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The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice

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Möller, Hans-Jürgen, Bandelow, Borwin, Volz, Hans-Peter, Barnikol, Utako Birgit, Seifritz, Erich, Kasper, Siegfried·2016·European Archives of Psychiatry and Clinical Neuroscience
DOI 10.1007/s00406-016-0684-7PMC PMC5097109
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Abstract

According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.

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  • Depression and anxiety, whether individually or in co-morbid form, are the most common mental health presentations.

    “The principal mental health conditions we evaluated were depression and anxiety—once more for the simple reason that these conditions, whether individually or in co-morbid form, are the most common mental health presentations [33].”

    From Five studies evaluating the impact on mental health and mood of recalling, reading, and discussing fiction (2022) · cites this paper as [33]

    The Background describes substantial overlap between depression and anxiety, and Clinical evidence reports that mixed anxiety and depression accounted for about half of common mental disorder cases in one British survey. These passages support their prominence, but do not establish that depression and anxiety, individually or together, are the most common mental health presentations overall. Page numbers are not available in our copy. (LLM, conf=0.78)

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Authors
Möller, H.-J., Bandelow, B., Volz, H.-P., Barnikol, U. B., Seifritz, E., & Kasper, S.
Affiliations
  • Ludwig-Maximilians-Universität München (DE)
  • Universitätsmedizin Göttingen (DE)
  • University of Cologne (DE)
  • Medical University of Vienna (AT)
Corresponding author
Kasper, Siegfried
ORCID
Venue
European Archives of Psychiatry and Clinical Neuroscience
Publisher
Springer Science and Business Media LLC
Published
2016-03-22
Volume
266
Issue
8
Pages
725-736
ISSN
  • 0003-9373 (ISSN-L)
  • 0940-1334
  • 1433-8491
DOI
10.1007/s00406-016-0684-7
PMC
PMC5097109
OpenAlex
W2308085552
Cited by
127
References
18
Citations by year
2026: 8 · 2025: 15 · 2024: 13 · 2023: 13 · 2022: 20 · 2021: 22 · 2020: 17 · 2019: 3 · 2018: 7 · 2017: 5 · 2016: 4
FWCI
0.84
Type
journal article
Language
en
Open access
Licence
Locations
  • European Archives of Psychiatry and Clinical Neuroscience (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
  • GRO (submittedVersion, cc-by)
Funders
Dr. Willmar Schwabe GmbH & Co
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords
mixed anxiety-depressive disorder, diagnostic validity, ICD-10, DSM-5, subthreshold anxiety, subthreshold depression, primary care, prevalence, remission, disease classification, health-related quality of life, psychiatric classification
MeSH terms
Anxiety Disorders, Depressive Disorder, Humans, Psychiatric Status Rating Scales, International Classification of Diseases

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