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At least 19 recordsLinked to original sources
PubMed2002

Geriatric Index of Comorbidity: validation and comparison with other measures of comorbidity.

BACKGROUND: the debate about measures of chronic comorbidity in the elderly is mainly due to the lack of consensus on pathogenetic models. OBJECTIVE: the aim of the present study was to compare the concurrent validity of a number of measures of chronic comorbidity assuming different pathogenic models, versus disability in elderly patients. SETTING: the Geriatric Evaluation and Rehabilitation Unit for subacute and disabled patients. PARTICIPANTS: 493 new and consecutive elderly patients (mean age 79 years, 71% females) admitted to the Geriatric Evaluation and Rehabilitation Unit. MEASUREMENTS: we evaluated age, gender, cognitive status, depressive symptoms, functional status, somatic health, and nutritional status on admission. Functional status was assessed by the self- or proxy reported Katz's BADL scale and by the performance-based Reuben's Physical Performance Test. Somatic health was assessed as presence and severity of diseases according to standardized criteria. Comorbidity was measured as number of diseases, sum of disease severity, and with a composite score (Geriatric Index of Comorbidity) which takes into account both number of diseases and occurrence of very severe diseases. Mortality was assessed after 12 months. RESULTS: specific diseases and their severity were found to be associated with disability measures. All measures of comorbidity were significantly correlated with disability, but only the Geriatric Index of Comorbidity was independently associated after adjustment for severity of individual diseases. In addition, increasing severity of comorbidity as defined by Geriatric Index of Comorbidity was associated with greater disability while this was not true for the other comorbidity measures (F statistics for the regression model including the Geriatric Index of Comorbidity=19.9). The Geriatric Index of Comorbidity, but not the other comorbidity measures, predicted mortality (relative risk of death 2.3, 95% confidence interval 1.7-3.1). CONCLUSION: the Geriatric Index of Comorbidity, a measure of comorbidity assuming that both number of diseases and occurrence of very severe diseases are determinants of health, has the greatest concurrent validity with disability and is the best predictor of mortality.

Aged↗
PubMed2005

Baseline comorbidity in kidney transplant recipients: a comparison of comorbidity indices.

BACKGROUND: An increasing number of patients starting renal replacement therapy are older and have complex comorbidity. In keeping with these demographics, an increased number of older patients undergo transplantation each year. To date, no study has reported baseline comorbidity characteristics of those who underwent transplantation, validated the use of comorbidity indices, or asked whether comorbidity predicts patient outcome after kidney transplantation. Our objective is to report baseline comorbidity and compare the use of different indices for recipients of kidneys from both deceased and living donors. METHODS: Using data from the Canadian Organ Replacement Registry, we tested the ability of 4 comorbidity indices to predict patient survival by using a Cox regression model. Model covariates included donor source, age, race, sex, treatment period, primary renal disease cause, months on dialysis therapy, and comorbidities. RESULTS: A total of 6,324 patients were included; 22% had > or =1 comorbid condition at baseline. After adjustment for age, sex, and cause of renal disease, increased comorbidity was associated strongly with reduced patient survival. Of all comorbidity indices examined, the model containing the Charlson Comorbidity Index (CCI) offered the best fit. The model containing log--CCI had an index of concordance of 74%. CONCLUSION: The CCI is a suitable tool for the measurement of comorbidity in renal transplant recipients.

Adult↗
PubMed2005

Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument.

BACKGROUND: Interventions to improve care for persons with chronic medical conditions often use quality of life (QOL) outcomes. These outcomes may be affected by coexisting (comorbid) chronic conditions as well as the index condition of interest. A subjective measure of comorbidity that incorporates an assessment of disease severity may be particularly useful for assessing comorbidity for these investigations. METHODS: A survey including a list of 25 common chronic conditions was administered to a population of HMO members age 65 or older. Disease burden (comorbidity) was defined as the number of self-identified comorbid conditions weighted by the degree (from 1 to 5) to which each interfered with their daily activities. We calculated sensitivities and specificities relative to chart review for each condition. We correlated self-reported disease burden, relative to two other well-known comorbidity measures (the Charlson Comorbidity Index and the RxRisk score) and chart review, with our primary and secondary QOL outcomes of interest: general health status, physical functioning, depression screen and self-efficacy. RESULTS: 156 respondents reported an average of 5.9 chronic conditions. Median sensitivity and specificity relative to chart review were 75% and 92% respectively. QOL outcomes correlated most strongly with disease burden, followed by number of conditions by chart review, the Charlson Comorbidity Index and the RxRisk score. CONCLUSION: Self-report appears to provide a reasonable estimate of comorbidity. For certain QOL assessments, self-reported disease burden may provide a more accurate estimate of comorbidity than existing measures that use different methodologies, and that were originally validated against other outcomes. Investigators adjusting for comorbidity in studies using QOL outcomes may wish to consider using subjective comorbidity measures that incorporate disease severity.

