Psychological Medicine

Original Articles

Age patterns in the prevalence of DSM-IV depressive/anxiety disorders with and without physical co-morbidity

K. M. Scotta1 c1, M. Von Korffa2, J. Alonsoa3, M. Angermeyera4, E. J. Brometa5, R. Bruffaertsa6, G. de Girolamoa7, R. de Graafa8, A. Fernandeza9, O. Gurejea10, Y. Hea11, R. C. Kesslera12, V. Kovessa13, D. Levinsona14, M. E. Medina-Moraa15, Z. Mneimneha16, M. A. Oakley Brownea17, J. Posada-Villaa18, H. Tachimoria19 and D. Williamsa20

a1 Department of Psychological Medicine, Otago University, Wellington, New Zealand

a2 Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA

a3 Health Services Research Unit, Institute Municipal d'Investigacio Medica (IMIM), and CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain

a4 Center for Public Mental Health, Austria

a5 SUNY Stony Brook, Stony Brook, New York, USA

a6 Department of Neurosciences and Psychiatry, University Hospital, Gasthuisberg, Leuven, Belgium

a7 Regional Health Care Agency, Emilia-Romagna Region, Bologna, Italy

a8 Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

a9 Fundació Sant Joan de Déu Research and Development Unit, Barcelona, Spain

a10 Department of Psychiatry, University College Hospital, Ibadan, Nigeria

a11 Shanghai Mental Health Center, Shanghai, People's Republic of China

a12 Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

a13 Fondation MGEN Pour La Santé Publique, Université Paris 5, Paris, France

a14 Mental Health Services, Ministry of Health, Jerusalem, Israel

a15 Department of Epidemiology, National Institute of Psychiatry, Mexico City, Mexico

a16 Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon

a17 Department of Rural and Indigenous Health, School of Rural Health, Monash University, Victoria, Australia

a18 Colegio Mayor de Cundinamarca University, Bogota, Colombia

a19 National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan

a20 Department of Society, Human Development and Health, Harvard School of Public Health, Harvard University, Boston, MA, USA

Abstract

Background Physical morbidity is a potent risk factor for depression onset and clearly increases with age, yet prior research has often found depressive disorders to decrease with age. This study tests the possibility that the relationship between age and mental disorders differs as a function of physical co-morbidity.

Method Eighteen general population surveys were carried out among household-residing adults as part of the World Mental Health (WMH) surveys initiative (n=42 697). DSM-IV disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). The effect of age was estimated for 12-month depressive and/or anxiety disorders with and without physical or pain co-morbidity, and for physical and/or pain conditions without mental co-morbidity.

Results Depressive and anxiety disorders decreased with age, a result that cannot be explained by organic exclusion criteria. No significant difference was found in the relationship between mental disorders and age as a function of physical/pain co-morbidity. The majority of older persons have chronic physical or pain conditions without co-morbid mental disorders; by contrast, the majority of those with mental disorders have physical/pain co-morbidity, particularly among the older age groups.

Conclusions CIDI-diagnosed depressive and anxiety disorders in the general population decrease with age, despite greatly increasing physical morbidity with age. Physical morbidity among persons with mental disorder is the norm, particularly in older populations. Health professionals, including mental health professionals, need to address barriers to the management of physical co-morbidity among those with mental disorders.

(Received September 14 2007)

(Revised February 22 2008)

(Accepted March 20 2008)

(Online publication March 26 2008)

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