Skip to main content
International Journal of Methods in Psychiatric Research logoLink to International Journal of Methods in Psychiatric Research
. 2006 Mar 24;11(1):1–18. doi: 10.1002/mpr.118

Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey

Frank Jacobi 1,, Hans‐Ulrich Wittchen 1, Christoph Hölting 1, Sieghard Sommer 1, Roselind Lieb 1, Michael Höfler 1, Hildegard Pfister 1
PMCID: PMC6878553  PMID: 12459800

Abstract

This paper outlines the principal aims and design of the German National Health Interview and Examination Survey, mental health supplement (GHS‐MHS), the first nationwide, epidemiological study of both somatic and mental health in Germany on a representative sample of 4,181 subjects in the community. Both the broader context of the study – in particular its methodological relation to the social and somatic core survey of the German National Health Interview and Examination Survey (GHS‐CS) – and the internal methodology of the mental health supplement (GHS‐MHS) are presented. The study's strategies and method are derived from a consideration of important theoretical issues arising from epidemiological studies in the field of public health. The main instrument used to assess diagnoses of mental disorders was a standardized diagnostic interview for mental disorders (following DSM‐IV (CIDI)) applied by clinically trained interviewers. This diagnostic interview was supplemented by modules on comorbidity, help seeking, treatment and impairment. Somatic health diagnoses were made using an integrated approach including self‐report measures, a standardized clinical interview, and laboratory measures.

Findings on sampling, response rate, weighting and sample characteristics are presented. Critical issues are discussed, including the scientific objectives that have been achieved by the study. Overall, the GHS core survey and its mental health supplement provide the mental health research community with complex data that allow for high‐quality analysis of mental disorders and associations with somatic disorders. Copyright © 2002 Whurr Publishers Ltd.

Keywords: German National Health Interview and Examination Survey (GHS‐MHS), epidemiological methods, Composite International Diagnostic Interview (CIDI), prevalence, comorbidity, somatic disorders, mental disorders, public health, impairment

Full Text

The Full Text of this article is available as a PDF (9.4 MB).

