Social phobia is increasingly recognized as a prevalent and socially impairing mental disorder. However, little data is available regarding the general and disease-specific impairments and disabilities associated with social phobia. Furthermore, most studies have not controlled for the confounding effects of comorbid conditions. This study investigates: (a) the generic quality of life; (b) work productivity; and, (c) various other disorder-specific social impairments in current cases with pure (n = 65), comorbid (n = 51) and subthreshold (n = 34) DSM-IV social phobia as compared to controls with no social phobia (subjects with a history of herpes infections). Social phobia cases reported a mean illness duration of 22.9 years with onset in childhood or adolescence. Current quality of life, as assessed by the SF-36, was significantly reduced in all social phobia groups, particularly in the scales measuring vitality, general health, mental health, role limitations due to emotional health, and social functioning. Comorbid cases revealed more severe reductions than pure and subthreshold social phobics. Findings from the Liebowitz self-rated disability scale indicated that: (a) social phobia affects most areas of life, but in particular education, career, and romantic relationship; (b) the presence of past and current comorbid conditions increases the frequency and severity of disease-specific impairments; and, (c) subthreshold social phobia revealed slightly lower overall impairments than comorbid social phobics. Past-week work productivity of social phobics was significantly diminished as indicated by: (a) a three-fold higher rate of unemployed cases; (b) elevated rates of work hours missed due to social phobia problems; and (c) a reduced work performance. Overall, these findings underline that social phobia in our sample of adults, whether comorbid, subthreshold, or pure was a persisting and impairing condition, resulting in considerable subjective suffering and negative impact on work performance and social relationships. The current disabilities and impairments were usually less pronounced than in the past, presumably due to adaptive behaviors in life style of the respondents. Data also confirmed that social phobia is poorly recognized and rarely treated by the mental health system.

Anxiety and depressive disorders are common mental disorders in general population, imposing tremendous burden on both affected persons and society. Moreover, comorbidity between anxiety and depressive conditions is high, leading to substantial disability and functional impairment. Findings consistently suggest that anxiety disorders are primary to depression in the majority of comorbid cases. Yet, the question of whether anxiety disorders are risk factors for depression, and potentially even causal risk factors for the first onset of depression, remains unresolved. Recent results have shown that anxiety disorders increase the risk for subsequent depression, and also affect the course of depression, resulting in a poorer prognosis. Further, some results suggest a dose–response-relationship in revealing that a higher number of anxiety disorders and more severe impairment associated with anxiety disorders additionally increase the risk for subsequent depression. The goal of this paper is to review recent literature, summarize implications of previous findings, and suggest directions for future research regarding preventive and intervention strategies.

Background. The proposed revisions of the ICD and DSM diagnostic systems have led to increased interest in evaluation of diagnostic criteria. This report focuses on the DSM-IV requirement that episodes of generalized anxiety disorder (GAD) must persist for at least 6 months. Community epidemiological data are used to study the implications of changing this requirement in the range 1–12 months for estimates of prevalence, onset, course, impairment, co-morbidity, associations with parental GAD, and sociodemographic correlates. Method. Data come from the US National Comorbidity Survey Replication (NCS-R), a US household survey carried out during 2001–2003. Version 3.0 of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used to assess DSM-IV anxiety disorders, mood disorders, substance disorders, and impulse-control disorders. Results. Lifetime, 12-month, and 30-day prevalence estimates of DSM-IV GAD changed from 6·1%, 2·9%, and 1·8% to 4·2–12·7%, 2·2–5·5%, and 1·6–2·6% when the duration requirement was changed from 6 months to 1–12 months. Cases with episodes of 1–5 months did not differ greatly from those with episodes of [gt-or-equal, slanted]6 months in onset, persistence, impairment, co-morbidity, parental GAD, or sociodemographic correlates. Conclusions. A large number of people suffer from a GAD-like syndrome with episodes of <6 months duration. Little basis for excluding these people from a diagnosis is found in the associations examined here.