Aged↗
PubMedDate not supplied

Comorbidities in stroke patients as assessed with a newly developed comorbidity scale.

We previously reported reliability and validity of our newly developed comorbidity scale (CS) for stroke outcome research based on a retrospective sample. The objectives of this study were to cross-validate the comorbidity scale in a new prospective sample and to investigate longitudinal changes of the comorbidity scale during hospitalization. In a prospective sample of 175 stroke patients admitted to five nonacute rehabilitation hospitals in Japan, we analyzed the frequency and grading of comorbidities and compared the comorbidity scale with demographic data, impairment as assessed with the Stroke Impairment Assessment Set (SIAS), and disability as measured with the Functional Independence Measure (FIM(SM)). The results were compared with our previous retrospective study. We also studied longitudinal changes by measuring the comorbidity scale on admission, 2 wk later, and at discharge of 67 patients. As a result, the comorbidity scaling was significantly lower in the prospective sample, and it increased at the second measurement and then plateaued. Among the comorbidities, hypertension ranked first, followed by shoulder pain, and diabetes mellitus. Similar to our previous retrospective study, the comorbidity scale correlated positively with age and length of stay and correlated negatively with the SIAS motor item scores and the FIM scores. In conclusion, the present study suggested concurrent and predictive validity of the comorbidity scale in a prospective sample as well and clarified the comorbidity characteristics of stroke inpatients.

Activities of Daily Living↗
PubMed2004

Pathways to comorbidity: the transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study.

BACKGROUND: To describe transitions to comorbidity within a 3-year period in three cohorts of subjects with at baseline a 12-month pure mood, anxiety or substance use disorder but no lifetime history of any other disorder category. To assess the role of personal and social vulnerability factors, life events, clinical factors and functional disability in the pathway to comorbidity. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study of a representative sample of 7076 adults aged 18-65, interviewed in three waves (baseline, 1 and 3 years after baseline) with the Composite International Diagnostic Interview. RESULTS: 15.2% of 99 pure mood, 10.5% of 220 anxiety and 6.8% of 192 substance use disorder cases became comorbid. Comorbid transition from pure mood disorder was multivariately associated with higher age, external mastery and severity of the disorder. Comorbidity developing from pure anxiety disorder was associated with past and recent stressful life circumstances (childhood trauma, negative life events) and physical functional disability. Predictors of comorbid transition from pure substance use disorder were personal and social vulnerability variables only (high neuroticism, low social support). LIMITATIONS: Although NEMESIS was performed among a substantial number of cases, the number of cases with a pure disorder at baseline subsequently developing comorbidity was low. This limited analysing determinants of different comorbid conditions. CONCLUSIONS: Risk factors for comorbid transitions vary depending on whether subjects have a primary mood, anxiety or substance use disorder. Interventions aimed at primary prevention of comorbidity to reduce psychiatric burden in populations with a history of pure disorders are indicated in response to clearly identified risk factors.

Adolescent↗
PubMedDate not supplied

Alcohol-dependent patients with comorbid phobic disorders: a comparison between comorbid patients, pure alcohol-dependent and pure phobic patients.

