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Jitender Sareen, BSc, MD, FRCPC; Frank Jacobi, PhD; Brian J. Cox, PhD; Shay-Lee Belik, BSc(Hons); Ian Clara, MA; Murray B. Stein, MD, MPH

Arch Intern Med. 2006;166:2109-2116.

Background  Evidence has been emerging that anxiety disorders are associated with several physical health conditions. We used the first community survey, which assessed physical conditions based on physician assessment and included standardized diagnostic assessment of mental disorders by trained health professionals, to examine the relationship between anxiety disorders and physical conditions.

Methods  The German Health Survey (N = 4181; response rate, 87.6%; ages 18-65 years) used the Composite International Diagnostic Interview to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mood, substance use, and anxiety disorders (panic disorder, social phobia, specific phobia, generalized anxiety disorder, agoraphobia, obsessive-compulsive disorder) and a standardized medical interview supplemented by laboratory data to assess a broad range of physical conditions. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used to measure health-related quality of life. Number of days of role impairment was used to measure past 30-day disability.

Results  After adjusting for sociodemographic factors and other common mental disorders, the presence of an anxiety disorder was significantly associated with thyroid disease, respiratory disease, gastrointestinal disease, arthritis, migraine headaches, and allergic conditions (adjusted odds ratios between 1.39 and 2.12; P<.05). Compared with physical disorders alone, the presence of comorbid anxiety disorder with 1 or more physical disorders was associated with poorer physical component scores on the SF-36 (adjusted mean scores for physical condition alone and physical condition with anxiety disorder, 48.50 and 45.86, respectively; P<.001) and past 30-day disability due to physical problems (adjusted odds ratio, 1.69; 95% confidence interval, 1.20-2.37).

Conclusion  Anxiety disorders are independently associated with several physical conditions in the community, and this comorbidity is significantly associated with poor quality of life and disability.

Author Affiliations: Department of Psychiatry and Community Health Sciences, University of Manitoba, Winnipeg (Drs Sareen and Cox, Ms Belik, and Mr Clara); Institute of Clinical Psychology and Psychotherapy Unit: Epidemiology and Service Research, Technical University of Dresden, Dresden, Germany (Dr Jacobi); and Departments of Psychiatry and Family & Preventive Medicine, University of California, San Diego (Dr Stein).

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