Depression is frequently accompanied by other mental disorders and various somatic diseases; however, previous comorbidity studies often relied on self-reported data and have not simultaneously assessed the entire spectrum of mental and somatic diagnoses. The aim is to provide a complete picture of mental and somatic comorbidity of depression in routine outpatient care in a high income country with a relatively well equipped health care system. Using ambulatory claims data covering 87% of the German population (age 15+), we designed a cross-sectional study by identifying persons diagnosed with mild, moderate and severe depression in 2017 (N = 6.3 million) and a control group matched 4:1 on sex, 5-year age group and region of residence (N = 25.2 million). Stratified by severity, we calculated the prevalence of 202 diagnosis groups included in the ICD-10 in persons with depression as compared to matched controls using prevalence ratios (PR). Nearly all mental disorders were at least twice as prevalent in persons with depression relative to controls, showing a dose-response relationship with depression severity. Irrespective of severity, the three most prevalent somatic comorbid diagnosis groups were ‘other dorsopathies’ (M50-M54), ‘hypertensive diseases’ (I10-I15) and ‘metabolic disorders’ (E70-E90), exhibiting PRs in moderate depression of 1.56, 1.23 and 1.33, respectively. Strong associations were revealed with diseases of the central nervous system (i.e. multiple sclerosis) and several neurological diseases, among them sleep disorders, migraine and epilepsy, most of them exhibiting at least 2- to 3-fold higher prevalences in depression relative to controls. Utilization of health care was higher among depression cases compared to controls. The present study based on data from nearly the complete adolescent and adult population in Germany comprehensively illustrates the comorbidity status of persons diagnosed with depression as coded in routine health care. Our study should contribute to increasing the awareness of the strong interconnection of depression with all other mental and the vast majority of somatic diseases. Our findings underscore clinical and health-economic relevance and the necessity of systematically addressing the high comorbidity of depression and somatic as well as other mental diseases through prevention, early identification and adequate management of depressive symptoms.

中文翻译：

---

抑郁症的心理和躯体合并症：使用德国全国范围内的非住院索赔数据对202个诊断组进行全面的横断面分析。

抑郁症经常伴有其他精神障碍和各种躯体疾病；但是，以前的合并症研究通常依赖于自我报告的数据，并且没有同时评估精神和躯体诊断的整个范围。目的是提供一个配备完善的医疗保健系统的高收入国家，在例行门诊中抑郁症的心理和躯体合并症的完整情况。我们使用覆盖87％的德国人口（15岁以上）的动态求偿数据，通过识别2017年被诊断患有轻度，中度和重度抑郁症的人群（N = 630万）和对照组匹配的4个设计了一项横断面研究：在性别，5岁年龄组和居住地区方面排名1（N = 2520万）。按严重性分层 我们使用患病率（PR）与相匹配的对照组进行了比较，计算出ICD-10中202个诊断组的患病率。相对于对照组，几乎所有精神障碍患者的抑郁症患病率至少是其两倍，显示出与抑郁症严重程度的剂量反应关系。不论严重程度如何，三个最普遍的躯体合并症诊断组是“其他背痛”（M50-M54），“高血压疾病”（I10-I15）和“代谢异常”（E70-E90），在中度抑郁为1.56时表现为PR ，分别为1.23和1.33。与中枢神经系统疾病（即多发性硬化症）和多种神经系统疾病（包括睡眠障碍，偏头痛和癫痫症）的相关性很强，他们中的大多数人抑郁症的患病率比对照组高至少2到3倍。与对照组相比，抑郁症患者的医疗保健利用率更高。基于来自德国几乎全部青少年和成年人口的数据的本研究，全面说明了常规医疗保健中被诊断出患有抑郁症的人的合并症状态。我们的研究应有助于提高人们对抑郁症与所有其他精神疾病和绝大多数躯体疾病之间紧密联系的认识。我们的发现强调了临床和健康-经济相关性，并且有必要通过预防，及早发现和适当管理抑郁症状来系统解决抑郁症和身体疾病以及其他精神疾病的高合并症。