Anxiety disorders in the general population: prevalences, impairments, and associations with physical illness

Transcription

1 Eurocertificate XIV Canterbury, UK, 29 June - 04 July 2002 Anxiety disorders in the general population: prevalences, impairments, and associations with physical illness Frank Jacobi, PhD Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany Introduction: Background need of population based representative data for health care planning limitations of most nationwide health surveys need of coordinated survey data simultaneously addressing somatic and mental health 1

2 Introduction: Consequences The German National Health Interview and Examination Survey (GHS) first study to investigate somatic and mental health simultaneously broad range of disorders assessed valid measures (clinical interviews) allows for analyses of comorbidity, impairment/ disabilities, quality of life, use of health services Anxiety Disorders: addressed research questions prevalence estimates (4-week, 12-month) comorbidity (mental, overall) impairment / disabilities (impairment days, health related quality of life) 2

3 Modules of the GHS Folacid Supply Survey Diet history, questionnaire, Folacid, erythrocytes, serum, vitamin B12 and zink Environmental Health Questionaires, blood samples, urine, water supply, other environmental agents Pharmacoepidemiologic Survey Questionnaire, Interview, serum Core Survey (GHS-CS) Aims: Prevalence of somatic illnesses, comorbidity, health care utilization, health behaviors, quality of life, disabilities Instruments: Questionnaires, medical and laboratory examinination, standardized CAPI medical inquiry, scales (SF-36, disability, symptoms) Nutrition Survey Diet history questionnaire Mental Health Supplement (GHS-MHS) Aims: Prevalence, comorbidity, disabilities, treatment of mental disorders (DSM-IV) Instruments: CAPI standardized diagnostic interview (CIDI) by clinical interviewers; scales and questionnaires German National Health Interview and Examination Survey (GHS): somatic disorders hypertension cardiac diseases (heart circulation disturbances, angina pectoris, cardiac infarct, heart weakness, heart insufficiency) chronic-obstructive pulm. (asthma, chronic bronchitis) ulcers, gastritis stomach (lining inflammation, gastritis, gastric ulcer or ulcus duodeni, ulcus pepticum) endocrine disorders (thyroid gland disease, osteoporosis) diabetes (diabetes with and without insulin treatment) cancer (cancer, malignant tumors) neurological diseases (migraine, epilepsy, Parkinson s disease, multiple sclerosis, meningitis) musculo-skeletal diseases (wear and tear type of arthritis, arthritis of the knee or hip, spinal arthritis, inflammatory diseases of the joints or spinal column, low back pain) allergies (hay fever, allergic conjunctivitis, allergic eczema, neurodermatitis, food allergy, allergic hives, other allergies) gynecological diseases (diseases of uterus, ovaries or oviduct) 3

4 German National Health Interview and Examination Survey (GHS): mental disorders mental disorders due to general medical condition substance-related disorders (nicotine dependence, alcohol abuse, alcohol dependence, drug abuse, drug dependence) schizophrenia and other psychotic disorders (unspecific screening) mood disorders (bipolar affective disorders, major depression (including subtypes), dysthymia) anxiety Disorders (panic disorder with and without agoraphobia, agoraphobia without the history of panic disorder, social phobia, specific phobia (including subtypes), anxiety disorder NOS, GAD, OCD) eating disorders (anorexia nervosa, bulimia nervosa) somatoform disorders and syndromes (somatization disorder, SSI4,6, hypochondriasis, pain disorder) additionally assessed: impairment days (within past 4 weeks) due to psychological/psycho-somatic problems or physical illness help seeking behaviour due to psychological problems German National Health Interview and Examination Survey (GHS): sample Core Survey N=7124 (age: 18-79) response rate: 61.4% Mental Health Supplement N=4181 (age: 18-65) response rate: 87.6% can be regarded as representative for German population (weighting for nonresponse to adjust for sex, age, community distributions, and design factors) detailed information: Jacobi et al. (2002) 4

5 Results: prevalence estimates 4-week 12-month total %w male%w female%w total %w male%w female%w any mental disorder 19,8 15,7 23,9 30,8 24,8 36,9 any anxiety disorder 9,0 5,3 12,7 14,5 9,2 19,8 any specific phobia 4,8 2,5 7,0 7,6 4,5 10,8 anxiety disorder NOS 1,3 0,8 1,9 3,4 1,4 4,1 agoraphobia 1,3 0,4 2,2 2,1 1,0 3,1 without panic disorder social phobia 1,2 0,7 1,8 2,0 1,3 2,7 GAD 1,2 0,9 1,5 1,5 1,0 2,1 panic disorder 0,6 0,4 0,9 1,2 0,8 1,6 with agoraphobia panic disorder 0,5 0,5 0,5 1,1 0,8 1,5 without agoraphobia OCD 0,4 0,2 0,6 0,7 0,6 0,9 Results: comorbidity with mental disorders (12-month) Nw No. of dx w hole sam ple ,6 any m ental dx ,8 No. of dx if dx(col) not present MR any mental dx w o anx 691 1,3 0,4 3,2 any anxiety disorder 604 2,4 0,2 9,7 OCD 30 4,4 0,5 8,7 GAD 63 4,1 0,5 8,2 social phobia 83 3,9 0,5 8,1 any panic dx 98 3,6 0,5 7,5 any specific phobia 319 2,5 0,4 5,9 5

6 Results: comorbidity with anxiety disorders Nw No. of anx. dx w hole sam ple ,22 No. of anx dx any m ental dx ,70 if dx(col) not any anxiety disorder 604 1,51 present MR OCD 30 2,36 0,20 12,62 any specific phobia 319 1,78 0,09 19,39 GAD 63 1,57 0,18 12,97 any panic dx 98 1,32 0,17 13,50 social phobia 83 1,31 0,17 13,95 Results: comorbidity with somatic disorders Anxiety disorders overall highly comorbid with somatic disorders This overall association not significant anymore when controlling for other metal disorders, sex and age Association only valid for specific anxiety disorders (e.g. panic disorder) 6

7 Results: impairment days Harvardmean Harvard Index Index if dx(col) not whole sample 0,5 present MR any m ental dx 1,4 0,1 16,9 any mental dx wo anx 0,7 0,4 1,9 any anxiety disorder 2,1 0,2 9,4 GAD 6,2 0,4 15,3 any panic dx 4,9 0,4 12,5 social phobia 4,6 0,4 12,0 OCD 4,5 0,5 17,8 any specific phobia 2,4 0,3 7,0 other phobia 1,0 0,3 3,3 Results: quality of life (psychological) mean SF-36 (psy) mean SF-36 (psy) if dx(col) whole sample 49,8 not present MR any m ental dx 45,7 52,6 0,87 any m ental dx w o anx 47,3 51,1 0,93 any anxiety disorder 43,9 51,6 0,86 any specific phobia 45,1 50,9 0,89 OCD 41,3 50,6 0,82 any panic dx 39,2 50,8 0,78 social phobia 36,9 50,4 0,73 GAD 34,5 50,8 0,68 7

8 Discussion: summary epidemiology of anxiety disorders very frequent (most common 4-week and 12-month aggregate diagnosis) very comorbid (other anxiety disorders, other mental disorders, somatic illness) very impairing (frequent impairment days, low quality of life) Discussion: design issues generalizability general population vs. clinical samples in speciality or primary care settings limitations for etiology research cross sectional only limited risk factors assessed invitation for cooperation (e.g. public use file) 8