Collaborative Psychiatric Epidemiology Surveys Research Articles

Intimate Partner Violence, Cumulative Violence Exposure, and Mental Health Service Use

Intimate partner violence (IPV) leaves victims with serious mental healthconsequences; some victims do not seek help even though they suffer from adverse mental health symptoms. Victims' use of mental health services seems to be affected by sociocultural factors and their history of experiences with violence. This study used the collaborative psychiatric epidemiology surveys to examine the effects of cumulative violence on IPV victims' mental health service use. The results showed that victims' mental health needs were the most prominent predictor of their use of mental health services, and that cumulative violence exposure also predicted mental health service use.

Psychiatric Disorders Differently Correlate with Physical Self-Rated Health across Ethnic Groups.

In this study, we compared 10 ethnic groups for associations between psychiatric disorders and physical self-rated health (SRH) in the United States. Data came from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. The study included 7587 non-Latino White, 4746 African American, 1442 Mexican, 1106 other Hispanic, 656 other Asian, 600 Chinese, 577 Cuban, 520 Vietnamese, 508 Filipino, and 495 Puerto Rican individuals. The Composite International Diagnostic Interview (CIDI) was used to measure psychiatric disorders, including major depressive disorder (MDD), general anxiety disorder (GAD), social phobia, panic disorder, post-traumatic stress disorder (PTSD), alcohol abuse, and binge eating disorders. A single-item measure was used to estimate physical SRH. Demographic (age and gender) and socioeconomic (education and income) factors were also measured. Unadjusted and adjusted correlations between psychiatric disorders and physical SRH were calculated. Major ethnic variations were found in the correlation between psychiatric disorders and physical SRH; as well as the role of demographic and socioeconomic status (SES) factors in explaining these associations. non-Hispanic Whites, Cubans, and African Americans showed more correlations between psychiatric disorders and physical SRH than other ethnic groups. In non-Hispanic Whites, the associations between psychiatric disorders and physical SRH were explained by demographic factors. In African Americans, the link between psychiatric disorders and poor physical SRH were explained by SES indicators. In conclusion, although single-item physical SRH measures are traditionally assumed to reflect the physical health needs of populations, they may also indicate psychiatric disorders in some ethnic groups, such as non-Hispanic Whites, Cubans, and African Americans. Demographic and socioeconomic factors also have differential roles in explaining the link between psychiatric disorders and physical SRH. Physical SRH does not exclusively reflect physical health, and it may be more biased by mental health across some ethnic groups.

Ethnic Groups Differ in How Poor Self-Rated Mental Health Reflects Psychiatric Disorders.

This study aimed to explore cross-ethnic variation in the pattern of the associations between psychiatric disorders and self-rated mental health (SRMH) in the USA. This cross-sectional study used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001-2003, a national household probability sample. The study enrolled 18,237 individuals who were either Non-Hispanic White (n=7587), African American (n=4746), Mexican (n=1442), Cuban (n=577), Puerto Rican (n=495), Other Hispanic (n=1106), Vietnamese (n=520), Filipino (n=508), Chinese (n=600) or Other Asian (n=656). SRMH was the outcome. Independent variables were psychiatric disorders including major depressive disorder [MDD], general anxiety disorder [GAD], social phobia, alcohol abuse, binge eating disorders, panic disorder, and post-traumatic stress disorder [PTSD], measured by the Composite International Diagnostic Interview (CIDI). Demographic (age and gender) and socioeconomic (education and income) factors were covariates. The only psychiatric disorder which was universally associated with SRMH across all ethnic groups was MDD. More psychiatric disorders were associated with poor SRMH in Non-Hispanic Whites than any other ethnic groups. Among African Americans, demographic and socioeconomic factors could fully explain the associations between psychiatric disorders and SRMH. Among Mexican and Other Hispanics, demographic and socioeconomic factors could only explain the association between some but not all psychiatric disorders and SRMH. In all other ethnic groups, demographic and socioeconomic factors did not explain the link between psychiatric disorders and SRMH. Although SRMH is a useful tool for estimation of mental health needs of populations, poor SRMH may not have universal meanings across ethnically diverse populations. Ethnic groups differ in how their poor SRMH reflects psychiatric conditions and the role of demographic and socioeconomic factors in explaining such links. These ethnic differences may be a source of measurement bias in cross-ethnic health comparisons.