Objective: Past research indicates that comorbid anxiety and depression in youth is associated with greater functional impairment than anxiety alone. To elucidate those factors which may increase vulnerability to depressive disorders, the current study examined several clinical correlates (i.e., feelings ratings, parental psychopathology symptoms, and family functioning) of comorbid depressive symptoms in young anxious children. Method: Sixty-eight children, aged 6 to 10 years (M = 9.06, SD = 1.10), and caregivers completed measures assessing child depressive symptoms. Furthermore, children completed self reports of anxiety symptoms, feelings ratings, and family functioning, while caregivers completed self reports of psychopathology symptoms and family functioning. Predictors of child depressive symptoms were examined separately for girls and boys. Results: In females, hierarchical regression analyses revealed that, after controlling for anxiety, higher sadness and lower positive feelings accounted for 30% of variance in child-reported depressive symptoms. Further analyses indicated that child-reported overall family dysfunction moderated the relationship between positive feelings and depressive symptoms, such that high family dysfunction increased the risk of depressive symptoms in females with low positive emotions. In males, hierarchical regression analyses revealed that, after controlling for anxiety, higher negative/hostile feelings and child-reported overall family dysfunction accounted for 19% of variance in child-reported depressive symptoms. Further analyses of family functioning in males revealed that child-reported family cohesion and conflict were negatively and positively correlated, respectively, with depressive symptoms. Family dysfunction did not moderate the relationship between feelings ratings and depressive symptoms. The only significant predictor of caregiver-reported child depressive symptoms, for males only, was caregiver self-reported overall psychopathology symptoms. Further analyses indicated that, for males, caregiver depression and hostility symptoms correlated positively with caregiver-reported child depressive symptoms. Conclusions: Different patterns of emotion and family functioning predicted self-reported depressive symptoms in males and females. Self and caregiver reports of child depressive symptoms were not related, with only caregivers’ psychopathology symptoms predicting their reports of child depressive symptoms. Results suggest the importance of assessing child-reported feelings and family dysfunction, and parental symptomatology, of clinically anxious children. To prevent future depressive disorders in these children, different targets of intervention for males and females may be warranted.

Theoretischer Hintergrund: Die diagnostischen Kriterien der Generalisierten Angststörung (GAS) und ihr Status als eigenständige psychische Störung waren lange umstritten. Inzwischen liegen neuere epidemiologische Daten vor, die ein präziseres Bild dieser Störung und ihrer Besonderheiten ermöglichen. Methode: Es wird ein systematischer Überblick zu Prävalenz, Verlauf und Komorbidität, zur Beeinträchtigung und zum Inanspruchnahmeverhalten sowie zur Spezifität des Kernsymptoms (Sorgen) erstellt. Ergebnisse: GAS ist eine häufige Störung, die im jungen Erwachsenenalter einsetzt, jedoch auch – anders als andere Angststörungen – hohe Inzidenzraten im mittleren Lebensalter aufweist. Der Verlauf ist eher chronisch. Trotz hoher Komorbidität lässt sich die Störung valide abgrenzen. Klinisch relevante Sorgen erweisen sich als störungsspezifisch. Die Beeinträchtigungen sind auch bei GAS-Patienten ohne Komorbidität beträchtlich. Schlussfolgerung: Der Forschungsstand spricht für die Bedeutung und Eigenständigkeit der Diagnose sowie für die stärkere Beachtung offener Forschungsfragen. / Background: The diagnostic criteria for generalized anxiety disorder (GAD) and its status as an independent mental disorder have been controversial. More recent epidemiological data provide a more precise picture of this disorder and its specific features. Methods: A systematic overview is given in regard to prevalence, course and comorbidity, impairment, and help-seeking behavior as well as to specificity of the core symptom (worries). Results: GAD is a frequent disorder with high incidence rates in middle-age groups, which are not seen in other anxiety disorders. Despite the high comorbidity GAD can be validly distinguished. Clinically relevant worries have been proven as specific for the disorder. The impairments are also considerable for patients without comorbid disorders. Conclusions: Research supports the independent status of GAD and the importance of this diagnosis. Unsolved questions are to be analyzed in future research.

Objective: To examine in a nationally representative sample (a) the differential association of specific anxiety and depressive disorders defined according to DSM-IV with pain disorder (PD) and pain symptoms, and (b) whether pain-associated anxiety and depressive disorders and their comorbidity have different implications in terms of impairment, disability, health care utilization, and substance use. Method: A nationally representative community study was conducted in Germany. Symptoms, syndromes and diagnoses of mental disorders, and pain were assessed in N = 4,181 participants aged 18–65 years using the DSM-IV/M-CIDI. Results: Logistic regressions revealed that pain is associated with both specific anxiety and depressive disorders, with increasing significant odds ratios (OR) for medically explained pain symptoms (EPS; OR range: 1.9–2.0), to unexplained pain symptoms (UPS; OR range: 2.4–7.3), to PD (OR range: 3.3–14.8). PD and UPS persistently showed associations after adjusting for comorbid other anxiety and depressive disorders and physical illnesses. All types of pain, particularly PD/UPS, are associated with decreased quality of life, greater impairment in role functioning, disability, health care utilization, and substance use. Depressive disorders, even more so anxiety disorders and their comorbidity account for a substantial proportion of variance in these functional correlates. Conclusions: Pain is strongly associated with specific anxiety and depressive disorders. In light of the individual and societal burden due to pain, and the demonstrated role of comorbid anxiety or/and depression, our results call for further investigation of the underlying mechanisms for this association as well as targeted treatments for these comorbidities.