BACKGROUND: Patients with a double diagnosis of alcohol dependence and phobic disorders are a common phenomenon in both alcohol and anxiety disorder clinics. If we are to provide optimum treatment we need to know more about the clinical characteristics of this group of comorbid patients. OBJECTIVE: To answer the following questions. (1). What are the clinical characteristics of treatment-seeking alcohol-dependent patients with a comorbid phobic disorder? (2). Are alcohol dependence and other clinical characteristics of comorbid patients different from those of 'pure' alcohol-dependent patients? (3). Are the anxiety symptoms and other clinical characteristics of comorbid patients different from those of 'pure' phobic patients? METHOD: Three groups of treatment-seeking patients were compared on demographic and clinical characteristics: alcohol dependent patients with a comorbid phobic disorder (n = 110), alcohol-dependent patients (n = 148) and patients with social phobia or agoraphobia (n = 106). In order to diagnose the comorbid disorders validly, the assessment took place at least 6 weeks after detoxification. RESULTS: Comorbid patients have high scores on depressive symptoms and general psychopathology: 25% of patients have a current and 52% a lifetime depressive disorder. The majority have no partner and are unemployed, they have a high incidence of other substance use (benzodiazepine, cocaine, cannabis) and a substantial proportion of comorbid patients have been emotionally, physically and sexually abused. They do not have a more severe, or different type of alcohol dependence or anxiety disorder than 'pure' alcohol-dependent patients and phobic patients respectively. CONCLUSION: Comorbid patients constitute a complex part of the treatment-seeking population in alcohol clinics and psychiatric hospitals. These findings should be taken into account when diagnosing and treating alcohol-dependent patients with a comorbid phobic disorder.

Adult↗
PubMed2006

Assessment of long-term physical function in acute respiratory distress syndrome (ARDS) patients: comparison of the Charlson Comorbidity Index and the Functional Comorbidity Index.

OBJECTIVE: It is often important to adjust for the effect of comorbid diseases on patient outcomes. This study compares the association between physical function in acute respiratory distress syndrome patients with scores on two comorbidity indices, the Charlson Comorbidity Index, designed to predict mortality, and the Functional Comorbidity Index (FCI), which was designed to predict physical function. DESIGN: This is a prospective, longitudinal, observational study. A total of 73 survivors of acute respiratory distress syndrome were contacted at 3, 6, and 12 mos. Patient comorbidity was evaluated with the Charlson Comorbidity Index and the FCI. Physical function was measured using the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Subscale and the Physical Component Subscale scores. RESULT: Mean FCI and Charlson Comorbidity Index scores correlated fairly strongly (Spearman rho = 0.62, P < 0.001). FCI, but not the Charlson Comorbidity Index, scores correlated with the Physical Function Subscale and Physical Component Subscale scores. After controlling for other potentially confounding variables such as age and severity of illness through regression analysis, the FCI score was still significantly associated with both Physical Function Subscale and Physical Component Subscale scores. CONCLUSIONS: The FCI is a better method of measuring comorbidity with physical function as the outcome. This study illustrates the importance of choosing the most appropriate comorbidity index for the outcome of interest.

Activities of Daily Living↗
PubMed2005

Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication.

This paper investigates comorbidity between chronic back and neck pain and other physical and mental disorders in the US population, and assesses the contributions of chronic spinal pain and comorbid conditions to role disability. A probability sample of US adults (n=5692) was interviewed. Chronic spinal pain, other chronic pain conditions and selected chronic physical conditions were ascertained by self-report. Mood, anxiety and substance use disorders were ascertained with the Composite International Diagnostic Interview (CIDI). Role disability was assessed with questions about days out of role and with impaired role functioning. The 1 year prevalence of chronic spinal pain was 19.0%. The vast majority (87.1%) of people with chronic spinal pain reported at least one other comorbid condition, including other chronic pain conditions (68.6%), chronic physical conditions (55.3%), and mental disorders (35.0%). Anxiety disorders showed as strong an association with chronic spinal pain as did mood disorders. Common conditions not significantly comorbid with chronic spinal pain were diabetes, heart disease, cancer, and drug abuse. Chronic spinal pain was significantly associated with role disability after controlling for demographic variables and for comorbidities. However, comorbid conditions explained about one-third of the gross association of chronic spinal pain with role disability. We conclude that chronic spinal pain is highly comorbid with other pain conditions, chronic diseases, and mental disorders, and that comorbidity plays a significant role in role disability associated with chronic spinal pain. The societal burdens of chronic spinal pain need to be understood and managed within the context of comorbid conditions.

Adolescent↗
PubMed2005

Utility of the Chronic Disease Score and Charlson Comorbidity Index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms.