References

  1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 4 edn. Washington DC: American Psychiatric Press, 1994. [Google Scholar]
  2. Andrews G, Henderson S. Unmet Need in Psychiatry. Cambridge: Cambridge University Press, 2000. [Google Scholar]
  3. Andrews G, Henderson S, Hall W. Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. British Journal of Psychiatry 2001; 178: 145–53. [DOI] [PubMed] [Google Scholar]
  4. Becker ES, Türke V, Neumer S, Soeder U, Krause P, Margraf J. Incidence and prevalence rates of mental disorders in a community sample of young women: results of the ‘Dresden study’ In Heeß‐Erler G, Manz R, Kirch W. (eds) Public Health Research and Practice: Report of the Public Health Research Association Saxonia 1998–1999. Volume 2. Regensburg: Roderer, 2000, pp. 259–91. [Google Scholar]
  5. Bellach B‐M, Knopf H, Thefeld W. Der Bundes‐Gesundheitssurvey 1997/98. Das Gesundheitswesen 1998; 60: 59–68. [PubMed] [Google Scholar]
  6. Bergmann E, Menzel R, Bergmann KE, Bergmann RL. Verbreitung von Übergewicht in der Bundesrepublik Deutschland. Tätigkeitsbericht des Bundesgesundheitsamtes. München: MMV Medizin Verlag, 1995: 222–4. [Google Scholar]
  7. Bijl RV, Ravelli A, Van Zessen G. Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology, 1998; 33: 587–95. [DOI] [PubMed] [Google Scholar]
  8. Bijl RV, Ravelli A. Current and residual functional disability associated with psychopathology: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Psychological Medicine 2000a; 30: 657–68. [DOI] [PubMed] [Google Scholar]
  9. Bijl RV, Ravelli A. Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study. American Journal of Public Health 2000b; 90: 602–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Binder DA. On the variances of asymptotically normal estimators from complex samples. International Statistical Review 1983; 51: 279–92. [Google Scholar]
  11. Bland RC, Newman SC, Orn H. Help‐seeking for psychiatric disorders. Canadian Journal of Psychiatry Revue Canadienne de Psychiatrie 1997; 42: 935–42. [DOI] [PubMed] [Google Scholar]
  12. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF‐36 health survey questionnaire: new outcome measure for primary care. British Medical Journal 1992; 305: 160–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Bullinger M. German translation and psychometric testing of the SF‐36 health survey: preliminary results from the IQOLA Project. Social Science and Medicine 1995; 41: 1359–66. [DOI] [PubMed] [Google Scholar]
  14. Bullinger M, Kirchberger I. SF‐36 Fragebogen zum Gesundheitszustand: Handanweisung. Göttingen: Hogrefe, 1998. [Google Scholar]
  15. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfor DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research 1989; 28: 193–213. [DOI] [PubMed] [Google Scholar]
  16. Carney RM, Freedland KE, Veith RC, Jaffe AS. Can treating depression reduce mortality after an acute myocardial infarction? Psychosomatic Medicine 1999; 61: 666–75. [DOI] [PubMed] [Google Scholar]
  17. Carter J, Bithell J. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Statistics in Medicine 2000; 19: 1141–64. [DOI] [PubMed] [Google Scholar]
  18. Carter RM, Wittchen H‐U, Pfister H, Kessler RC. One‐year prevalence of subthreshold and threshold DSM‐IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety 2001; 13: 78–88. [DOI] [PubMed] [Google Scholar]
  19. Centers for Disease Control and Prevention . The Third National Health and Nutrition Examination Survey (NHANES III 1988‐94) Reference Manuals and Reports. CD‐ROM. Bethesda MD: National Center for Health Statistics, 1996. [Google Scholar]
  20. Cohen HW, Madhaven S, Alderman MH. History of treatment for depression: risk factors for myocardial infarction in hypertensive patients. Psychosomatic Medicine Special Issue 2001; 63: 203–9. [DOI] [PubMed] [Google Scholar]
  21. Efron B, Tibshirani R. An Introduction to the Bootstrap. New York: Chapman & Hall, 1993. [Google Scholar]
  22. Escobar JI, Rubio Stipec M, Canino G, Karno M. Somatic Symptom Index (SSI): A new and abridged somatization construct: prevalence and epidemiological correlates in two large community samples. Journal of Nervous and Mental Disease 1989; 177: 140–6. [DOI] [PubMed] [Google Scholar]
