Author:
Alonso J.,Vilagut G.,Chatterji S.,Heeringa S.,Schoenbaum M.,Bedirhan Üstün T.,Rojas-Farreras S.,Angermeyer M.,Bromet E.,Bruffaerts R.,de Girolamo G.,Gureje O.,Haro J. M.,Karam A. N.,Kovess V.,Levinson D.,Liu Z.,Medina-Mora M. E.,Ormel J.,Posada-Villa J.,Uda H.,Kessler R. C.
Abstract
BackgroundThe methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles.MethodFace-to-face interviews in 13 countries (six developing, nine developed; n=31 067; response rate=69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects.ResultsThe best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24–0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity.ConclusionsPlausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings.
Publisher
Cambridge University Press (CUP)
Subject
Psychiatry and Mental health,Applied Psychology
Cited by
47 articles.
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