Including information about co-morbidity in estimates of disease burden: Results from the World Health Organization World Mental Health Surveys

J. Alonso, G. Vilagut, S. Chatterji, S. Heeringa, M. Schoenbaum, T. Bedirhan Üstün, S. Rojas-Farreras, M. Angermeyer, E. Bromet, R. Bruffaerts, G. De Girolamo, O. Gureje, J. M. Haro, A. N. Karam, V. Kovess, D. Levinson, Z. Liu, M. E. Medina-Mora, J. Ormel, J. Posada-VillaH. Uda, R. C. Kessler

Research output: Contribution to journalArticle

Abstract

Background The 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.Method Face-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.Results The 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.Conclusions Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings.

Original languageEnglish
Pages (from-to)873-886
Number of pages14
JournalPsychological Medicine
Volume41
Issue number4
DOIs
Publication statusPublished - Apr 2011

    Fingerprint

Keywords

  • Co-morbidity
  • epidemiology
  • global burden of disease
  • mental health
  • visual analog scale

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Applied Psychology

Cite this

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., ... Kessler, R. C. (2011). Including information about co-morbidity in estimates of disease burden: Results from the World Health Organization World Mental Health Surveys. Psychological Medicine, 41(4), 873-886. https://doi.org/10.1017/S0033291710001212