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Tara W Strine - One of the best experts on this subject based on the ideXlab platform.
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depression and Anxiety in the united states findings from the 2006 behavioral risk factor surveillance system
Psychiatric Services, 2008Co-Authors: Tara W Strine, Joyce T Berry, Lina S Balluz, Olinda Gonzalez, Raquel Crider, Kurt KroenkeAbstract:Objective: This study examined the unadjusted and adjusted prevalence estimates of depression and Anxiety at the state level and examined the odds ratios of depression and Anxiety for selected risk behaviors, obesity, and chronic diseases. Methods: The 2006 Behavioral Risk Factor Surveillance Survey, a random-digit-dialed telephone survey, collected depression and Anxiety data from 217,379 participants in 38 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Current depressive symptoms were assessed with the standardized and validated eight-item Patient Health Questionnaire, and lifetime Diagnosis of depression and Anxiety was assessed by two additional questions (one question for each Diagnosis). Results: The overall prevalence of current depressive symptoms was 8.7% (range by state and territory, 5.3%–13.7%); of a lifetime Diagnosis of depression, 15.7% (range, 6.8%–21.3%); and of a lifetime Diagnosis of Anxiety, 11.3% (range, 5.4%–17.2%). After sociodemographic characteristics, adverse health behaviors, and chronic illnesses were adjusted for, cardiovascular disease, diabetes, asthma, smoking, and obesity were all significantly associated with current depressive symptoms, a lifetime Diagnosis of Anxiety, and a lifetime Diagnosis of depression. Physically inactive adults were significantly more likely than those who were physically active to have current depressive symptoms or a lifetime Diagnosis of depression, whereas those who drank heavily were significantly more likely than those who did not to have current depressive symptoms or a lifetime Diagnosis of Anxiety. Conclusions: Depression and Anxiety were strongly associated with common chronic medical disorders and adverse health behaviors. Examination of mental health should therefore be an integral component of overall health care. (Psychiatric Services 59:1383–1390, 2008)
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diabetes and Anxiety in us adults findings from the 2006 behavioral risk factor surveillance system
Diabetic Medicine, 2008Co-Authors: Chaoyang Li, Earl S. Ford, Lawrence E Barker, Xuanping Zhang, Tara W StrineAbstract:Aims Anxiety disorders may cause substantial impairment in patient functioning and well-being. Little is known about the relationship between diabetes and Anxiety. We estimated the prevalence of lifetime Diagnosis of Anxiety in adults aged ≥ 18 years with and without diabetes in the USA. Methods We analysed data from the 2006 Behavioral Risk Factor Surveillance System (total, N = 201 575; 20 142 with diabetes; 39.4% men, 77.9% non-Hispanic Whites, 8.1% non-Hispanic Blacks and 7.7% Hispanics; mean age 52.4 years). Diabetes and lifetime Diagnosis of Anxiety were self-reported. A multivariable log–binomial model was used to estimate prevalence ratios (PR) and associated 95% confidence intervals (CI) of Anxiety based on diabetes status. Results The overall age-adjusted prevalence of lifetime Diagnosis of Anxiety was 19.5 and 10.9% in people with and without diabetes, respectively. After adjustment for educational level, marital status, employment status, current smoking, leisure-time physical activity and body mass index, people with diabetes had a 20% higher prevalence of lifetime Diagnosis of Anxiety than those without (PR 1.20; 95% CI 1.12, 1.30). There were no significant differences in the PR by gender (P = 0.06). However, the ratios differed significantly by age (P = 0.04) and by race/ethnicity (P < 0.01), indicating that people aged 18−29 years (PR 1.70; 95% CI 1.19, 2.43) and Hispanics (PR 1.69; 95% CI 1.33, 2.15) had a higher ratio than their counterparts. Conclusion Diabetes was significantly associated with Anxiety in adults in this large population-based sample, particularly in Hispanics and young adults.
Johan Ormel - One of the best experts on this subject based on the ideXlab platform.