  23. Fichter MM, Weyerer S, Wittchen HU, Dilling H. Psychotherapy services and the prevalence of mental disorders in urban and rural areas. Archiv für Psychiatrie und Nervenkrankheiten 1983; 233: 39–57. [DOI] [PubMed] [Google Scholar]
  24. Forschungsgruppe Gesundheitsberichterstattung . Aufbau einer Gesundheitsberichterstattung: Bestandsaufnahme und Konzeptvorschlag. Bd. 1‐3. Sankt Augustin: Asgard, 1990.
  25. Henderson SA, Wayne H. Australia's mental health: an overview of the general population survey. Australian and New Zeeland Journal of Psychiatry 2000; 34: 197–205. [DOI] [PubMed] [Google Scholar]
  26. Hoffmeister H, Bellach B‐M. (eds) Die Gesundheit der Deutschen–Ein Ost‐West Vergleich von Gesundheitsdaten. 2. Edition, RKI‐Heft 7/1995, Robert Koch‐Institut Berlin, 1995. [Google Scholar]
  27. Jacobi F. Public Use Files als Perspektive für die klinischpsychologische Forschung In Ott R, Eichenberg C. (eds) Klinische Psychologie im Internet. Göttingen: Hogrefe, in press. [Google Scholar]
  28. Jenkins R, Bebbington P, Brugha T, Farrell M, Gill B, Lewis G, Meltzer H, Petticrew M. The National Psychiatric Morbidity surveys of Great Britain–strategy and methods. Psychological Medicine 1997a; 27: 765–74. [DOI] [PubMed] [Google Scholar]
  29. Jenkins R, Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, Meltzer H. The National Psychiatric Morbidity surveys of Great Britain–initial findings from the household survey. Psychological Medicine 1997b; 27: 775–89. [DOI] [PubMed] [Google Scholar]
  30. Katz SJ, Kessler RC, Frank RG, Leaf P, Lin E. Mental health care use, morbidity, and socioeconomic status in the United States and Ontario. Inquiry 1997; 34: 38–49. [PubMed] [Google Scholar]
  31. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS. Lifetime and 12‐month prevalence of DSM‐III‐R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 1994; 51: 8–19. [DOI] [PubMed] [Google Scholar]
  32. Kessler RC, Frank RG, Edlund M, Katz SJ, Lin E, Leaf P. Differences in the use of psychiatric outpatient services between the United States and Ontario. New England Journal of Medicine 1997; 336: 551–7. [DOI] [PubMed] [Google Scholar]
  33. Knäuper B, Wittchen HU. Diagnosing major depression in the elderly: evidence for response bias in standardized diagnostic interviews? Journal of Psychiatric Research 1994; 28: 147–64. [DOI] [PubMed] [Google Scholar]
  34. Koch A. Wenn ‘mehr’ nicht gleichbedeutend mit ‘besser’ ist: Ausschöpfungsquoten und Stichprobenverzerrungen in allgemeinen Bevölkerungsumfragen. ZUMA‐Nachrichten 1998; 42: 66–90. [Google Scholar]
  35. Lachner G, Wittchen HU, Perkonigg A, Holly A, Schuster P, Wunderlich U, Türk D, Garczynski E, Pfister H. Structure, content and reliability of the Munich‐Composite International Diagnostic Interview (M‐CIDI). Substance use sections. European Addiction Research 1998; 4: 28–41. [DOI] [PubMed] [Google Scholar]
  36. Lee ES, Forthofer RN, Lorimor RJ. Analyzing Complex Survey Data. London: Sage Publications, 1989. [Google Scholar]
  37. Lepine JP, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: the first pan‐European study DEPRES (Depression Research in European Society). International Clinical Psychopharmacology 1997; 12: 19–29. [PubMed] [Google Scholar]
  38. Lieb R, Isensee B, Von Sydow K, Wittchen HU. The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. European Addiction Research 2000; 6: 170–82. [DOI] [PubMed] [Google Scholar]
  39. Linden M, Maier W, Achenberger M, Herr R. Psychiatrische Erkrankungen und ihre Behandlung in Allgemeinarztpraxen in Deutschland: Ergebnisse einer Studie der WHO. Nervenarzt 1996; 67(3): 205–15. [PubMed] [Google Scholar]
  40. Mason P, Wilkinson G. The prevalence of psychiatric morbidity. OPCS survey of psychiatric morbidity in Great Britain. British Journal of Psychiatry 1996; 168: 1–3. [DOI] [PubMed] [Google Scholar]
  41. McHorney CA, Ware JE Jr, Raczek AE. The MOS 36‐Item Short‐Form Health Survey (SF‐36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care 1993; 31: 247–63. [DOI] [PubMed] [Google Scholar]
