How global epidemiological evidence can inform the revision of ICD-10 classification of depression and anxiety disorders

Abstract

This article reviews current evidence from epidemiological surveys that may be relevant for improving the ICD classification of depression and anxiety disorders. Topics of special interest are the boundaries of these disorders, subthreshold presentations, patterns of comorbidity, and cultural variations in somatic presentations. Proposals for hierarchical structures that model the core factors underlying these disorders are presented. The need for a better description of mixed anxiety and depressive disorder in ICD-11 is highlighted. Questions regarding how to model somatic symptoms related to depression and anxiety disorders and how to take the cultural components of the these disorders into account are raised. The challenge of reformulating the current classification in order to enhance clinical utility should not cast aside basic conceptualizations of psychopathology.