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Comorbidity of PTSD in anxiety and depressive disorders: Prevalence and shared risk factors
Abstract
The present study aims to assess comorbidity of posttraumatic stress disorder (PTSD) in anxiety and depressive disorders and to determine whether childhood trauma types and other putative independent risk factors for comorbid PTSD are unique to PTSD or shared with anxiety and depressive disorders. The sample of 2402 adults aged 18-65 included healthy controls, persons with a prior history of affective disorders, and persons with a current affective disorder. These individuals were assessed at baseline (T0) and 2 (T2) and 4 years (T4) later. At each wave, DSM-IV-TR based anxiety and depressive disorder, neuroticism, extraversion, and symptom severity were assessed. Childhood trauma was measured at T0 with an interview and at T4 with a questionnaire, and PTSD was measured with a standardized interview at T4. Prevalence of 5-year recency PTSD among anxiety and depressive disorders was 9.2%, and comorbidity, in particular with major depression, was high (84.4%). Comorbidity was associated with female gender, all types of childhood trauma, neuroticism, (low) extraversion, and symptom severity. Multivariable significant risk factors (i.e., female gender and child sexual and physical abuse) were shared among anxiety and depressive disorders. Our results support a shared vulnerability model for comorbidity of anxiety and depressive disorders with PTSD. Routine assessment of PTSD in patients with anxiety and depressive disorders seems warranted.
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“Finally, traumatic experiences are highly prevalent in mood and anxiety disorders, where in a recent sample of 2000 persons with mood and anxiety disorders, 91.2% of reported having experienced a potentially traumatic or bothersome life event (Spinhoven et al., 2014).”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Spinhoven et al., 2014
In the citing paper
“This overlap may partly explain the significant association between PTSD symptom scores and depression scores reported in this study (Flory and Yehuda, 2015;Spinhoven et al., 2014;Greene et al., 2016).”
From Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape (2022) · cites this paper as Spinhoven et al., 2014
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“…presence of comorbidities and correlations between areas of neurodivergence and mental health conditions, which is expected (Kessler et al., 2005; Krueger & Eaton, 2015; Spinhoven et al., 2014; Swinbourne & Touyz, 2007; Smitherman et al., 2013; Carmichael et al., 2019; Price et al., 2021).”
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BackgroundClinchard, C., Harp, N. R., Lorenz, T. K., & Neta, M. (2024) · Emotion · doi:10.1037/emo0001335 · Cited by 8
“Given extant literature showing high comorbidity between PTSD and mood disorders (e.g., depression; Chiu et al., 2011; Spinhoven et al., 2014), and literature indicating stronger support for a directionality from PTSD to depression (Flory & Yehuda, 2015; Stander et al., 2014), a more negative…”
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“Previous studies have investigated common risk factors associated with comorbid PTSD and depressive disorder, including female gender, lower educational attainment, history of childhood abuse, and limited social support [38, 39].”
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Pair-housing rats does not protect from behavioral consequences of an acute traumatic experience.
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“Because of the high level of comorbidity of anxiety and depressive disorders in the PTSD population (Spinhoven et al., 2014), participants were not excluded if they had current or past anxiety or depressive disorders.”
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Sanger, B., Alarachi, A., McNeely, H. E., McKinnon, M. C., & McCabe, R. E. (2025) · Psychology Research and Behavior Management · doi:10.2147/prbm.s461173 · Cited by 7
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“Major depressive disorder (MDD), anxiety disorders (ANX), and post-traumatic stress disorder (PTSD) are closely related disorders with both high degrees of comorbidity among them and shared risk factors (Ginzburg, Ein-Dor, & Solomon, 2010; Spinhoven et al., 2014).”
Seow, T. X. F., Jelinek, L., Moritz, S., & Hauser, T. U. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00503-4 · Cited by 11
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“Different factors may impact risk for co-occurrences of these concerns (e.g., Spinhoven et al. 2014), and future research assessing multi-morbidity of mental health concerns may increase understanding of how emotion regulation relates to complex mental health presentations.”
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Early life stress, depression and epigenetics
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History of posttraumatic stress disorder and outcomes after kidney transplantation
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Understanding the Role of Endocannabinoids in Posttraumatic Stress Disorder
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“PTSD often presents with co-morbid depression and anxiety, and those with comorbiddiagnoseshavegreaterfunctionalimpairments, 70,71 perhaps explaining why in our study AD with PTSD possessed the youngest age at onset of all (Table 2).”
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Trauma and Posttraumatic Stress Disorder Among First Responders
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“PTSD is associated with a high rate of psychiatric comorbidity (Brady et al., 2000), including depressive disorders, anxiety disorders (Ginzburg et al., 2010; Spinhoven et al., 2014), and substance use disorders (Galatzer-Levy et al., 2013).”
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Au, M., Lipschutz, R. S., Mekawi, Y., Lathan, E. C., Dixon, H. D., Carter, S. E., Hinrichs, R. C., Bradley, B., Kaslow, N. J., Nugent, N. R., et al. (2024) · Journal of Mood and Anxiety Disorders · doi:10.1016/j.xjmad.2024.100092 · Cited by 7
“Moreover, the presence of depression with comorbid PTSD has been associated with an increase of treatment dropout rates [5].”
Kar, N., Swain, S. P., Parija, S., Banerjee, S., Mahakul, S., Behura, S. S., Palei, B., & Kar, S. (2025) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2025.113 · Cited by 4
“31,58,59 Their significant association as observed in this study of train accident survivors suggests that comorbidity should be explored, which might help in intervention planning.”
