Volume 323, 15 February 2023, Pages 280-291Author links open overlay panel…Highlights•

Minimal research has been conducted on anxiety-anxiety comorbidity.

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Anxiety-anxiety displayed similarly severe/complex profiles of symptoms as anxiety-MDD.

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Anxiety-anxiety had higher current anxiety but lower current depressive symptom severity than anxiety-MDD.

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Anxiety-MDD first-onset anxiety had a younger age of onset and more severe symptoms.

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Lower self-reported diagnosis rates may indicate less recognition of anxiety than MDD.

AbstractBackground

Anxiety 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.

Methods

Online, 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.

Results

Anxiety-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.

Limitations

Self-report, retrospective measures may introduce recall bias. The familial risk analyses were likely underpowered.

Conclusions

Anxiety-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.

Keywords

Depressive disorders

Anxiety disorders

Comorbidity

Polygenic risk score

Affective disorders

AbbreviationsMDD

major depressive disorder

NESDA

Netherlands Study of Depression and Anxiety

ADHD

attention deficit hyperactivity disorder

ASD

autism spectrum disorder

NIHR

National Institute for Health and Care Research

GLAD

Genetic Links to Anxiety and Depression

COPING

COVID-19 Psychiatry and Neurological Genetics

NHS

National Health Service

GAD

generalised anxiety disorder

CIDI-SF

Composite International Diagnostic Interview - short form

DSM-5

Diagnostic and Statistical Manual of Mental Disorders, 5th edition

NVQ

National vocational qualification

CTS

Childhood Trauma screener

PTSD

post-traumatic stress disorder

PHQ-9

Patient Health Questionnaire, 9-items

GAD-7

Generalised Anxiety Disorder Assessment, 7-items

GWAS

genome-wide association study

VIF

variance inflation factor

© 2022 The Author(s). Published by Elsevier B.V.