COMORBIDITY AND BOUNDARIES OF AFFECTIVE-DISORDERS WITH ANXIETY DISORDERS AND SUBSTANCE MISUSE - RESULTS OF AN INTERNATIONAL TASK-FORCE

Associations between affective disorders,anxiety disorders, and substa nce use disorders were examined in epidemiological studies conducted i n Germany, Switzerland, Puerto Rico, and the mainland US. There was a remarkable degree of similarity across studies in the magnitude and ty pe of specific disorders associated with the affective disorders. Como rbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the s pecific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The o nset of anxiety disorders generally preceded that of depression, where as alcohol misuse was equally likely to pre- or post-date ?he onset of affective disorders. Finally, comorbidity was associated with an elev ation in treatment rates across all sites, confirming Berkson's parado x on an international level.