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neuroticism s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history but the adjusted association hardly decays with time a meta analysis on 59 longitudinal prospective studies with 443 313
Psychological Medicine, 2016Co-Authors: Bertus F Jeronimus, Harriette Riese, Roman Kotov, Johan OrmelAbstract:Background This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including Anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. Method This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. Results The results showed large unadjusted prospective associations between neuroticism and symptoms/Diagnosis of Anxiety, depression, and non-specific mental distress ( d = 0.50–0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half ( d = 0.10–0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker ( d = 0.03–0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short ( Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect. Conclusion High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.
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neuroticism s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history but the adjusted association hardly decays with time a meta analysis on 59 longitudinal prospective studies with 443 313
Psychological Medicine, 2016Co-Authors: Bertus F Jeronimus, Harriette Riese, Roman Kotov, Johan OrmelAbstract:Background This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including Anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. Method This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. Results The results showed large unadjusted prospective associations between neuroticism and symptoms/Diagnosis of Anxiety, depression, and non-specific mental distress (d = 0.50-0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10-0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03-0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short ( Conclusion High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.
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neuroticism s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history but the adjusted association hardly decays with time a meta analysis on 59 longitudinal prospective studies with 443 313
Psychological Medicine, 2016Co-Authors: Bertus F Jeronimus, Harriette Riese, Roman Kotov, Johan OrmelAbstract:Background This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including Anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. Method This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. Results The results showed large unadjusted prospective associations between neuroticism and symptoms/Diagnosis of Anxiety, depression, and non-specific mental distress (d = 0.50–0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10–0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03–0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short (<4 year) than long (⩾4 years) follow-up intervals, suggesting a substantial decay of the association with increasing time intervals. Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect. Conclusion High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.
Bertus F Jeronimus - One of the best experts on this subject based on the ideXlab platform.
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neuroticism s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history but the adjusted association hardly decays with time a meta analysis on 59 longitudinal prospective studies with 443 313
Psychological Medicine, 2016Co-Authors: Bertus F Jeronimus, Harriette Riese, Roman Kotov, Johan OrmelAbstract:Background This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including Anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. Method This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. Results The results showed large unadjusted prospective associations between neuroticism and symptoms/Diagnosis of Anxiety, depression, and non-specific mental distress ( d = 0.50–0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half ( d = 0.10–0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker ( d = 0.03–0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short ( Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect. Conclusion High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.
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neuroticism s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history but the adjusted association hardly decays with time a meta analysis on 59 longitudinal prospective studies with 443 313
Psychological Medicine, 2016Co-Authors: Bertus F Jeronimus, Harriette Riese, Roman Kotov, Johan OrmelAbstract:Background This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including Anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. Method This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. Results The results showed large unadjusted prospective associations between neuroticism and symptoms/Diagnosis of Anxiety, depression, and non-specific mental distress (d = 0.50-0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10-0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03-0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short ( Conclusion High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.
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neuroticism s prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history but the adjusted association hardly decays with time a meta analysis on 59 longitudinal prospective studies with 443 313
Psychological Medicine, 2016Co-Authors: Bertus F Jeronimus, Harriette Riese, Roman Kotov, Johan OrmelAbstract:Background This meta-analysis seeks to quantify the prospective association between neuroticism and the common mental disorders (CMDs, including Anxiety, depression, and substance abuse) as well as thought disorders (psychosis/schizophrenia) and non-specific mental distress. Data on the degree of confounding of the prospective association of neuroticism by baseline symptoms and psychiatric history, and the rate of decay of neuroticism's effect over time, can inform theories about the structure of psychopathology and role of neuroticism, in particular the vulnerability theory. Method This meta-analysis included 59 longitudinal/prospective studies with 443 313 participants. Results The results showed large unadjusted prospective associations between neuroticism and symptoms/Diagnosis of Anxiety, depression, and non-specific mental distress (d = 0.50–0.70). Adjustment for baseline symptoms and psychiatric history reduced the associations by half (d = 0.10–0.40). Unadjusted prospective associations for substance abuse and thought disorders/symptoms were considerably weaker (d = 0.03–0.20), but were not attenuated by adjustment for baseline problems. Unadjusted prospective associations were four times larger over short (<4 year) than long (⩾4 years) follow-up intervals, suggesting a substantial decay of the association with increasing time intervals. Adjusted effects, however, were only slightly larger over short v. long time intervals. This indicates that confounding by baseline symptoms and psychiatric history masks the long-term stability of the neuroticism vulnerability effect. Conclusion High neuroticism indexes a risk constellation that exists prior to the development and onset of any CMD. The adjusted prospective neuroticism effect remains robust and hardly decays with time. Our results underscore the need to focus on the mechanisms underlying this prospective association.
