Brief reportSymptom dimensions as predictors of the two-year course of depressive and anxiety disorders
Introduction
Although several predictive factors are known, course predictions for depression and anxiety are usually unspecific. Depression is known to be episodic and sometimes chronic (± 20%) (e.g. Keller and Baker, 1992, Ormel et al., 1993, Piccinelli and Wilkinson, 1994), anxiety disorders are known to remit less often (e.g. Keller and Hanks, 1993, Pollack and Otto, 1997, Tiemens et al., 1996), and comorbid depression–anxiety is known to have a particularly unfavorable course (e.g. Shankman and Klein, 2002, Merikangas et al., 2003, Patten et al., 2010, Penninx et al., 2011). Other predictors of poor prognosis include old age (Penninx et al., 2011), young age-of-onset (Karlsson et al., 2008, Penninx et al., 2011), high severity (van Beljouw et al., 2010, Penninx et al., 2011) and long disorder duration (Conradi et al., 2008).
Still, prognosis varies between individuals with seemingly similar characteristics. To account for this heterogeneity, symptom-dimensions could be used as additional predictors, increasing homogeneity, circumventing comorbidity (Widiger and Samuel, 2005) and increasing statistical power (Goldberg, 2000, MacCallum et al., 2002). The tripartite model (Clark and Watson, 1991) describes well-validated common and specific dimensions for depression and anxiety (e.g. de Beurs et al., 2007, Keogh and Reidy, 2000, Marshall et al., 2003). The common dimension of ‘General distress (GD)’ covers psychological distress seen in both depression and anxiety and accounts for their comorbidity. The specific dimension of ‘Anhedonic depression (AD)’ covers depression-specific anhedonia/energy loss and ‘Anxious arousal (AA)’ covers anxiety/panic-specific somatic arousal. Each tripartite dimension was hypothesized to have specific prognostic value (Clark et al., 1994). Indeed, GD and AD were found to predict outcome of depression (Joiner and Lonigan, 2000, Lonigan et al., 2003) and generalized anxiety disorder (Chambers et al., 2004) and related dimensions made similar predictions (Geerts and Bouhuys, 1998, Clark et al., 2003). However, there were large methodological differences across studies and the AA-dimension was not often investigated. Moreover, anxiety and comorbid depression–anxiety patients were not accounted for in these studies, hampering the differentiation between the predictive abilities of GD, AD and AA. Importantly, the added value of dimensions on top of known predictors was not evaluated.
Therefore, we investigated the ability and added value of the tripartite dimensions in predicting the 2-year course and outcome of depression, anxiety and comorbid depression–anxiety in a large outpatient cohort (n = 992).
Section snippets
Participants
Participants came from the Netherlands Study of Depression and Anxiety (NESA), a large longitudinal cohort study (N = 2981) of participants with (n = 2329) or without (n = 652) a lifetime depressive/anxiety disorder (see Penninx et al. (2008) for details). Exclusion criteria were: not being fluent in Dutch or a psychotic, obsessive-compulsive, bipolar or severe addiction disorder. Ethical Review Boards of all participating universities approved the study-protocol. All participants signed informed
Baseline characteristics
Of the sample, 66.2% was female and the mean age was 42.5 years (s.d. = 12.3, see Table 1). Of the participants 227 (22.9%) had a single depressive disorder, 400 (40.3%) had single anxiety, and 365 (36.8%) had comorbid depression–anxiety. At baseline, mean age-at-onset was 20.9 (s.d. = 12.5), the mean percentage of months with symptomatology prior to baseline was 31.6 (s.d. = 20.1) and 384 participants (38.7%) used antidepressants. AD and AA were weakly correlated (r = 0.31) and GD was moderately
Discussion
The current study showed that common and specific dimensions of depression and anxiety, each add specific prognostic information on top of baseline DSM-diagnosis and other prognostic factors. Increased baseline GD was associated with increased odds of comorbid depression–anxiety at follow-up. Increased AD was associated with increased odds of single depression and increased AA was associated with increased odds of anxiety. In addition, increased GD predicted unfavourable course trajectories.
Role of funding source
The funding sources had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Conflict of interest
The authors have no conflicts of interest to declare.
Acknowledgments
The infrastructure for the NESDA study (www.nesda.nl) is funded through the Geestkracht program of the Netherlands Organisation for Health Research and Development (Zon-Mw, grant number 10-000-1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Scientific Institute for Quality of
References (35)
- et al.
The relationship between trait vulnerability and anxiety and depressive diagnoses at long-term follow-up of Generalized Anxiety Disorder
Journal of Anxiety Disorders
(2004) - et al.
Prediction of the three-year course of recurrent depression in primary care patients, different risk factors for different outcomes
Journal of Affective Disorders
(2008) - et al.
The tripartite model for assessing symptoms of anxiety and depression, psychometrics of the Dutch version of the Mood and Anxiety Symptoms Questionnaire
Behaviour Research and Therapy
(2007) - et al.
Distinguishing between depression and anxiety, a proposal for an extension of the tripartite model
European Psychiatry
(2010) - et al.
Multi-level prediction of short-term outcome of depression, non-verbal interpersonal processes, cognitions and personality traits
Psychiatry Research
(1998) Plato versus Aristotle, categorical and dimensional models for common mental disorders
Comprehensive Psychiatry
(2000)- et al.
The impact of comorbid anxiety disorders on the course of dysthymic disorder, a 5-year prospective longitudinal study
Journal of Affective Disorders
(2002) - et al.
Development and validation of a 30-item short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ)
Psychiatry Research
(2010) - et al.
Tripartite model of anxiety and depression, psychometric evidence and taxonomic implications
Journal of Abnormal Psychology
(1991) - et al.
Temperament, personality, and the mood and anxiety disorders
Journal of Abnormal Psychology
(1994)
Separate personality traits from states to predict depression
Journal of Personality Disorders
Distinguishing between symptom-dimensions of depression and anxiety: an integrative approach
Journal of Affective Disorders
Tripartite model of depression and anxiety in youth psychiatric inpatients, relations with diagnostic status and future symptoms
Journal of Clinical Child Psychology
One-year course and predictors of outcome of adolescent depression, a case–control study in Finland
The Journal of Clinical Psychiatry
The clinical course of panic disorder and depression
The Journal of Clinical Psychiatry
Course and outcome in panic disorder
Progress in Neuro-Psychopharmacology & Biological Psychiatry
Exploring the factor structure of the mood and anxiety symptom questionnaire (MASQ)
Journal of Personality Assessment
Cited by (43)
Characterizing stress processes by linking big five personality states, traits, and day-to-day stressors
2024, Journal of Research in PersonalityAssociation between overt aggression and anhedonia in patients with major depressive disorder during the acute phase
2023, Journal of Psychiatric ResearchEffect of Daily Life Reward Loop Functioning on the Course of Depression
2023, Behavior TherapySpecificity of anhedonic alterations in resting-state network connectivity and structure: A transdiagnostic approach
2021, Psychiatry Research - NeuroimagingModeling the symptoms of psychopathology: A pluralistic approach
2020, New Ideas in Psychology