  42. McHorney CA, Ware JE Jr, Rogers W, Raczek AE, Lu JF. The validity and relative precision of MOS short‐ and long‐form health status scales and Dartmouth COOP charts. Results from the Medical Outcomes Study. Medical Care 1992; 30: MS253–MS265. [DOI] [PubMed] [Google Scholar]
  43. Meltzer H, Baljit G, Petticrew M, Hinds K. The Prevalence of Psychiatric Morbidity among Adults living in Private Households. London: HSMO, PCS Reports, 1995, 1–8. [Google Scholar]
  44. Murray CJL, Lopez AD. Evidence‐based health policy–lessons from the global burden of disease study. Science 1996; 274: 740–3. [DOI] [PubMed] [Google Scholar]
  45. National Center for Health Statistics . National Health and Nutrition Examination Survey,http://www.cdc.gov/nchs/nhanes.htm(12/12/ 2001).
  46. Ormel J, Von Korff M, Üstün TB, Pini S, Korten A, Oldehinkel T. Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. Journal of the American Medical Association 1994; 272: 1741–8. [DOI] [PubMed] [Google Scholar]
  47. Penninx BW, Guralnik JM, Mendes de Leon CF, Pahor M, Visser M, Corti M‐C, Wallace RB. Cardiovascular events and mortality in newly and chronically depressed persons >70 years of age. American Journal of Cardiology 1998; 81: 988–94. [DOI] [PubMed] [Google Scholar]
  48. Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–94. Vital Health Stat 1, 1994; 32: 1–407. [PubMed] [Google Scholar]
  49. Potthoff P, Schroeder E, Reis U, Klamert A. Ablauf und Ergebnisse der Feldarbeit beim Bundes‐Gesundheitssurvey. Gesundheitswesen, Sonderheft 1999; 2: 44–59. [PubMed] [Google Scholar]
  50. Radloff LS. The CES‐D scale: a self‐report depression scale for research in the general population. Applied Psychological Measurement 1977; 1: 385–401. [Google Scholar]
  51. Reed V, Gander F, Pfister H, Steiger A, Sonntag H, Trenkwalder C, Hundt W, Wittchen HU. To what degree the Composite International Diagnostic Interview (CIDI) correctly identifies DSM‐IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research 1998; 7: 142–55. [Google Scholar]
  52. Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The NIMH Epidemiologic Catchment Area program. Historical context, major objectives, and study population characteristics. Archives of General Psychiatry 1984; 41: 934–41. [DOI] [PubMed] [Google Scholar]
  53. Rehm J, Üstün B, Saxena S, Nelson CB, Chatterji S, Ivis F, Adlaf E. On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population. International Journal of Methods in Psychiatric Research 1999; 8: 110–22. [Google Scholar]
  54. Rice DP, Miller LS. Health economics and cost implications of anxiety and other mental disorders in the United States. British Journal of Psychiatry 1998; 173: 4–9. [PubMed] [Google Scholar]
  55. Robins NL, Regier DA. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Portland, Oregon: Book News, 1990. [Google Scholar]
  56. Royall RM. Model robust confidence intervals using maximum likelihood estimators. International Statistical Review 1986; 54: 221–6. [Google Scholar]
  57. Sartorius N, Nielson JA, Strömgren E (eds). Changes in frequency of mental disorders over time: results of repeated surveys of mental disorders in the general population. Acta Psychiatrica Scandnavia 79, Suppl. 348, 1989. [PubMed] [Google Scholar]
  58. Sartorius N, Üstün TB, Korten A, Cooper JE, van Drimmelen J. Progress toward achieving a common language in psychiatry: II. Results from the international field trials of the ICD‐10 Diagnostic Criteria for Research for mental and behavioural disorders. American Journal of Psychiatry 1995; 152: 1427–37. [DOI] [PubMed] [Google Scholar]
  59. Schroeder E, Potthoff P, Reis U, Klamert A. Erhebungsarbeiten im Bundes‐Gesundheitssurvey. Das Gesundheitswesen 1998; 60: 104–7. [PubMed] [Google Scholar]
  60. Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JB, deGruy FV3, Brody D, Davies M. Health‐related quality of life in primary care patients with mental disorders. Results from the PRIME‐MD 1000 Study. Journal of the American Medical Association 1995; 274: 1511–17. [PubMed] [Google Scholar]
  61. StataCorp . Stata Statistical Software: Release 7.0. College Station; TX: Stata Corporation, 2001. [Google Scholar]
  62. Statistics Canada . Information about the national population health survey,http://www.statcan.ca:80/english/ freepub/82F0068XIE/free.htm.