Gutiérrez López Beatriz - One of the best experts on this subject based on the ideXlab platform.
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Estabilidad de la personalidad durante la presencia y tras la remisión completa de un trastorno mental
'Edicions de la Universitat de Barcelona', 2020Co-Authors: Gutiérrez López BeatrizAbstract:[spa] Estudiar la relación que mantiene la personalidad y el Trastorno Mental (TM) resulta de gran interés en el momento actual. Uno de los objetivos principales de esta investigación es valorar la estabilidad-cambio de los rasgos de personalidad durante la presencia de un TM y tras la remisión completa del mismo. También nos interesa conocer si existen tipos de TM y/o condiciones clínicas que afectan de modo diferencial a la estabilidad-cambio de la evaluación de la personalidad. Para ello hemos realizado un estudio longitudinal a 6 meses en la comunidad de Navarra (España), en el cual se ha evaluado la personalidad y la psicopatología de 146 sujetos que inician y/o reinician un tratamiento especializado en salud mental. Para evaluar la personalidad de los sujetos se ha utilizado el NEO-PI-R ( Costa y McCrae, 1992) y para valorar la psicopatología general el SCL-90-R (Derogatis, 1994). El 67.1% (N= 98) de muestra son mujeres con una media de edad de 36.01 años. El 28,1% presenta un Trastornos de Ansiedad (TA), el 24,6 % un Trastorno del Humor (TH), el 20,5% un Trastorno de Estrés (TE), el 17,8 % un Trastorno de Personalidad (TP) y el 0,6 % otro tipo de cuadro psicopatológico. El perfil de personalidad de la muestra se caracteriza por una puntuación alta en Neuroticismo (N), baja Extraversión (E), media en Apertura a la experiencia (O), media en Amabilidad (A) y baja en Responsabilidad (C). Tras analizar todos los datos con el programa estadístico SPSS-21, nuestros resultados son indicativos de que a excepción de la dimensión N, todas las dimensiones de personalidad presentan una adecuada estabilidad relativa y absoluta frente a la psicopatología y su tratamiento. Según nuestros datos, el TM produce un efecto amplificador y transitorio de la dimensión N y todas sus facetas, y una tendencia a la baja en la puntuación C, que es significativa para las facetas “Autodisciplina” y “Competencia”. Este cambio en la dimensión N parece asociarse al cambio psicopatológico que se produce durante la realización del tratamiento. Además nuestros datos son indicativos de que los rasgos de personalidad N y E se asocian de manera significativa con la psicopatología y que los sujetos con cuadros psicopatológicos de menor duración y gravedad clínica presentan mayor remisión completa de su TM, que los sujetos con cuadros psicopatológicos más graves y cronificados en el tiempo. Todos los datos extraídos de nuestro estudio parecen converger en la hipótesis de que la duración del TM afecta de manera diferencial a la patoplastia de la personalidad.[eng] Studying the association between personality and mental disorders is of great interest at present times. One of the main aims of this research is to assess the stability-change of personality traits during the presence of a mental disorder and after its complete referral. We are also interested in finding out if there are types of mental disorders and/or clinical conditions that differentially affect the stability-change of personality assessment. Using a longitudinal study from Comunidad de Navarra followed during 6 months, we assessed personality and psychopathology in 146 participants starting or restarting specialized mental health care. NEO-PI-R (Costa y McCrae, 1992) has been used to assess personality and SCL- 90-R (Derogatis, 1994) to evaluate general psychopathology. 67.1% (N= 98) of the sample are women with a mean age of 36.01. 