Comorbidity is a known risk factor for antibiotic-resistant bacterial infections. Although aggregate comorbidity measures are useful in epidemiologic research, none of the existing measures was developed for use with this outcome. This study compared the utility of two comorbidity measures, the Charlson Comorbidity Index and the Chronic Disease Score, in assessing the comorbidity-attributable risk of nosocomial infections with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE). Two case-control studies were conducted at the University of Maryland Medical System in Baltimore, Maryland. Cases were inpatients with a first positive clinical culture of MRSA or VRE at least 48 hours postadmission (July 1, 1998-July 1, 2001). Three inpatient controls were randomly selected per case. The MRSA study included 2,164 patients, and the VRE study included 1,948. The scores' discrimination and calibration were measured by using the c statistic and Hosmer-Lemeshow chi-square test. The Charlson Comorbidity Index (c = 0.653) and Chronic Disease Score (c = 0.608) were similar discriminators of MRSA and VRE (c = 0.670 and c = 0.647, respectively). Calibration of the scores was poor for both outcomes (p < 0.05). A revised comorbidity measure specific to resistant infections would likely provide a better assessment of the comorbidity-attributable risk of antibiotic-resistant infections.

Adolescent↗
PubMed2003

Adjustment for comorbidity in studies on health status in ESRD patients: which comorbidity index to use?

Health status can be an important outcome in studies on patients with end-stage renal disease (ESRD). In these studies, adjustment for prognostic factors, such as comorbidity, often has to be made. None of the comorbidity indices that are commonly used in research on ESRD patients has been validated for studies on health status. This study evaluated three existing indices (Khan, Davies, and Charlson) and four indices specifically developed for use in studies on health status. In a large prospective multi-center study (NECOSAD-2), new ESRD patients were included (n = 1041). Comorbidity was assessed at the start of dialysis. Health status was assessed with the physical and mental component summary score of the SF-36 (PCS and MCS), the symptoms dimension of the KDQOL-SF, and the Karnofsky Scale. Patient data were randomly allocated to a modeling or a testing set. The new indices were developed in the modeling set. The three existing indices explained about the same percentage of variance in the PCS (7 to 8%), MCS (1 to 3%), symptoms (2 to 4%), and Karnofsky (10 to 12%). The new indices performed better than the existing indices in the modeling population (13% PCS, 10% MCS, 10% symptoms, 18% Karnofsky), but not in the testing population (8% PCS, 1% MCS, 3% symptoms, 8% Karnofsky). Individual comorbidities explained more variance in PCS (10 to 15%), MCS (1 to 7%), symptoms (6 to 11%), and Karnofsky (11 to 18%) than comorbidity indices. The Khan, Davies, and the Charlson indices will adjust to the same extent for the potential confounding effect of comorbidity in studies with health status as an outcome. Separate comorbidity diagnoses will adjust best for comorbidity.

Aged↗
PubMed2000

Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking.

BACKGROUND: Most prior studies of panic-depression comorbidity have been limited methodologically by use of small clinical samples and incomplete analyses. AIMS: General population data were used to study the association of lifetime and recent (12 months) panic-depression comorbidity with symptom severity, impairment, course and help-seeking in the National Comorbidity Survey (NCS). METHOD: The NCS is a nationally representative survey of the prevalences and correlates of major DSM-III-R disorders in the US household population. RESULTS: Strong lifetime and current comorbidity were found between panic and depression. Comorbidity was associated with greater symptom severity, persistence, role impairment, suicidality and help-seeking, with many findings persisting after controlling for additional comorbid diagnoses. Findings did not differ according to which disorder was chronologically primary. CONCLUSIONS: Both lifetime and current panic-depression comorbidity are markers for more severe, persistent and disabling illness. Neither additional comorbid diagnoses nor the primary-secondary distinction were important moderators of these associations.

Adolescent↗
PubMed1996

Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices.

OBJECTIVES: This study was designed to determine if comorbidity added more information than knowing only the patient's age in predicting survival and length of hospital stay. METHODS: The authors compared the relative predictive validity of three comorbidity indices: the Cumulative Illness Rating Scale, the Charlson Index, and a count of International Classification of Diseases, 9th Revision, Clinical Modification medical diagnoses in relation to survival and length of hospital stays in patients with spinal cord injury. The sample consisted of 330 longitudinally followed spinal-cord injured patients admitted between January 1989 and December 1990 who were followed for an additional 18 months. RESULTS: During the follow-up, 25 (7.5%) patients died and 249 (75.5%) were readmitted to hospital with a median of one admission (range, 1-8). The corresponding lengths of hospital stay ranged from 0 to 548 days, with a median of 7 days. CONCLUSIONS: Patients who died were not significantly older but had higher comorbidity scores. Using patients alive at the end of the follow-up period, linear regression models were fit to the data to determine if comorbidity added more information regarding length of hospital stay than knowing only the patient's age. In the model that included only age as an independent variable, there was a significant relation between age and length of stay (F(1,303) = 5.2; P = 0.012). The R2 value for this model was 0.017. In further models that included age and each of the three comorbidity scores (separately) as the independent variables, the model that included age and the Cumulative Illness Rating Scale yielded the highest R2 value (R2 = 0.062). This study is among the first to compare three different measures of comorbidity and documents that comorbidity provides more information than knowing only the patient's age in relation to survival and length of hospital stay.