Demographic and Socioeconomic Determinants of Physical and Mental Self-rated Health Across 10 Ethnic Groups in the United States.

The aim of this study was to explore ethnic differences in demographic and socioeconomic determinants of poor physical and mental self-rated health (SRH) in the United States. We used data from the Collaborative Psychiatric Epidemiology Surveys (CPES) 2001-2003, which included a national household probability sample of 18237 individuals including 520 Vietnamese, 508 Filipino, 600 Chinese, 656 other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 other Hispanic, 4746 African American, and 7587 non-Latino Whites. Demographic factors (age and gender), socioeconomic factors (education and income), body mass index (BMI), and physical and mental SRH were measured. Pearson correlation was used to explore correlates of physical and mental SRH across ethnic groups. While age was positively associated with poor physical SRH, ethnic groups differed in the effect of age on mental SRH. Age was positively associated with mental SRH among Vietnamese, Filipino, Chinese, Cuban, Puerto Rican, and African American individuals, but this was not so for other Asians, Mexicans, other Hispanics, and non-Hispanic Whites. Chinese and Cubans were the only groups where female gender was associated with poor physical and mental SRH. With other Asians being an exception, education and income were protective against poor physical and mental SRH in all ethnic groups. Ethnic groups also differed in how their mental and physical SRH reflect BMI. Demographic and socioeconomic determinants of physical and mental SRH vary across ethnic groups. Poor physical and mental SRH are differently shaped by social determinants across ethnic groups. These ethnic differences may cause bias in health measurement in ethnically diverse populations.

Social Status, Discrimination, and Minority Individuals' Mental Health: a Secondary Analysis of US National Surveys.

Our study measured minority individuals' social status factors and frequency of discrimination experiences, in order to delineate social mechanisms linking race/ethnicity to mental status (specifically, to current mood/anxiety disorder and self-rated mental health). In this nationally representative secondary research, our data analyses drew on the cross-sectional "Collaborative Psychiatric Epidemiology Surveys," dating 2001-2003. The sample for the final model numbered 9368 respondents (2016 Asians, 2676 Latinos, 4676 blacks). Across races/ethnicities, better mental health was associated with male gender, higher income, marriage, more education, and less-frequent discrimination experiences; discrimination experiences could impair health, especially among blacks. Marriage's strong contribution to Asians' mental health did not hold among blacks; education's contribution to Latinos' mental health did not hold among blacks either. Blacks' mental health was unaffected by immigration status, but Asian and Latino immigrants showed less-robust mental health than native-born counterparts. Across the three racial/ethnic groups studied, differences were noted in relationships between self-reported mental health status and the employed social status and discrimination factors.

Use of Complementary and Alternative Medicine among Older Adults: Differences between Baby Boomers and Pre-Boomers

To compare use of complementary and alternative medicine (CAM) across age cohorts. Secondary analysis of data from the Collaborative Psychiatric Epidemiology Surveys. Adults born in 1964 or earlier (N = 11,371). Over half (61.3%) are baby boomers and 53% are female. Seventy-five percent of the sample is white, 10.2% African American, 0.6% black Caribbean, 9.35% Latino, and 4.1% Asian. The dependent variable is a dichotomous variable indicating use of any CAM. The main predictor of interest is age cohort categorized as pre-boomers (those born in 1945 or earlier) and baby boomers (those born between 1946 and 1964). Covariates include the use of traditional service providers in the past 12 months and 12-month levels of mood, anxiety, and substance disorder. Disorders were assessed with the Diagnostic and Statistical Manual World Mental Health Composite International Diagnostic Interview. Logistic regression was used to test the association between use of CAM and age cohort. Baby boomers were more likely than pre-boomers to report using CAM for a mental disorder. Among identified CAM users, a higher proportion of baby boomers reported using most individual CAM modalities. Prayer and spiritual practices was the only CAM used by more pre-boomers. Age cohort plays a significant role in shaping individual healthcare behaviors and service use and may influence future trends in the use of CAM for behavioral health. Healthcare providers need to be aware of patient use of CAM and communicate with them about the pros and cons of alternative therapies.