28.1% with a primary Diagnosis of Anxiety Disorder (AD), 24.6% of Mood Disorders (MD), 20.5% of Stress Disorder (SD), 17.8% of Personality Disorder (PD) and 0.6% of other psychopathological problems. Sample personality profile is characterized by high scores in neuroticism (N), low extraversion (E) scores, average scores in openness to experience (O), average scores in agreeableness (A) and low conscientiousness (C) scores. After analyzing all the data with SPSS-21 software, the results highlight that with the exception of N domain, all other personality domains have adequate relative and absolute stability as compare with psychopathology and its treatment. According to our data, the mental disorder produce an amplifier and transient effect in N domain and all its facets and a downward trend in the C score significant for "self-discipline" and "competence" facets. This change in N domain seems to be related to the psychopathological change produced during treatment. Also our data are indicative that N and E domains are significantly associated to psychopathology. In our sample, subjects with milder or shorter psychological problems show successful mental health referral as compare with subjects with more severe and chronic disorders. All the data extracted from our study seem to converge on the hypothesis that the course and duration of the mental disorder affect differentially personality pathoplasty
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Estabilidad de la personalidad durante la presencia y tras la remisión completa de un trastorno mental
'Edicions de la Universitat de Barcelona', 2020Co-Authors: Gutiérrez López BeatrizAbstract:Estudiar la relación que mantiene la personalidad y el Trastorno Mental (TM) resulta de gran interés en el momento actual. Uno de los objetivos principales de esta investigación es valorar la estabilidad-cambio de los rasgos de personalidad durante la presencia de un TM y tras la remisión completa del mismo. También nos interesa conocer si existen tipos de TM y/o condiciones clínicas que afectan de modo diferencial a la estabilidad-cambio de la evaluación de la personalidad. Para ello hemos realizado un estudio longitudinal a 6 meses en la comunidad de Navarra (España), en el cual se ha evaluado la personalidad y la psicopatología de 146 sujetos que inician y/o reinician un tratamiento especializado en salud mental. Para evaluar la personalidad de los sujetos se ha utilizado el NEO-PI-R ( Costa y McCrae, 1992) y para valorar la psicopatología general el SCL-90-R (Derogatis, 1994). El 67.1% (N= 98) de muestra son mujeres con una media de edad de 36.01 años. El 28,1% presenta un Trastornos de Ansiedad (TA), el 24,6 % un Trastorno del Humor (TH), el 20,5% un Trastorno de Estrés (TE), el 17,8 % un Trastorno de Personalidad (TP) y el 0,6 % otro tipo de cuadro psicopatológico. El perfil de personalidad de la muestra se caracteriza por una puntuación alta en Neuroticismo (N), baja Extraversión (E), media en Apertura a la experiencia (O), media en Amabilidad (A) y baja en Responsabilidad (C). Tras analizar todos los datos con el programa estadístico SPSS-21, nuestros resultados son indicativos de que a excepción de la dimensión N, todas las dimensiones de personalidad presentan una adecuada estabilidad relativa y absoluta frente a la psicopatología y su tratamiento. Según nuestros datos, el TM produce un efecto amplificador y transitorio de la dimensión N y todas sus facetas, y una tendencia a la baja en la puntuación C, que es significativa para las facetas “Autodisciplina” y “Competencia”. Este cambio en la dimensión N parece asociarse al cambio psicopatológico que se produce durante la realización del tratamiento. Además nuestros datos son indicativos de que los rasgos de personalidad N y E se asocian de manera significativa con la psicopatología y que los sujetos con cuadros psicopatológicos de menor duración y gravedad clínica presentan mayor remisión completa de su TM, que los sujetos con cuadros psicopatológicos más graves y cronificados en el tiempo. Todos los datos extraídos de nuestro estudio parecen converger en la hipótesis de que la duración del TM afecta de manera diferencial a la patoplastia de la personalidad.Studying the association between personality and mental disorders is of great interest at present times. One of the main aims of this research is to assess the stability-change of personality traits during the presence of a mental disorder and after its complete referral. We are also interested in finding out if there are types of mental disorders and/or clinical conditions that differentially affect the stability-change of personality assessment. Using a longitudinal study from Comunidad de Navarra followed during 6 months, we assessed personality and psychopathology in 146 participants starting or restarting specialized mental health care. NEO-PI-R (Costa y McCrae, 1992) has been used to assess personality and SCL- 90-R (Derogatis, 1994) to evaluate general psychopathology. 