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Results From the National Comorbidity Survey

Ronald C. Kessler, PhD; Katherine A. McGonagle, PhD; Shanyang Zhao, PhD; Christopher B. Nelson, MPH; Michael Hughes, PhD; Suzann Eshleman, MA; Hans-Ulrich Wittchen, PhD; Kenneth S. Kendler, MD

Arch Gen Psychiatry. 1994;51(1):8-19.

Abstract
Background
This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States.

Methods
The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview.

Results
Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status.

Conclusions
The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.

Author Affiliations
From the Institute for Social Research (Drs Kessler, McGonagle, and Zhao, Mr Nelson, and Ms Eshleman) and Department of Sociology (Dr Kessler), The University of Michigan, Ann Arbor; the Virginia Polytechnic Institute and State University, Blacksburg (Dr Hughes); the Max Planck Institution of Psychiatry, Munich, Germany (Dr Wittchen); and the Departments of Psychiatry (Dr Kendler) and Human Genetics (Dr Kendler), Medical College of Virginia/Virginia Commonwealth University, Richmond.

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