Psychotic experiences and disability: Findings from the Collaborative Psychiatric Epidemiology Surveys

Psychotic experiences are associated with a number of poor clinical outcomes, including multimorbid psychopathology, suicidal behavior, and poor treatment response. We wished to investigate the relationship between psychotic experiences and disability, including the following domains: cognition, mobility, self-care, social interaction, role functioning, and days out of role. We used three nationally representative and racially/ethnically diverse samples of the general US adult population: the National Comorbidity Survey Replication (NCS-R), the National Latino and Asian American Survey (NLAAS), and the National Survey of American Life (NSAL). Multi-variable logistic regression analyses were used to assess the associations between lifetime psychotic experiences (visual and auditory hallucinatory experiences and delusional ideation; WHO Composite International Diagnostic Interview psychosis screen) and 30-day impairments in functioning across disability domains (using the WHO Disability Assessment Schedule II). In all three samples, models were adjusted for socio-demographics and co-occurring psychiatric disorders. In the NCS-R, models were also adjusted for chronic health conditions. Across all three studies, our adjusted models showed that people with disability had anywhere from about 1.5 to over 3 times the odds of reporting lifetime psychotic experiences, depending on the domain. This was true for each disability domain, except self-care in the NLAAS and in the NSAL. Psychotic experiences are markers of risk for disability across a wide range of domains. This may explain the elevated rates of service utilization among individuals who report psychotic experiences and supports the need to assess for and respond to psychotic experiences even in the absence of psychotic disorder.

Perceived Need for Mental Health Care: The Intersection of Race, Ethnicity, Gender, and Socioeconomic Status.

Racial/ethnic minority populations underutilize mental health services, even in the presence of psychiatric disorder, and differences in perceived need may contribute to these disparities. Using the Collaborative Psychiatric Epidemiology Surveys, we assessed how the intersections of race/ethnicity, gender, and socioeconomic status affect perceived need. We analyzed a nationally representative sample of U.S. adults (18 years or older; N=14,906), including non-Latino whites, Asian Americans, Latinos, African Americans, and Afro-Caribbeans. Logistic regressions were estimated for the total sample, a clinical need subsample (meets lifetime diagnostic criteria), and a no disorder subsample. Perceived need varies by gender and nativity, but these patterns are conditional on race/ethnicity. Men are less likely than women to have a perceived need but only among non-Latino whites and African Americans. Foreign-born immigrants have lower perceived need than U.S.-born persons, only among Asian Americans. Intersectional approaches to understanding perceived need may help uncover social processes that lead to disparities in mental health care.

The association of posttraumatic stress disorder and chronic medical conditions by ethnicity.

Our study extends the literature on associations between posttraumatic stress disorder (PTSD) and chronic medical conditions by assessing differences in the magnitude of these relations by ethnicity. We examined group differences in the magnitude of the relation between PTSD and chronic medical conditions (cardiovascular disease [CVD], hypertension, obesity, diabetes). We obtained data from Latino (n = 3,224) and non-Latino white (n = 4,180) respondents from the Collaborative Psychiatric Epidemiology Surveys. Logistic regression models were constructed to test for the modification of the effect of PTSD on chronic medical conditions by ethnicity, and then by nativity. Unadjusted models revealed significant interactions between Latino ethnicity and PTSD for odds of diabetes (OR = 2.18 [Latino] v. 0.81 [non-Latino white]), CVD (OR = 3.23 [Latino] v. 1.28 [non-Latino white]), and hypertension (OR = 1.61 [Latino] v. 0.98 [non-Latino white]). Among U.S.-born Latinos, we found a significant interaction between ethnicity and PTSD for odds of CVD (OR = 4.18 [Latino] v. 1.28 [non-Latino white]) and diabetes (OR = 2.27 [Latino] v. 0.81 [non-Latino white]). These findings attenuated in adjusted models with the exception of differences in PTSD and odds of diabetes among Latinos (including aggregated group & U.S.-born) compared to non-Latino whites. Our findings support the need for further research on the complex relations between PTSD and chronic conditions, including the investigation of conditional risk by Latino sub-groups.