67.1% (N= 98) of the sample are women with a mean age of 36.01. 28.1% with a primary Diagnosis of Anxiety Disorder (AD), 24.6% of Mood Disorders (MD), 20.5% of Stress Disorder (SD), 17.8% of Personality Disorder (PD) and 0.6% of other psychopathological problems. Sample personality profile is characterized by high scores in neuroticism (N), low extraversion (E) scores, average scores in openness to experience (O), average scores in agreeableness (A) and low conscientiousness (C) scores. After analyzing all the data with SPSS-21 software, the results highlight that with the exception of N domain, all other personality domains have adequate relative and absolute stability as compare with psychopathology and its treatment. According to our data, the mental disorder produce an amplifier and transient effect in N domain and all its facets and a downward trend in the C score significant for "self-discipline" and "competence" facets. This change in N domain seems to be related to the psychopathological change produced during treatment. Also our data are indicative that N and E domains are significantly associated to psychopathology. In our sample, subjects with milder or shorter psychological problems show successful mental health referral as compare with subjects with more severe and chronic disorders. All the data extracted from our study seem to converge on the hypothesis that the course and duration of the mental disorder affect differentially personality pathoplasty
Kurt Kroenke - One of the best experts on this subject based on the ideXlab platform.
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depression and Anxiety in the united states findings from the 2006 behavioral risk factor surveillance system
Psychiatric Services, 2008Co-Authors: Tara W Strine, Joyce T Berry, Lina S Balluz, Olinda Gonzalez, Raquel Crider, Kurt KroenkeAbstract:Objective: This study examined the unadjusted and adjusted prevalence estimates of depression and Anxiety at the state level and examined the odds ratios of depression and Anxiety for selected risk behaviors, obesity, and chronic diseases. Methods: The 2006 Behavioral Risk Factor Surveillance Survey, a random-digit-dialed telephone survey, collected depression and Anxiety data from 217,379 participants in 38 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Current depressive symptoms were assessed with the standardized and validated eight-item Patient Health Questionnaire, and lifetime Diagnosis of depression and Anxiety was assessed by two additional questions (one question for each Diagnosis). Results: The overall prevalence of current depressive symptoms was 8.7% (range by state and territory, 5.3%–13.7%); of a lifetime Diagnosis of depression, 15.7% (range, 6.8%–21.3%); and of a lifetime Diagnosis of Anxiety, 11.3% (range, 5.4%–17.2%). After sociodemographic characteristics, adverse health behaviors, and chronic illnesses were adjusted for, cardiovascular disease, diabetes, asthma, smoking, and obesity were all significantly associated with current depressive symptoms, a lifetime Diagnosis of Anxiety, and a lifetime Diagnosis of depression. Physically inactive adults were significantly more likely than those who were physically active to have current depressive symptoms or a lifetime Diagnosis of depression, whereas those who drank heavily were significantly more likely than those who did not to have current depressive symptoms or a lifetime Diagnosis of Anxiety. Conclusions: Depression and Anxiety were strongly associated with common chronic medical disorders and adverse health behaviors. Examination of mental health should therefore be an integral component of overall health care. (Psychiatric Services 59:1383–1390, 2008)