2017-06-292026-03-272017-06-292011Tomás Martínez Ibarra0033-291710.1017/S0033291710001212https://doi.org/10.1017/S0033291710001212https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045479/https://repositorio.inprf.gob.mx/handle/123456789/5378Background. The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles. Method. Face-to-face interviews in 13 countries (six developing, nine developed; n = 31 067; response rate = 69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. Results. The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24-0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. Conclusions. Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings.engacceso cerradoarticle4Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz873-886New York41QUALITY-OF-LIFEVISUAL ANALOG SCALESTATE VALUATIONSDISORDERSDEPRESSIONIMPACTCOMORBIDITYDISABILITYOUTCOMESVERSIONCo-morbidityepidemiologyglobal burden of diseasemental healthvisual analog scale