Der Beitrag diskutiert kritische theoretische und praktische Aspekte der Komorbidität auf der Grundlage von klinischen und epidemiologischen Befunden zur Komorbidität. Angststörungen weisen statistisch hochsignifikante Assoziationen untereinander sowie mit affektiven, psychotischen Störungen, Eβstörungen sowie Substanzstörungen und Persönlichkeitsstörungen auf. Sie gehen zumeist eindeutig den komorbiden Störungen voraus, so daβ Angststörungen als Risikofaktoren für viele andere Formen psychischer Störungen angesehen werden können. Die möglicherweise kausalen pathogenetischen Mechanismen sind jedoch nach wie vor umstritten und sind offensichtlich vielfältig. Der Beitrag diskutiert vor diesem Hintergrund besonders die möglicherweise kritische Bedeutung von Panikattacken als zentraler «Vulnerabilitätsmarker» nicht nur für die Entwicklung von Angststörungen, sondern auch für affektive Erkrankungen. Hier konnte z.B. nachgewiesen werden, daβ initiale Panikattacken nicht nur die Wahrscheinlichkeit für Rückfälle sekundärer Depressionen erhöhen, sondern auch signifikant die Häufigkeit und Länge depressiver Phasen beeinflussen. Die Vielzahl differenzierter Befunde legt nahe, Komorbidität bei der Eingangs- und Verlaufsdiagnostik ebenso wie bei der Indikationsstellung umfassender zu berücksichtigen.

Research has demonstrated that problem gambling is associated with substance and alcohol abuse (Petry, Stinson, & Grant, 2005), participation in criminal activities (McCorkle, 2002; Meyer & Stadler, 1999), and involvement in the criminal justice system (NORC, 1999). This study assessed problem gambling and its relation to crime and substance use within a population in which these risk factors are compounded: Adults mandated to participate in drug and DUI courts. Results indicate that the prevalence and severity of problem gambling may be higher within this population than any other. Furthermore, the results of qualitative and quantitative analyses converged to highlight that gambling, crime and substance use are interrelated behaviors, as each may lead to and/or reinforce the other. These findings suggest that problem gambling is a salient issue among substance-abusing offenders and that resources should be dedicated to screening those involved with the criminal justice system for problem gambling, establishing evidence based best practices in the prevention and treatment of problem gambling within this population, and that such practices may incorporate components addressing gambling, crime, and substance use.

This study investigated the association between the severity of Tourette Syndrome (TS) and comorbid tendencies (Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), and rage), maternal differential treatment, fairness evaluation of maternal differential treatment, and communication with both sibling and family relationships. Fifty-five mothers and healthy siblings of individuals with Tourette Syndrome participated in the study. The parents provided information regarding family demographics and the severity of Tourette Syndrome and comorbid tendencies, and the healthy siblings completed the sibling and family relationship questionnaires. The questionnaires were posted on a secure website, where the parents and healthy siblings could complete the online measures via internet connections. <br /><br /> The study revealed several important findings. The results showed significant associations between the severity of Tourette Syndrome and comorbid OCD, ADHD and rage tendencies thus suggesting that studying Tourette Syndrome without considering comorbidity would be unrealistic. Additionally, communication regarding Tourette Syndrome between the healthy siblings and their parents played an important role with respect to sibling and family relationships. Communication between the healthy siblings and their parents predicted more warmth between the healthy siblings and their sibling with Tourette Syndrome as well as more family cohesion and adaptability as reported by the healthy siblings. Communication had a significant moderating effect on both severity of Tourette Syndrome and healthy siblings' fairness evaluation of maternal differential treatment in predicting family relationships. When the sibling had less severe Tourette Syndrome, the healthy siblings reported more family adaptability when they had more communication with their parents, and reported less family adaptability when they had less communication with their parents. The results also indicated that when healthy siblings perceived their maternal differential treatment to be unfair, they reported more family cohesion when they had more communication with their parents, and reported less family cohesion when they had less communication with their parents. The study did not support the negative impact of maternal differential treatment on sibling relationships; however, the results confirmed the previous findings regarding the moderating effect of fairness evaluation on maternal differential treatment in predicting sibling relationships. When the sibling with Tourette Syndrome was favored, the healthy siblings reported more sibling warmth when they perceived the favouritism (maternal differential treatment) to be fair. Furthermore, the results showed that healthy siblings' perceptions of maternal differential treatment could predict cohesion and adaptability in the family. The more the healthy siblings reported being treated differently by their mothers, the less cohesion and adaptability they reported in their families. <br /><br /> The present study supported previous studies in finding that sibling conflict decreased with age. The results also highlighted the role of age in moderating the effects of communication and maternal differential treatment in predicting sibling conflict. When healthy siblings had more communication with their parents they reported more conflict with their sibling with Tourette Syndrome when they were younger, and reported less sibling conflict with their sibling with Tourette Syndrome when they were older. Furthermore, when healthy siblings were favored by their mothers, they reported more conflict with their sibling with Tourette Syndrome when they were younger than when they were older, thereby emphasizing the importance of developmental differences in dynamics between the siblings. The significant contributions of the study include underlining the importance of communication, the relationship between Tourette Syndrome and comorbid conditions, and healthy siblings' perceptions of sibling and family relationships.

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