Symptom severity and disability in psychiatric disorders: The U.S. Collaborative Psychiatric Epidemiology Survey

BackgroundWhile most psychiatric diagnoses are based on simple counts of symptoms, some symptoms may be sign of a more severe mental syndrome than others. This calls for validated estimates of the relative severity specific symptoms imply within a disorder. We focused on four diagnostic disorders: Manic Episode (ME), Major Depressive Episode (MDE), Post-traumatic Stress Disorder (PTSD) and Generalized Anxiety Disorder (GAD). Symptom-specific severity parameters were estimated, and validated by examining their association with levels of self-reported disability in daily activities over and above the number of symptoms. MethodsData from the cohort study of the U.S. Collaborative Psychiatric Epidemiology Surveys (CPES) was used, which comprises the National Comorbidity Survey Replication, National Survey of American Life, and the National Latino and Asian American Study. The four analytic datasets included respondents who endorsed disorder-specific pre-screening symptoms according to the World Mental Health Survey Initiative's version of the Composite International Diagnostic Interview. Disability was measured using the WHO Disability Assessment Schedule. Item Response Theory and Tobit models were implemented. ResultsFor ME, PTSD, and GAD (not MDE) symptom severity based on psychometric Item Response Theory predicted disability outcomes after adjusting for symptom count. For PTSD, symptom count was not associated with disability. LimitationsThe analytic sample for each psychiatric disorder was based on a pre-selection stemming from index criteria (e.g. sadness or pleasure loss for MDE), which implies that our results are only generalizable to those individuals at risk rather than for the entire population. Additionally, we acknowledge that the use of unidimensional models is only one of the several options to model psychopathological constructs. ConclusionsThe same number of symptoms may be related to different levels of disability, depending on the specific symptoms from which the person suffers. Diagnostic procedures and treatment decisions may benefit from such additional information without extra costs.

Predictors of Mental Health Services Use Across the Life Course among Racially–Ethnically Diverse Adults

Little is known about key factors associated with use of mental health services across the life course. This study determined key socioeconomic, social support, psychiatric, and medical predictors of services use in younger, middle, and older age. The sample included 3,708 adults with DSM-IV-based mood, anxiety, and substance use disorders in the Collaborative Psychiatric Epidemiology Surveys. Key predictors of mental health services use for each age group were systematically determined by multivariable models, and exploratory analyses examining potential effect modification by race-ethnicity and sex were assessed by interaction terms. Statistical analyses included complex design-corrected and weighted logistic regression analyses that provide results generalizable to the United States. Psychiatric and medical issues such as prior suicidal behavior, comorbid psychiatric disorders, and perceived cognitive impairment increased odds of mental health services use in younger, middle, and older age. Chronic medical conditions also influenced services use in younger and older age, with their impact on use across age potentially modified by racial-ethnic disparities (p interaction = 0.01). Moreover, socioeconomic factors like marital status influenced use in middle and older age, where being divorced, separated, widowed, or never married encouraged use. The effect of marital status on use across age was also potentially modified by racial-ethnic disparities (p interaction = 0.02). Key socioeconomic, social support, psychiatric, and medical predictors uniquely influence use of mental health services across the life course. These findings will help inform efforts to encourage greater services use by adults across the life course in need of care.

Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders.

The main purpose of this paper is to examine geographic variation in unmet need for mental health care among racially/ethnically diverse adults with psychiatric disorders in the US. Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; 2001-2003), adults with any past year psychiatric disorder diagnosis (n=3211) from diverse racial/ethnic backgrounds were selected for analyses. Using weighted data, descriptive analyses and logistic regression analyses were conducted. Two-thirds of the total sample had unmet mental health care need, which differed significantly by race/ethnicity (p<.001). Logistic regression analyses show regional variation of the effect of race/ethnicity in unmet need: after adjusting for covariates, Latinos in the South, Blacks and Latinos in the Midwest, and Latinos and Asians in the West had higher unmet need than non-Hispanic Whites, whereas no significant racial/ethnic effects were found in the Northeast. Findings suggest that geographic region plays an important role in the sufficient use of mental health services among racial/ethnic minorities. Further research should elucidate reasons for geographic disparities in mental health care among racial/ethnic minority adults to reduce disparities.

Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences

ABSTRACTObjective: This paper examines ethnic differences in the co-occurrence of physical and psychiatric health problems (physical-psychiatric comorbidity) for women and men. The following ethnic groups are included: Non-Latino Whites, African Americans, Caribbean Blacks, Spanish Caribbean Blacks, Mexicans, Cubans, Puerto Ricans, Other Latinos, Chinese, Filipinos, Vietnamese, and Other Asian Americans. In addition, the study assesses the extent to which social factors (socioeconomic status, stress exposure, social support) account for ethnic differences in physical-psychiatric comorbidity (PPC).Design: This study uses data from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N = 12,787). Weighted prevalence rates of physical-psychiatric comorbidity (PPC) – the co-occurrence of physical and psychiatric health problems – are included to examine ethnic group differences among women and men. Multinomial logistic regression analysis was used to determine group differences in PPC before and after adjusting for social factors.Results: Puerto Rican men have significantly higher risk of PPC in comparison to Non-Latino White men. Among women, Blacks and Cubans were more likely than Non-Latino Whites to experience PPC as opposed to ‘Psychiatric Only’ health problems. Social factors account for the Puerto Rican/Non-Latino White difference in comorbid health among men, but have little explanatory power for understanding ethnic differences in comorbidity among women.Conclusion: These findings have implications for medical care and can guide intervention programs in targeting a specific constellation of co-occurring physical and psychiatric health problems for diverse ethnic groups in the United States. As comorbidity rates increase, it is crucial to identify the myriad factors that give rise to ethnic group differences therein.

The Prevalence of Past 12-Month and Lifetime DSM-IV Eating Disorders by BMI Category in US Men and Women.

This study aims to determine whether the prevalence of lifetime and past 12-month DSM-IV eating disorders (ED) diagnoses differed by body mass index category among men and women in a general population sample. Data from the Collaborative Psychiatric Epidemiology Surveys (n = 12 337 adults) were analysed using logistic regression. Analyses were conducted separately by gender. Lifetime ED prevalence was 2.22% in men and 4.93% in women. In both genders, the prevalence of any lifetime and past 12-month ED, binge eating disorder and recurrent binge eating was highest among obese individuals. Among obese men and women, lifetime and past 12-month ED prevalence was highest among those with class III obesity. Eating disorders were most prevalent among high-weight individuals. This information is important for planning targeted public health ED and obesity prevention and intervention activities, as well as for informing the clinical care of obese individuals. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Potential Moderators of Racial Differences in Responses to Traumatic Events

ABSTRACTResearch regarding the influence of race on outcomes after trauma has been mixed, and we aimed to identify potential moderators of the relation between race and posttraumatic stress disorder (PTSD)–related outcomes. We conducted a secondary analysis of data from 477 participants in the Collaborative Psychiatric Epidemiology Surveys. African American individuals reported a shorter duration of and less frequent PTSD symptoms than Caucasian individuals, and also endorsed a greater number of reexperiencing and avoidance symptoms. Education, socioeconomic status, and social support did not significantly moderate relations between age of worst trauma and PTSD-related outcomes. Clinical and research implications are discussed.

Racial and Ethnic Differences in Perceptions of Everyday Discrimination

This study examines differences in perceptions of discrimination across multiple racial and ethnic minority groups. We focus on structural factors such as race/ethnicity and socioeconomic status (SES) and psychosocial factors such as racial/ethnic identities as predictors of perceived everyday discrimination. Data come from the Collaborative Psychiatric Epidemiology Surveys (CPES), and analyses reveal several important patterns. First, perceived everyday discrimination is highly prevalent among racial/ethnic minorities in the United States and these perceptions largely reflect existing racial/ethnic hierarchies: African Americans and Afro-Caribbeans report the highest level of discrimination, whereas most Asian and Latino groups report less. Second, education, income, and immigration-related factors such as duration of residence and English language proficiency are positively associated with perceived discrimination. Third, the effects of racial/ethnic identity on perceived discrimination vary across ethnic groups, showing stronger associations among Afro-Caribbeans than among other racial and ethnic minorities. Findings from this study help to advance our theoretical understanding and empirical knowledge of racial/ethnic stratification and perceived discrimination in the United States.

Statistical Effects of Religious Participation and Marriage on Substance Use and Abuse in Racial and Ethnic Minorities.

