Comorbidity of physical and anxiety symptoms in adolescent: Functional impairment, self-rated health and subjective well-being

Judit Balázs, Mónika Miklósi, Agnes Keresztény, Christina W. Hoven, Vladimir Carli, Camilla Wasserman, Gergö Hadlaczky, Alan Apter, Julio Bobes, Romuald Brunner, Paul Corcoran, Doina Cosman, Christian Haring, Jean Pierre Kahn, Vita Postuvan, Michael Kaess, Airi Varnik, Marco Sarchiapone, Danuta Wasserman

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Physical disorders and anxiety are frequently comorbid. This study investigates the characteristics of physical disorders, self-rated heath, subjective well-being and anxiety in adolescents. Data were drawn from the Saving and Empowering Young Lives in Europe cohort study. From 11 countries 11,230 adolescents, aged 14–16 years were included. Zung Self-Rating Anxiety Scale (SAS), WHO-5 Well-Being Index and five questions prepared for this study to evaluate physical illnesses and self-rated heath were administered. Anxiety levels were significantly higher in adolescents who reported having physical disability (p < 0.001, Cohen’s d = 0.40), suffering from chronic illnesses (p < 0.001, Cohen’s d = 0.40), impairments associated to health conditions (p < 0.001, Cohen’s d = 0.61), or reported poor to very poor self-rated health (p < 0.001, Cohen’s d = 1.11). Mediational analyses revealed no direct effect of having a chronic illness/physical disability on subjective well-being, but the indirect effects through higher levels of anxiety were significant. Functional impairment related to health conditions was both directly and indirectly (through higher levels of anxiety) associated with lower well-being. The co-occurrence of anxiety and physical disorders may confer a greater level of disability and lower levels of subjective well-being. Clinicians have to screen anxiety, even in a subthreshold level in patients with choric physical illness or with medically unexplained physical symptoms.

Original languageEnglish
Article number1698
JournalInternational Journal of Environmental Research and Public Health
Issue number8
StatePublished - 9 Aug 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 by the authors. Licensee MDPI, Basel, Switzerland.


  • Adolescent
  • Anxiety
  • Categorical diagnostic model
  • Comorbidity
  • Dimensional diagnostic model
  • Physical morbidity
  • Self-rated heath


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