title: Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys.
abstract: BACKGROUND
  To examine cross-national patterns and correlates of lifetime and 12-month comorbid DSM-IV anxiety disorders among people with lifetime and 12-month DSM-IV major depressive disorder (MDD).
  
  
  METHODS
  Nationally or regionally representative epidemiological interviews were administered to 74 045 adults in 27 surveys across 24 countries in the WHO World Mental Health (WMH) Surveys. DSM-IV MDD, a wide range of comorbid DSM-IV anxiety disorders, and a number of correlates were assessed with the WHO Composite International Diagnostic Interview (CIDI).
  
  
  RESULTS
  45.7% of respondents with lifetime MDD (32.0-46.5% inter-quartile range (IQR) across surveys) had one of more lifetime anxiety disorders. A slightly higher proportion of respondents with 12-month MDD had lifetime anxiety disorders (51.7%, 37.8-54.0% IQR) and only slightly lower proportions of respondents with 12-month MDD had 12-month anxiety disorders (41.6%, 29.9-47.2% IQR). Two-thirds (68%) of respondents with lifetime comorbid anxiety disorders and MDD reported an earlier age-of-onset (AOO) of their first anxiety disorder than their MDD, while 13.5% reported an earlier AOO of MDD and the remaining 18.5% reported the same AOO of both disorders. Women and previously married people had consistently elevated rates of lifetime and 12-month MDD as well as comorbid anxiety disorders. Consistently higher proportions of respondents with 12-month anxious than non-anxious MDD reported severe role impairment (64.4 v. 46.0%; χ 2 1 = 187.0, p < 0.001) and suicide ideation (19.5 v. 8.9%; χ 2 1 = 71.6, p < 0.001). Significantly more respondents with 12-month anxious than non-anxious MDD received treatment for their depression in the 12 months before interview, but this difference was more pronounced in high-income countries (68.8 v. 45.4%; χ 2 1 = 108.8, p < 0.001) than low/middle-income countries (30.3 v. 20.6%; χ 2 1 = 11.7, p < 0.001).
  
  
  CONCLUSIONS
  Patterns and correlates of comorbid DSM-IV anxiety disorders among people with DSM-IV MDD are similar across WMH countries. The narrow IQR of the proportion of respondents with temporally prior AOO of anxiety disorders than comorbid MDD (69.6-74.7%) is especially noteworthy. However, the fact that these proportions are not higher among respondents with 12-month than lifetime comorbidity means that temporal priority between lifetime anxiety disorders and MDD is not related to MDD persistence among people with anxious MDD. This, in turn, raises complex questions about the relative importance of temporally primary anxiety disorders as risk markers v. causal risk factors for subsequent MDD onset and persistence, including the possibility that anxiety disorders might primarily be risk markers for MDD onset and causal risk factors for MDD persistence.
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: Institute for Social Research, University of Michigan,Ann Arbor,MI,USA.
authors.forename: P
authors.initials: P
authors.lastname: Berglund
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gruber
authors.affiliation: College of Medicine, Al-Qadisiya University,Diwania governorate,Iraq.
authors.forename: A
authors.initials: A
authors.lastname: Al-Hamzawi
authors.affiliation: Institute of Psychiatry, University of São Paulo Medical School,São Paulo,Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Andrade
authors.affiliation: School of Psychology, Ulster University,Londonberry,Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Bunting
authors.affiliation: Department of Psychiatry,University Hospital Gasthuisberg, Katholieke Universiteit Leuven,Leuven,Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Demyttenaere
authors.affiliation: National School of Public Health,Management and Professional Development,Bucharest,Romania.
authors.forename: S
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Unit of Epidemiological and Evaluation Psychiatry,IRCCS St John of God Clinical Research Centre,Brescia,Italy.
authors.forename: G
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: Department of Psychiatry,Centre for Research and Training in Mental Health, Neurosciences, Drug and Alcohol Abuse, University of Ibadan,Ibadan,Nigeria.
authors.forename: O
authors.initials: O
authors.lastname: Gureje
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine,Shanghai,People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: He
authors.affiliation: Shenzhen Institute of Mental Health & Shenzhen Kanging Hospital,Guangdon Province,PRC.
authors.forename: C
authors.initials: C
authors.lastname: Hu
authors.affiliation: Institute of Mental Health, Peking University,Beijing,China.
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Psychiatry and Clinical Psychology,Faculty of Medicine,Balamand University,Beirut,Lebanon.
authors.forename: E
authors.initials: E
authors.lastname: Karam
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,Paris,France.
authors.forename: V
authors.initials: V
authors.lastname: Kovess-Masfety
authors.affiliation: Department of Psychiatry,The Chinese University of Hong Kong,Shatin,Hong Kong SAR.
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.affiliation: Ministry of Health Israel,Mental Health Services,Jerusalem,Israel.
authors.forename: D
authors.initials: D
authors.lastname: Levinson
authors.affiliation: Ramond e la Fuente Muñiz National Institute of Psychiatry,Mexico City,Mexico.
authors.forename: M E
authors.initials: ME
authors.lastname: Medina Mora
authors.affiliation: Institute of psychiatry and Neurology,Warsaw,Poland.
authors.forename: J
authors.initials: J
authors.lastname: Moskalewicz
authors.affiliation: Department of Public Health,Jichi Medical University,Shimotsuke,Tochigi,Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM),Servicio Murciano de Salud,IMIB-Arrixaca,CIBERESP-Nodo Murcia,Spain.
authors.forename: F
authors.initials: F
authors.lastname: Navarro-Mateu
authors.affiliation: Department of Psychiatry,School of Medicine, University of Tasmania,Tasmania,Australia.
authors.forename: M A Oakley
authors.initials: MA
authors.lastname: Browne
authors.affiliation: National Institute of Health,Lima,Peru.
authors.forename: M
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Universidad Colegio Mayor de Cundinamarca,Bogota,Colombia.
authors.forename: J
authors.initials: J
authors.lastname: Posada-Villa
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales,Sydney,Australia.
authors.forename: T
authors.initials: T
authors.lastname: Slade
authors.affiliation: Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Center for Excellence on Research in Mental Health, CES University,Medellin,Colombia.
authors.forename: Y
authors.initials: Y
authors.lastname: Torres
authors.affiliation: Health Services Research Unit, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques),Carrer del Doctor Aiguader,88,Edifici PRBB,08003,Barcelona,Spain.
authors.forename: G
authors.initials: G
authors.lastname: Vilagut
authors.affiliation: Department of Mental Health - CEDOC and Faculdade Ciencias Medicas,Universidade Nova de Lisboa,Lisbon,Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Xavier
authors.affiliation: Department Mental Health,NCPHA,Sofia,Bulgaria.
authors.forename: Z
authors.initials: Z
authors.lastname: Zarkov
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston,MA,USA.
authors.forename: V
authors.initials: V
authors.lastname: Shahly
authors.affiliation: Janssen Pharmaceutical Research & Development,Titusville,NJ,USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Wilcox
keywords: Anxious depression; comorbidity; epidemiology