Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment

Bernd Löwe, Robert L. Spitzer, Janet B.W. Williams, Monika Mussell, Dieter Schellberg, Kurt Kroenke

Research output: Contribution to journalArticle

377 Scopus citations


Objective: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to functional impairment. Method: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and functional impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with functional impairment. Results: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to functional impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of functional impairment. Conclusions: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.

Original languageEnglish (US)
Pages (from-to)191-199
Number of pages9
JournalGeneral Hospital Psychiatry
Issue number3
StatePublished - May 1 2008


  • Anxiety
  • Classification
  • Depression
  • Primary health care
  • Somatoform disorder

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)
  • Psychiatry and Mental health

Fingerprint Dive into the research topics of 'Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment'. Together they form a unique fingerprint.

  • Cite this