  63. Stolzenberg H. Bundes‐Gesundheitssurvey 1998: Dokumentation des Datensatzes. Berlin: Robert Koch Institut, 2000. [Google Scholar]
  64. Thefeld W, Stolzenberg H, Bellach BM. Bundes‐Gesundheitssurvey: Response, Zusammensetzung der Teilnehmer und Non‐Responder‐Analyse. Gesundheitswesen, Sonderheft 1999; 2: 57–61. [PubMed] [Google Scholar]
  65. Vollebergh WA, Iedema J, Bijl RV, de Graaf R, Smit F, Ormel J. The structure and stability of common mental disorders: the NEMESIS study. Archives of General Psychiatry 2001; 58: 597–603. [DOI] [PubMed] [Google Scholar]
  66. Von Troschke, Klaes L , Maschewsky‐Schneider U, Deutsche Herz‐Kreislauf‐Präventionsstudie. Design und Ergebnisse. Göttingen: H Huber, 1998. [Google Scholar]
  67. Von Zerssen D, Koeller DM. B‐L Beschwerden‐Liste. Volume 20. Weinheim: Beltz, 1976. [Google Scholar]
  68. Ware JE Jr, Sherbourne CD. The MOS 36‐item short‐form health survey (SF‐36). I. Conceptual framework and item selection. Medical Care 1992; 30: 473–83. [PubMed] [Google Scholar]
  69. Winkler G, Filipiak B, Hense H‐W, Schwertner B. Externe Qualitätskontrolle im Bundes‐Gesundheitssurvey 1997/98: Konzept und erste Erfahrungen. Das Gesundheitswesen 1998; 60: 108–12. [PubMed] [Google Scholar]
  70. Wittchen HU. Reliability and validity studies of the WHO‐Composite International Diagnostic Interview (CIDI): a critical review. International Journal of Psychiatric Research 1994; 28: 57–84. [DOI] [PubMed] [Google Scholar]
  71. Wittchen HU. What is comorbidity–fact or artefact? British Journal of Psychiatry 1996; 168: 7–8. [PubMed] [Google Scholar]
  72. Wittchen HU. Ein Schlußbericht zum Zusatzsurvey ‘Psychische Störungen’ (Bundesgesunndheitssurvey 98): Häufigkeit, psychosoziale Beeinträchtigungen und Zusammenhänge mit körperlichen Erkrankungen. München: Max‐Planck Institut für Psychiatrie, 1999.
  73. Wittchen HU, Höfler M, Gander F, Pfister H, Storz S, Üstün TB, Müller N, Kessler RC. Screening for mental disorders: performance of the Composite International Diagnostic‐Screener (CID‐S). International Journal of Methods in Psychiatric Research 1999a; 8: 59–70. [Google Scholar]
  74. Wittchen HU, Jacobi F. Die Versorgungssituation psychischer Störungen in Deutschland–Eine klinisch‐epidemiologische Abschätzung anhand des Bundesgesundheitssurveys '98. Bundesgesundheitsblatt 2001; 44: 993–1000. [Google Scholar]
  75. Wittchen HU, Müller N., Pfister H, Winter S, Schmidtkunz B. Affektive, somatoforme und Angststörungen in Deutschland–Erste Ergebnisse des bundesweiten Zusatzsurveys ‘Psychische Störungen’. Gesundheitswesen 1999b, 61, Sonderheft 2: 216–22. [PubMed]
  76. Wittchen HU, Müller N, Storz S. Psychische Störungen: Häufigkeit, psychosoziale Beeinträchtigungen und Zusammenhänge mit körperlichen Erkrankungen. Gesundheitswesen 1998; 60: 85–100. [PubMed] [Google Scholar]
  77. Wittchen HU, Pfister H. DIA‐X‐Interviews: Manual für Screening‐Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA‐X‐Lifetime); Ergänzungsheft (DIA‐X‐Lifetime); Interviewheft Querschnittuntersuchung (DIA‐X‐12 Monate); Ergänzungsheft (DIA‐X‐12Monate); PC‐Programm zur Durchführung des Interviews (Längs‐ und Querschnittuntersuchung); Auswertungsprogramm. Frankfurt: Swets & Zeitlinger, 1997. [Google Scholar]
  78. Wittchen HU, Von Zerssen D. The longterm outcome of treatment of psychiatric disorders with special regard to chronicity of symptom and social functioning In Sluss TK, Kramer M, Gruenberg BM, Cooper B. (eds) The Chronically Mentally Ill: An International Perspective. Cambridge: Cambridge University Press, 1985: 225–44. [Google Scholar]
  79. Woodruff RS. A simple method of approximating the variance of a complicated estimate. Journal of the American Statistical Association 1971; 66: 411–14. [Google Scholar]
  80. World Health Organization . Tenth revision of the international classification of diseases. Chapter V (F): Mental and behavioral disorders. Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1993. [Google Scholar]
  81. World Health Organization . Composite International Diagnostic Interview (CIDI, Version 2.1). Geneva: World Health Organization, 1997. [Google Scholar]

Articles from International Journal of Methods in Psychiatric Research are provided here courtesy of Wiley

RESOURCES