Minimal research has been conducted on anxiety-anxiety comorbidity.
•Anxiety-anxiety displayed similarly severe/complex profiles of symptoms as anxiety-MDD.
•Anxiety-anxiety had higher current anxiety but lower current depressive symptom severity than anxiety-MDD.
•Anxiety-MDD first-onset anxiety had a younger age of onset and more severe symptoms.
•Lower self-reported diagnosis rates may indicate less recognition of anxiety than MDD.
AbstractBackgroundAnxiety and depressive disorders often co-occur and the order of their emergence may be associated with different clinical outcomes. However, minimal research has been conducted on anxiety-anxiety comorbidity. This study examined factors associated with anxiety comorbidity and anxiety-MDD temporal sequence.
MethodsOnline, self-report data were collected from the UK-based GLAD and COPING NBR cohorts (N = 38,775). Logistic regression analyses compared differences in sociodemographic, trauma, and clinical factors between single anxiety, anxiety-anxiety comorbidity, anxiety-MDD (major depressive disorder) comorbidity, and MDD-only. Additionally, anxiety-first and MDD-first anxiety-MDD were compared. Differences in familial risk were assessed in those participants with self-reported family history or genotype data.
ResultsAnxiety-anxiety and anxiety-MDD had higher rates of self-reported anxiety or depressive disorder diagnoses, younger age of onset, and higher recurrence than single anxiety. Anxiety-MDD displayed greater clinical severity/complexity than MDD only. Anxiety-anxiety had more severe current anxiety symptoms, less severe current depressive symptoms, and reduced likelihood of self-reporting an anxiety/depressive disorder diagnosis than anxiety-MDD. Anxiety-first anxiety-MDD had a younger age of onset, more severe anxiety symptoms, and less likelihood of self-reporting a diagnosis than MDD-first. Minimal differences in familial risk were found.
LimitationsSelf-report, retrospective measures may introduce recall bias. The familial risk analyses were likely underpowered.
ConclusionsAnxiety-anxiety comorbidity displayed a similarly severe and complex profile of symptoms as anxiety-MDD but distinct features. For anxiety-MDD, first-onset anxiety had an earlier age of onset and greater severity than MDD-first. Anxiety disorders and comorbidity warrant further investigation and attention in research and practice.
KeywordsDepressive disorders
Anxiety disorders
Comorbidity
Polygenic risk score
Affective disorders
AbbreviationsMDDmajor depressive disorder
NESDANetherlands Study of Depression and Anxiety
ADHDattention deficit hyperactivity disorder
ASDautism spectrum disorder
NIHRNational Institute for Health and Care Research
GLADGenetic Links to Anxiety and Depression
COPINGCOVID-19 Psychiatry and Neurological Genetics
NHSNational Health Service
GADgeneralised anxiety disorder
CIDI-SFComposite International Diagnostic Interview - short form
DSM-5Diagnostic and Statistical Manual of Mental Disorders, 5th edition
NVQNational vocational qualification
CTSChildhood Trauma screener
PTSDpost-traumatic stress disorder
PHQ-9Patient Health Questionnaire, 9-items
GAD-7Generalised Anxiety Disorder Assessment, 7-items
GWASgenome-wide association study
VIFvariance inflation factor
© 2022 The Author(s). Published by Elsevier B.V.
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