The World Mental Health Surveys were established by the World health Organization (WHO) in 2000 with the aim of providing valuable information on prevalence, correlates, burden, and treatment of mental disorders throughout the world for physicians and policy makers. This volume focuses on the epidemiology of mental and physical comorbidity. Almost 20 000 people sampled from the general population of 17 countries in six different continents were assessed for mental disorders, physical conditions and psychosocial stressors, such as early childhood adversity, which makes it the largest population study that focuses on mental-physical comorbidity. The study confirms previous reports that depressive and anxiety disorders occur with greater frequency in persons with chronic physical conditions and pain, but also that the majority of persons with such chronic conditions do not report anxiety or depression. New insights are that early childhood adversities and early onset depression and anxiety not only predispose for later psychopathology, but also for a range of chronic physical diseases such as asthma, hypertension, heart failure, diabetes and arthritis. Second, the data revealed that the combined effects of comorbid mental and physical comorbidity on disability and impairment are greater then the sum of their parts. Finally and surprisingly, the pattern of results was consistent across the diverse cultural settings and the different states of economic development in the participating countries.

The book is divided into four sections. After an introductory chapter, the first section focuses on the epidemiology of mental-physical comorbidity. The chapter on methods discusses, among others, sampling procedures, measurement of mental and physical disorders, the assessment of childhood psychosocial stressors, the statistical approach, and the strength and limitations of the survey's design. The major limitation of this survey, acknowledged in this chapter, is the fact that whereas mental disorders are diagnosed with a structured interview assessing the DSM diagnostic criteria, physical disease is diagnosed by a self-report checklist only. Another limitation is that at the different sites certain aspects of the methods, such as sampling methods, may have been adapted to local circumstances and hence differ between countries. Such limitations and adaptations are probably inevitable in a project of this scope and magnitude and do not compromise the data nor the conclusions drawn from them. The second section focuses on risk factors for mental-physical comorbidity in patients with specified physical conditions, such as asthma, heart disease, hypertension, diabetes, obesity, etc.; the third section focuses on the consequences of mental-physical comorbidity. In this section, among others, disability, workforce participation and perceived stigma are addressed. Throughout these three sections an unprecedented wealth of data is presented in 55 prevalence tables, 17 prevalence figures, 31 odds ratio tables, 16 funnel plots and 10 other tables. The last section is a state-of-the-art synthesis of the findings, in which the implications for research, patient care and health-care policy are discussed. All chapters are worth reading and show evidence of a very up-to-date and nuanced view of mental-physical comorbidity.

This book is the reflection of a ground-breaking effort that provides us with a lot of new insights on mental-physical comorbidity. It shows us that the interrelation between mental disorders, physical disorders and psychosocial stressors is stronger and more bidirectional then previously thought. In this book, health-care policy-makers will find the evidence they need to make the case for reintegrating general and mental health care. Its findings stress the need for further development of an integrated approach for chronic diseases, and open the road for new and early intervention targets for preventing chronic disease. Researchers may find the arguments and inspiration for further longitudinal population-based studies on mental-physical comorbidity that may unravel the biological consequences of psychological, psychosocial and societal factors in their disease modifying effects, both as risk factors and protective factors. This work will become a standard work of reference and is therefore compulsory reading for clinicians, policy makers, researchers and other disciplines working in the field of psychosomatic medicine.