The Societal Costs of Anxiety and Mood Disorders: An Epidemiological Perspective

  • R. C. Kessler
  • P. S. Wang
  • H.-U. Wittchen
Reference work entry


This chapter reviews the epidemiological literature on the prevalence and adverse societal consequences of anxiety and mood disorders. A special emphasis is put on the recently collected data from the completed World Health Organization (WHO) World Mental Health (WMH) Surveys (Kessler and Üstün, 2008). The first section of the chapter discusses the methods used in community epidemiological surveys to estimate the prevalence and correlates of mental disorders. The next section reviews the recent worldwide epidemiological literature on the general population prevalence of anxiety and mood disorders. This is followed by reviews of recent epidemiological evidence on age-of-onset distributions, illness course, and comorbidity among the anxiety and mood disorders. The last section reviews the recent epidemiological literature on the adverse effects of anxiety and mood disorders. The evidence presented in these sections documents clearly that anxiety and mood disorders are commonly occurring, that many of them start at an early age and have a chronic-recurrent course, and that they have a number of adverse effects that make them among the most costly of all health problems from a societal perspective.


Major Depressive Disorder Anxiety Disorder Obsessive Compulsive Disorder Mood Disorder Separation Anxiety Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:




Bipolar Disorder


The National Institute of Mental Health Collaborative Depression Study


The Composite International Diagnostic Interview


The Diagnostic Interview Schedule


The American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders


Generalized Anxiety Disorder


The Harvard/Brown Anxiety Disorders Research Program


The World Health Organization International Classification of Diseases


The World Health Organization International Consortium of Psychiatric Epidemiology


Inter-Quartile Range


Major Depressive Disorder


The National Comorbidity Survey Replication


The National Institute of Mental Health


Obsessive-Compulsive Disorder


Post-Traumatic Stress Disorder


Separation Anxiety Disorder


World Health Organization

WMH Surveys

The World Mental Health Surveys



Preparation of this chapter was supported, in part, by grants The National Comorbidity Survey Replication (NCS-R) is supported by NIMH (U01-MH60220) with supplemental support from the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044780), and the John W. Alden Trust. Collaborating NCS-R investigators include Ronald C. Kessler (Principal Investigator, Harvard Medical School), Kathleen Merikangas (Co-Principal Investigator, NIMH), James Anthony (Michigan State University), William Eaton (The Johns Hopkins University), Meyer Glantz (NIDA), Doreen Koretz (Harvard University), Jane McLeod (Indiana University), Mark Olfson (New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University), Harold Pincus (University of Pittsburgh), Greg Simon (Group Health Cooperative), Michael Von Korff (Group Health Cooperative), Philip Wang (Harvard Medical School), Kenneth Wells (UCLA), Elaine Wethington (Cornell University), and Hans-Ulrich Wittchen (Max Planck Institute of Psychiatry; Technical University of Dresden). The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government. A complete list of NCS publications and the full text of all NCS-R instruments can be found at Send correspondence to

The NCS-R is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. These activities were supported by the National Institute of Mental Health (R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at

Portions of this chapter appeared previously in Kessler, R.C., Ruscio, A.M., Shear, K., Wittchen, H.-U. (in press). The epidemiology of anxiety disorders. In M.M. Antony and M.B. Stein (Eds.), Handbook of Anxiety and the Anxiety Disorders. New York: Oxford University Press Oxford University Press; Wang, P.S., Kessler, R.C. (2005). Global burden of mood disorders. In D. Stein, D. Kupfer and A. Schatzberg (Eds.), Textbook of Mood Disorders (pp. 55–67). Washington DC: American Psychiatric Publishing, Inc. American Psychiatric Publishing, Inc. 2005; Kessler, R.C. (2007). The global burden of anxiety and mood disorders: Putting the European Study of the Epidemiology of Mental Disorders (ESEMeD) findings into perspective. Journal of Clinical Psychiatry 68 (suppl. 2), 10–19, Physicians Postgraduate Press, Inc. 2007. All used with permission.