Substance use and abuse, which includes alcohol use, alcohol dependence, drug use, and drug dependence, inflicts a substantial toll on Americans. Although studies have demonstrated the protective effect of social support, such as religious participation and via marriage, understanding their influence on racial and ethnic minorities is limited. Thus, the aim of this study is to assess the impact of social support on substance use and abuse in racial and ethnic minorities. The Collaborative Psychiatric Epidemiology Surveys, sponsored by the National Institute of Mental Health, a repository of race, ethnicity, and mental health data, was leveraged to develop four models using multivariate analysis, specifically logistic regression to estimate the probability of meeting the criteria for substance use and abuse. Racial and ethnic minorities were found to have lower rates of substance use and abuse compared to Whites, and foreign-born individuals were consistently less likely to use or abuse substances compared to American-born minorities. Mental health conditions were highly associated with substance use and abuse, and social support by way of religious participation and marriage was protective against substance use and abuse. In racial and ethnic minorities, nativity and social support were protective against substance use and abuse; however, these protective factors did not completely eliminate risk. Thus, although race and ethnicity are important to understanding health outcomes and health behaviors, such as substance use and abuse, it is the intersection of multiple factors, representing internal and external forces, which may be more informative and offer a more comprehensive picture of the landscape influencing drug and alcohol use and dependence. Targeted interventions should consider leveraging religious spaces and bilingual materials when attempting to reach racial and ethnic minorities.

Reconsidering the definition of Major Depression based on Collaborative Psychiatric Epidemiology Surveys

BackgroundDiagnostic definitions for depressive disorders remain a debated topic, despite their central role in clinical practice and research. We use both recent evidence and nationally representative data to derive an empirically-based modification of DSM-IV/-5 Major Depressive Disorder (MDD). MethodA modified MDD diagnosis was derived by analyzing data from Collaborative Psychiatric Epidemiology Surveys, a multistage probability sample of adults (n=20 013; age ≥ 18 years) in coterminous USA, Alaska and Hawaii. The old and the newly suggested MDD definitions were compared for their associated disability (WHO Disability Assessment Schedule and number of disability days in past month), suicide attempt, and other covariates. ResultsOur data-driven definition for major depression was “lack of interest to all or most things” plus four other symptoms from the set {weight gain, weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness, diminished ability to think/concentrate, suicidal ideation/attempt}. The new definition captured all the disability implied by MDD and excluded cases that showed no greater disability than the general population nor increased risk of suicide attempts. The lifetime prevalence of the new diagnosis was 14.7% (95% CI=14–15.4%) of the population, slightly less than for the old definition (16.4%; CI=15.4–17.3%). LimitationsOnly conservative modifications of MDD could be studied, because of restrictions in the symptom data. ConclusionsWith only small adjusting, the new definition for major depression may be more clinically relevant than the old one, and could serve as a conservative replacement for the old definition.

Is smoking tobacco associated with psychotic experiences across racial categories in the United States? Findings from the Collaborative Psychiatric Epidemiological Surveys.

Smoking tobacco has been associated with psychosis, though research has yet to fully examine the extent to which this association reaches into the sub-threshold range of the psychosis continuum within the US, and whether this association persists after accounting for co-occurring disorders. We analyzed data from three large racially-diverse surveys of the US population and found that current smokers were more likely to report a lifetime psychotic experience when compared with never smokers after adjusting for socio-demographics. But after controlling for anxiety, mood, and substance use disorders, these effects only remained strong and statistically significant for Asian-Americans.

When social anxiety and depression go together: A population study of comorbidity and associated consequences

BackgroundDespite several studies suggesting higher depression severity and dysfunction occurring in individuals with major depressive disorder (MDD) comorbid with social anxiety disorder (SAD), a clear understanding of the specific risks associated with this comorbidity is lacking. In this study we compared the disease characteristics and level of disability of individuals with MDD-SAD with other comorbidities between depression and anxiety. MethodsData from the Collaborative Psychiatric Epidemiology Surveys (CPES) (N=20,013) were used. Individuals were divided in four groups comparing MDD-SAD with MDD alone, as well as other comorbidities between MDD and one anxiety (MDD-1ANX) or more than two anxiety disorders (MDD≥2ANX), with respect to several clinical, demographic, and functional characteristics. ResultsMDD-SAD comorbidity in the general population occurred in younger people, particularly men, and seemed to have an earlier onset of MDD. Occupational and social dysfunction was similar between individuals with MDD-SAD and those with MDD-1ANX. However, individuals with MDD≥2ANX had significantly higher severity as measured by suicidality as well as substance abuse and social and occupational dysfunction. SAD was the most prevalent comorbid anxiety in this group. LimitationsThe findings of this study were derived from the cross-sectional data. ConclusionOur results suggest that the particular risks associated with MDD-SAD are the early onset and likelihood of additional anxiety, leading to higher severity and disability levels. Clinicians should increase the screening and treatment of SAD and other anxiety disorders in individuals with MDD given the higher associated health risk and functional impairment.