Adult↗
PubMed2002

Applicability of the adult comorbidity evaluation - 27 and the Charlson indexes to assess comorbidity by notes extraction in a cohort of United Kingdom patients with head and neck cancer: a retrospective study.

The term comorbidity stands for disease processes that co-exist and are not related to the index disease being studied. Comorbidity in cancer has been shown to be a major determinant in treatment selection and survival. Patients with head and neck cancer can have significant comorbidity owing to the high incidence of tobacco and alcohol abuse. No studies to date have addressed this problem in head and neck cancer patients in the United Kingdom. The applicability of the adult comorbidity evaluation - 27 index (ACE-27) and the Charlson index (CI) to assess the comorbidity burden by retrospective notes review is studied here. Retrospective data collection and completion of a comorbidity index in a United Kingdom setting is feasible. We conclude that the pre-assessment visit is a useful time to record comorbidity and as a significant amount of information required for grading relates to historical items, this is best done using a self-administered patient questionnaire.

Abstracting and Indexing↗
PubMed2006

[Association between serotonin 1D gene polymorphisms and attention deficit hyperactivity disorder comorbid or not comorbid disruptive behavior disorder].

OBJECTIVE: To investigate the relationship between two HTR1D gene polymorphisms, that is 1350T > C and 1236A > G polymorphisms, and attention deficit hyperactivity disorder (ADHD) comorbid or not comorbid disruptive behavior disorder (DBD). METHODS: Blood samples were taken from 90 trios with probands of ADHD comrbid DBD and 182 trios with probands of ADHD not comorbid DBD. DNA was extracted. 1350T > C and 1236A > G were genotyped by restriction fragment length polymorphism analysis. Transmit/disequilibrium test and haplotype analysis were used to test the association of the two polymorphisms of HTR1D gene and ADHD comorbid or not comorbid disruptive behavior disorder (DBD) separately. RESULTS: 1350T allele(chi2 = 3.67, P = 0.055)and G/T haplotype(chi2 = 3.84, P = 0.050)were overtransmitted, while 1350C allele(chi2 = 3.67, P = 0.055) and G/C haplotype(chi2 = 5.22, P = 0.022)were undertransmitted to probands of ADHD with DBD. No biased transmission of any allele and haplotype was found in families with probands of ADHD without DBD. CONCLUSION: ADHD comorbid or not comorbid DBD are different at the level of HTR1D gene polymrohisms of 1350T > C and 1236A > G. The current results indicate that ADHD with DBD has more heritable backgrounds when compared with ADHD without DBD.

Adolescent↗
PubMed2005

Testing hypotheses regarding the causes of comorbidity: examining the underlying deficits of comorbid disorders.

The authors examined the validity of a method commonly used to test alternative hypotheses regarding the causes of comorbidity: the examination of underlying deficits of comorbid disorders. The authors simulated data in which the true causes of comorbidity were known, then compared the patterns of underlying deficits of the comorbid disorders found in the simulated data with the predicted results. The method of examining the underlying deficits of comorbid disorders could distinguish between several comorbidity models, including those that could not be distinguished well using other methods. The ability to distinguish the correct model decreased as the sample size and the correlation between the underlying deficits and the symptom scores decreased, suggesting that the issue of power should be considered carefully.

Adult↗
PubMed2005

[Comorbidity in child psychiatry: is the comorbidity of pediatric mania and ADHD really that high?].