  1. Angst J, Vollrath M. (1991). Acta Psychiatr Scand. 84: 446–452.PubMedCrossRefGoogle Scholar
  2. Benazzi F. (2007). CNS Drugs. 21: 727–740.PubMedCrossRefGoogle Scholar
  3. Bijl RV, van Zessen G, Ravelli A, de Rijk C, Langendoen Y. (1998). Soc Psychiatry Psychiatr Epidemiol. 33: 581–586.PubMedCrossRefGoogle Scholar
  4. Bittner A, Goodwin RD, Wittchen HU, Beesdo K, Hofler M, Lieb R. (2004). J Clin Psychiatry. 65: 618–626; quiz 730.PubMedCrossRefGoogle Scholar
  5. Brown TA, Barlow DH. (2005). J Abnorm Psychol. 114: 551–556.PubMedCrossRefGoogle Scholar
  6. Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, Shea MT, Keller MB. (2005). Am J Psychiatry. 162: 1179–1187.PubMedCrossRefGoogle Scholar
  7. Christiana JM, Gilman SE, Guardino M, Kessler RC, Mickelson K, Morselli PL, Olfson M. (2000). Psychol Med. 30: 693–703.PubMedCrossRefGoogle Scholar
  8. Cox BJ, Clara IP, Enns MW. (2002). Depress Anxiety. 15: 168–171.PubMedCrossRefGoogle Scholar
  9. Fontenelle LF, Mendlowicz MV, Versiani M. (2006). Prog Neuropsychopharmacol Biol Psychiatry. 30: 327–337.PubMedCrossRefGoogle Scholar
  10. Furmark T. (2002). Acta Psychiatr Scand. 105: 84–93.PubMedCrossRefGoogle Scholar
  11. Greenberg PE, Birnbaum HG. (2005). Expert Opin Pharmacother. 6: 369–376.PubMedCrossRefGoogle Scholar
  12. Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ. (1999). J Clin Psychiatry. 60: 427–435.PubMedCrossRefGoogle Scholar
  13. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC. (2006). Int J Methods Psychiatr Res. 15: 167–180.PubMedCrossRefGoogle Scholar
  14. He Y, Zhang M, Lin EH, Bruffaerts R, Posada-Villa J, Angermeyer MC, Levinson D, de Girolamo G, Uda H, Mneimneh Z, Benjet C, Graaf RD, Scott KM, Gureje O, Seedat S, Haro JM, Bromet EJ, Alonso J, von Korff M, Kessler R. (2008). Psychol Med. 1–12.Google Scholar
  15. Horwath E, Weissman MM. (2000). Psychiatr Clin North Am. 23: 493–507.PubMedCrossRefGoogle Scholar
  16. Judd LL, Akiskal HS. (2000). Pharmacopsychiatry. 33: 3–7.PubMedCrossRefGoogle Scholar
  17. Kendall PC, Kessler RC. (2002). J Consult Clin Psychol. 70: 1303–1306.PubMedCrossRefGoogle Scholar
  18. Kendler KS, Prescott CA, Myers J, Neale MC. (2003). Arch Gen Psychiatry. 60: 929–937.PubMedCrossRefGoogle Scholar
  19. Kessler RC. (1995). In: Tsuang MT, Tohen M, Zahner GEP (eds.) Textbook in Psychiatric Epidemiology. Wiley, New York, pp. 179–197.Google Scholar
  20. Kessler RC, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Anthony JC, Berglund P, Chatterji S, de Girolamo G, de Graaf R, Demyttenaere K, Gasquet I, Gluzman S, Gruber MJ, Gureje O, Haro JM, Heeringa S, Karam A, Kawakami N, Lee S, Levinson D, Medina-Mora ME, Oakley-Browne MA, Pennell B, Petukhova M, Posada-Villa J, Ruscio R, Stein DJ, Tsang CHA, Üstün TB (2008). In: Kessler RC, Üstün TB (eds.) The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. Cambridge University Press, New York, NY, pp. 511–521.Google Scholar
  21. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Üstün TB. (2007). Curr Opin Psychiatry. 20: 359–364.PubMedCrossRefGoogle Scholar
  22. Kessler RC, Berglund PA, Foster CL, Saunders WB, Stang PE, Walters EE. (1997). Am J Psychiatry. 154: 1405–1411.PubMedGoogle Scholar
  23. Kessler RC, Foster CL, Saunders WB, Stang PE. (1995). Am J Psychiatry. 152: 1026–1032.PubMedGoogle Scholar
  24. Kessler RC, Üstün TB (eds.) (2008). The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. Cambridge University Press, New York, NY.Google Scholar
  25. Kessler RC, Walters EE, Forthofer MS. (1998). Am J Psychiatry. 155: 1092–1096.PubMedGoogle Scholar
