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Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Stockholm University, Sweden.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
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2013 (English)In: PeerJ, ISSN 2167-8359, Vol. 1, e98- p.Article in journal (Refereed) Published
Abstract [en]

Background. Depression and anxiety disorders are major world-wide problems. There are no or few epidemiological studies investigating the prevalence of depression, generalized anxiety disorder and anxiety disorders in general in the Swedish population.

Methods. Data were obtained by means of a postal survey administered to 3001 randomly selected adults. After two reminders response rate was 44.3%. Measures of depression and general anxiety were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7). The PHQ-9 identified participants who had experienced clinically significant depression (PHQ-9 ≥ 10), and who had a diagnosis of major depression (defined by using a PHQ-9 scoring algorithm). Clinically significant anxiety was defined as having a GAD-7 score ≥ 8. To specifically measure generalized anxiety disorder, the Generalized Anxiety Disorder Questionnaire-IV (GAD-Q-IV) was used with an established cut-off. Health-related quality of life was measured using the EuroQol (EQ-5D). Experiences of treatments for psychiatric disorders were also assessed.

Results. Around 17.2% (95% CI: 15.1–19.4) of the participants were experiencing clinically significant depression (10.8%; 95% CI: 9.1–12.5) and clinically significant anxiety (14.7%; 95% CI: 12.7–16.6). Among participants with either clinically significant depression or anxiety, nearly 50% had comorbid disorders. The point prevalence of major depression was 5.2% (95% CI: 4.0–6.5), and 8.8% (95% CI: 7.3–10.4) had GAD. Among those with either of these disorders, 28.2% had comorbid depression and GAD. There were, generally, significant gender differences, with more women having a disorder compared to men. Among those with depression or anxiety, only between half and two thirds had any treatment experience. Comorbidity was associated with higher symptom severity and lower health-related quality of life.

Conclusions. Epidemiological data from the Swedish community collected in this study provide point prevalence rates of depression, anxiety disorders and their comorbidity. These conditions were shown in this study to be undertreated and associated with lower quality of life, that need further efforts regarding preventive and treatment interventions.

Place, publisher, year, edition, pages
2013. Vol. 1, e98- p.
National Category
Applied Psychology
URN: urn:nbn:se:liu:diva-96837DOI: 10.7717/peerj.98PubMedID: 23862109OAI: diva2:643543
Available from: 2013-08-27 Created: 2013-08-27 Last updated: 2014-11-28
In thesis
1. Treating depression and its comorbidity: From individualized Internet-delivered cognitive behavior therapy to affect-focused psychodynamic psychotherapy
Open this publication in new window or tab >>Treating depression and its comorbidity: From individualized Internet-delivered cognitive behavior therapy to affect-focused psychodynamic psychotherapy
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att behandla depression och dess komorbiditet : Från individanpassad internetbaserad kognitiv beteendeterapi till affektfokuserad psykodynamisk psykoterapi
Abstract [en]

The overarching goal of this thesis has been to enhance Internet-delivered psychological treatments for depression and its comorbidity. To this end, three randomized controlled trials (Study II, III and IV) with a total of 313 participants were conducted. A prevalence study (Study I) was also conducted to provide an up-to-date estimate of the prevalence of depression, anxiety disorders, and their comorbidity in the Swedish general population.

Study I showed that more than every sixth individual in Sweden suffers from symptoms of depression and/or anxiety. Comorbidity between depression and anxiety was substantial and associated with higher symptom burden and lower health-related quality of life. Study II showed that a tailored Internet-based CBT protocol (ICBT) was effective in reducing symptoms of depression when compared to a control group. Among individuals with more severe depression and comorbidities, the tailored ICBT treatment worked better than standardized ICBT. Study III showed that a psychodynamic Internet-based psychotherapy was highly effective in the treatment of depression, when compared to a group who received psychoeducation and online support. In Study IV, an Internet-delivered affect-focused psychodynamic psychotherapy proved to have a large effect on depression and a moderately large effect on anxiety disorders.

In conclusion, this thesis shows that in the context of treating depression and its comorbidity, Internet-delivered psychological treatments can be potentially enhanced by psychodynamic psychotherapy and by individualization.

Abstract [sv]

Det övergripande syftet med denna avhandling har varit att vidareutveckla internetbaserad psykologisk behandling för depression och dess komorbiditet. Tre randomiserade kontrollerade studier (Studie II, III och IV) med totalt 313 deltagare genomfördes i linje med detta syfte. En prevalensstudie (Studie I) genomfördes också för att tillhandahålla ett uppdaterat estimat av prevalensen av depression, ångest och deras komorbiditet i Sverige.

Studie I visade att mer än var sjätte individ i Sverige lider av symptom på depression och/eller ångest. Det fanns påtaglig komorbiditet mellan depression och ångest, vilket var associerat med högre symptombörda och lägre livskvalitét. Studie II visade att en skräddarsydd internetbaserad KBT-behandling var effektiv för att reducera symptom på depression, i jämförelse med en kontrollgrupp. Bland individer med svårare depression och komorbiditet, fungerade den skräddarsydda interventionen bättre än en standardiserad. Studie III visade att psykodynamisk internetbehandling var effektiv vid behandling av depression, i jämförelse med en grupp som fick psykoedukation och stödsamtal online. I Studie IV visades att en affektfokuserad psykodynamisk internetbehandling hade stor effekt vad gällde att reducera symptom på depression, och medelstor effekt vad gällde att reducera symptom på ångest.

Sammanfattningsvis visar denna avhandling att internetbaserad psykologisk behandling kan potentiellt vidareutvecklas av psykodynamisk psykoterapi och individanpassning, vid behandling av depression och dess komorbiditet.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 104 p.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 596Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 179
Depression, comorbidity, psychological treatment, psychotherapy, Internet, Internet-delivered treatment, cognitive behavior therapy, psychodynamic psychotherapy, Depression, komorbiditet, psykologisk behandling, psykoterapi, Internet, internetbaserad behandling, kognitiv beteendeterapi, psykodynamisk psykoterapi
National Category
urn:nbn:se:liu:diva-100385 (URN)10.3384/diss.diva-100385 (DOI)978-91-7519-467-7 (print) (ISBN)
Public defence
2013-12-06, VAL, Hus Vallfarten, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2013-11-04 Created: 2013-11-04 Last updated: 2014-11-28Bibliographically approved

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