OBJECTIVE: The purpose of our study was to investigate possible reasons of diagnosing comorbidity in child psychiatric disorders, with special attention to the comorbidity of mania and attention deficit-hyperactivity syndrome (ADHD). METHOD: Using a structured interview, the Mini International Neuropsychiatric Interview Kid (M.I.N.I. Kid) we examined 112 consecutive admitted children aged under 18 in the Vadaskert Children's Psychiatric Hospital. For all children, best-estimated diagnoses were made by an independent child-psychiatrist as well, who was blind to the diagnoses of the M.I.N.I. Kid. Six children were diagnosed as having pervasive developmental disorder by the independent clinician, their data were excluded. In this way the data of 106 children were included in the statistical analysis. RESULTS: Comorbidity: Based on the M.I.N.I. Kid test comorbid diagnoses were found in 74.53% of the children and 51.90% of the children with comorbid diagnoses had three or more concomitant diagnoses. The maximum number of diagnoses obtained concomitantly by the M.I.N.I. Kid was 9. The M.I.N.I. Kid produced 2.58 diagnoses for one child on average. The independent child-psychiatrist found comorbid diagnoses in 25.47% of the children. The maximum number of diagnoses made by the independent child-psychiatrist for 1 child was 2. The independent child-psychiatrist established 1.25 diagnoses for one child on average. Manic/hypomanic episode: Based on the M.I.N.I. Kid manic episode was diagnosed in 14.15% of the children and hypomanic episode in 6,60% of them, while the independent psychiatrist did not diagnose these conditions in any of the children. 99.33% of the children with manic episode were diagnosed together with ADHD by the M.I.N.I. Kid. In 57.14% of those cases, where the M.I.N.I. Kid diagnosed a hypomanic episode, it found an ADHD at the same time. The independent psychiatrist found ADHD in 73.33% of the children with the diagnoses of manic episode and in 57.14% of the children with hypomanic episode determined by the M.I.N.I. Kid. CONCLUSIONS: The considerable differences found in the number of diagnoses made by using the M.I.N.I. Kid and by the independent child psychiatrist may indicate the possible over-sensitivity of structured interviews and the characteristics of diagnostic systems: several disorders have overlapping symptoms, making the differential diagnoses difficult.

Adolescent↗
PubMed1991

Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults.

The current and lifetime comorbidity of depressive (i.e., major depressive disorder and dysthymia) with other common mental disorders was examined in community samples of older adolescents (n = 1,710) and adults (n = 2,060). Current and lifetime histories of depression in the adolescents were highly comorbid with several other mental disorders. The adults had a lower but statistically significant degree of comorbidity, primarily with substance use disorder. Depression in both groups was more likely to occur after the other disorder rather than to precede it. Comorbidity did not affect the duration or severity of depression. Comorbidity in the adolescents was associated with greater frequency of suicidal behavior and treatment seeking. The findings suggest that early-onset depression is associated with a greater degree of comorbidity and may represent a more serious form of the disorder.

Adolescent↗
PubMed2006

Comorbid substance and mental disorders among rural Americans: results from the National Comorbidity Survey.

BACKGROUND: The purpose of this study was to examine whether rural inhabitants were more likely than urban inhabitants to meet the criteria for comorbid mental health and substance abuse or dependence disorders. METHODS: Data were from the National Comorbidity Survey, and included 5185 (532=rural; 4653=urban) persons age 14-54 years of age who were interviewed using the Composite International Diagnostic Interview (CIDI). Logistic regression that accounted for the complex survey data and weighting scheme was utilized. RESULTS: Participants residing in rural areas were more likely to meet the DSM-III-R criteria for past month alcohol abuse or dependence if they also met the diagnostic criteria for past month major depressive disorder (MDD) or lifetime antisocial personality disorder (ASPD), adjusting for age, race, gender, education and income. Similarly, rural participants were more likely to meet the criteria for comorbid drug abuse or dependence in the past month if they met the diagnosis for either past month MDD, generalized anxiety disorder or lifetime ASPD, controlling for demographic characteristics. Rural residents with any current mental disorder also were less likely to seek treatment than their urban counterparts. LIMITATIONS: Data were collected in 1991 and do not capture changes in prevalence of comorbidities. Also, the small number of rural residents sampled resulted in small cell sizes for some comorbidities. CONCLUSIONS: Rural residents were significantly more likely to meet the criteria for substance disorders given they also met the criteria for a mental disorder, and those with any current mental disorder were less likely to seek treatment. Since the overall prevalence of these disorders does not differ between rural and urban inhabitants, findings suggest that rural persons may lack access to adequate treatment for their mental health disorders and subsequently may be self-medicating with alcohol and/or drugs.

Adolescent↗