  26. Knight DC, Nguyen HT, Bandettini PA. (2005). Neuroimage. 26: 1193–1200.PubMedCrossRefGoogle Scholar
  27. Kringlen E, Torgersen S, Cramer V. (2001). Am J Psychiatry. 158: 1091–1098.PubMedCrossRefGoogle Scholar
  28. Leon AC, Solomon DA, Mueller TI, Endicott J, Rice JP, Maser JD, Coryell W, Keller MB. (2003). Am J Psychiatry. 160: 727–733.PubMedCrossRefGoogle Scholar
  29. Matsunaga H, Seedat S. (2007). CNS Spectr. 12: 392–400.PubMedGoogle Scholar
  30. Mylle J, Maes M. (2004). J Affect Disord. 78: 37–48.PubMedCrossRefGoogle Scholar
  31. Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, Haro JM, Huang Y, Karam E, Kessler RC, Lepine JP, Levinson D, Medina-Mora ME, Ono Y, Posada-Villa J, Williams D. (2008). Br J Psychiatry. 192: 98–105.PubMedCrossRefGoogle Scholar
  32. Ormel J, Petukhova M, Chatterji S, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Bromet EJ, Burger H, Demyttenaere K, de Girolamo G, Haro JM, Hwang I, Karam E, Kawakami N, Lepine JP, Medina-Mora ME, Posada-Villa J, Sampson N, Scott K, Üstun TB, Von Korff M, Williams D, Zhang M, Kessler RC (2008) Br J Psychiatry. 192: 368–375.Google Scholar
  33. Ormel J, Von Korff M, Burger H, Scott K, Demyttenaere K, Huang YQ, Posada-Villa J, Lepine JP, Angermeyer MC, Levinson D, de Girolamo G, Kawakami N, Karam E, Medina-Mora ME, Gureje O, Williams D, Haro JM, Bromet EJ, Alonso J, Kessler RC. (2007). Gen Hosp Psychiatry. 29: 325–334.PubMedCrossRefGoogle Scholar
  34. Robins LN, Helzer JE, Croughan JL, Ratcliff KS. (1981). Arch Gen Psychiatry. 38: 381–389.PubMedGoogle Scholar
  35. Robins LN, Regier A. (1991). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. The Free Press, New York.Google Scholar
  36. Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA. (1988). Arch Gen Psychiatry. 45: 1069–1077.PubMedGoogle Scholar
  37. Ruscio AM, Chiu WT, Roy-Byrne P, Stang PE, Stein DJ, Wittchen HU, Kessler RC. (2007). J Anxiety Disord. 21: 662–676.PubMedCrossRefGoogle Scholar
  38. Silverman WK, Moreno J. (2005). Child Adolesc Psychiatr Clin N Am. 14: 819–843; ix–x.PubMedCrossRefGoogle Scholar
  39. Skeppar P, Adolfsson R. (2006). Nord J Psychiatry. 60: 7–26.PubMedCrossRefGoogle Scholar
  40. Somers JM, Goldner EM, Waraich P, Hsu L. (2006). Can J Psychiatry. 51: 100–113.PubMedGoogle Scholar
  41. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE. (2007). Lancet. 370: 841–850.PubMedCrossRefGoogle Scholar
  42. Waraich P, Goldner EM, Somers JM, Hsu L. (2004). Can J Psychiatry. 49: 124–138.PubMedGoogle Scholar
  43. Watson D. (2005). J Abnorm Psychol. 114: 522–536.PubMedCrossRefGoogle Scholar
  44. Whiteside SP, Port JD, Abramowitz JS. (2004). Psychiatry Res. 132: 69–79.PubMedCrossRefGoogle Scholar
  45. WHO International Consortium in Psychiatric Epidemiology. (2000). Bull World Health Organ. 78: 413–426.Google Scholar
  46. Wittchen HU, Lieb R, Schuster P, Oldehinkel T. (1999). In: Rapoport JL (ed.) Childhood Onset of “Adult” Psychopathology: Clinical and Research Advances. American Psychiatric Press, Washington, DC, pp. 259–302.Google Scholar
  47. Wittchen HU. (1994). J Psychiatr Res. 28: 57–84.PubMedCrossRefGoogle Scholar
  48. Wittchen HU, Jacobi F. (2005). Eur Neuropsychopharmacol. 15: 357–376.PubMedCrossRefGoogle Scholar
  49. Zimmermann P, Wittchen HU, Hofler M, Pfister H, Kessler RC, Lieb R. (2003). Psychol Med. 33: 1211–1222.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • R. C. Kessler
  • P. S. Wang
  • H.-U. Wittchen

There are no affiliations available

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