder main effects and interactions for number of disorders. Adjustment for comorbidity reduced individual-level disorder-specific burden estimates substantially, but with considerable between-disorder variation (0.07–0.69 ratios of disorder-specific estimates with and without adjustment for comorbidity). Four of the five most burdensome disorders at the individual level were mental disorders based on bivariate analyses (panic/agoraphobia, bipolar disorder, posttraumatic stress disorder, major depression) but only two based on multivariate analyses, adjusting for comorbidity (panic/agoraphobia, major depression). Neurological disorders, chronic pain conditions, and diabetes were the other most burdensome individual-level disorders. Chronic pain conditions, cardiovascular disorders, arthritis, insomnia, and major depression were the most burdensome societal-level disorders.
Adjustments for comorbidity substantially influence estimates of disease burden, especially those of mental disorders, underlining the importance of including information about comorbidity in studies of mental disorders.