Narrative analysis of interviews conducted with African unaccompanied refugee minors
Bründlmayer, A., Sales, C., Zhang, R., Pien, J., Plener, P. L., Laczkovics, C., & Schwarzenberg, J. (2025) · Journal of Global Health · doi:10.7189/jogh.15.04174 · Cited by 4
Jiang, S., Li, X., Jin, C., & Liang, Z. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.118566 · Cited by 4
Dell, L., Madden, K., Baur, J., Sbisa, A. M., McFARLANE, A. C., VanHooff, M., Bryant, R. A., & Lawrence‐Wood, E. (2024) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674241286818 · Cited by 4
“In a longitudinal sample of veterans, occurrence of comorbid PTSD, depression and anxiety was higher than PTSD alone (Ginzburg et al., 2010), with evidence indicating that female gender increases risk for comorbidity among these disorders (Spinhoven et al., 2014).”
Karadağ, M. (2020) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.686609 · Cited by 4
DeGrace, S., Barrett, S. P., Yakovenko, I., Tibbo, P. G., Romero‐Sanchiz, P., Carleton, R. N., Snooks, T., Rudnick, A., & Stewart, S. H. (2024) · The Canadian Journal of Psychiatry · doi:10.1177/07067437241255104 · Cited by 4
Correia‐Santos, P., Morgado, D., Maia, Â., Levendosky, A. A., Jongenelen, I., & Pinto, R. J. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22469 · Cited by 4
Claxton, J., Alberici, A., Meiser‐Stedman, R., & Chiu, H. T. S. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2527550 · Cited by 5
“…high comorbidity rates found in epidemiological studies of post-traumatic stress disorder (PTSD) ranging from 78.5 to 84.4% (Qassam et al., 2021; Spinhoven et al., 2014; Breslau et al., 1991), comorbidity for this disorder has been shown to be the rule rather than the exception (Kessler, 1995;…”
InfluentialTrauma Type and Posttraumatic Stress Symptoms in Youth
Doehrmann, A., Bibb, S. A., Kreutzer, K. A., & Gorka, S. M. (2025) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001837 · Cited by 3
Moshfeghinia, R., Sanaei, E., Kavari, K., Barzegari, A. M., Ahmadzadeh, A. M., Bafrani, M. A., Habibzadeh, A., Boroon, M., & Shalbafan, M. (2025) · BMC Pharmacology and Toxicology · doi:10.1186/s40360-025-00996-y · Cited by 4
Karchoud, J. F., Hoeboer, C. M., Piwanski, G., Haagsma, J. A., Olff, M., van de Schoot, R., & van Zuiden, M. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06110-6 · Cited by 4
Stricher-Stern, H., Shalev, A., & Lahav, Y. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.118289 · Cited by 3
Minwoo, Y., & Kim, E. (2021) · Journal of Aggression Maltreatment & Trauma · doi:10.1080/10926771.2020.1866133 · Cited by 3
“Moreover, some studies have found that there is a high degree of comorbidity between (a) PTSD symptoms and depression and (b) depression and anxiety symptoms among refugees (Persson & Gard, 2013; Spinhoven et al., 2014).”
BackgroundBazmandegan, G., Kamiab, Z., Nasab, M. G., Khaloobagheri, E., Zinaddini, M., Movahedi, F., parizi, A. S., & Zakeri, M. A. (2022) · Journal of Occupational Health and Epidemiology · doi:10.52547/johe.11.1.83 · Cited by 3
El-Khoury, F., Héroin, V., & Fareng, M. (2024) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2024.100482 · Cited by 3
Patel, T. A., Swaine, V. K., Sala, M. C., & Cougle, J. R. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.05.034 · Cited by 3
Effects of Traumatic Incident Reduction on Posttraumatic Symptoms in a Community-Based Agency
Descilo, T., Fava, N. M., Burke, S. L., Acosta, I., Swanson, A. C., & Figley, C. R. (2017) · Research on Social Work Practice · doi:10.1177/1049731517745993 · Cited by 3
Volumetric Differences of Thalamic Nuclei Are Associated With Posttrauma Psychopathology
Steele, N., Hussain, A. T., Baird, C. L., Haswell, C. C., Sun, D., Rangel-Jimenez, L., Abdallah, C. G., Angstadt, M., May, G., Berg, H. E., et al. (2025) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2025.10.016 · Cited by 2
“50% of patients with PTSD, typically results in more severe symptomatology and more treatment-resistant illness (4,6,7).”
Yoon, J. K., & Kim, M. S. (2026) · Current Psychology · doi:10.1007/s12144-026-09118-1 · Cited by 2
“While the CTQ physical neglect subscale showed acceptable reliability in this study (α = 0.79), its known psychometric lim - itations in nonclinical populations warrant cautious interpretation (Bernstein et al., 2003; Spinhoven et al., 2014).”
InfluentialVirtual Reality Exposure Therapy and Physiological Data Analysis for Treatment of Stress Disorders
Trappey, C. V., Trappey, A. J. C., Chang, C., Tsai, M.-J., Kuo, R. R. T., & Lin, A. P. C. (2021) · Advances in medical technologies and clinical practice book series · doi:10.4018/978-1-7998-8371-5.ch010 · Cited by 2
Metadata
- Authors
- Spinhoven, P., Penninx, B. W., van Hemert, A. M., de Rooij, M., & Elzinga, B. M.
- Affiliations
- Leiden University (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Spinhoven, Philip
- Venue
- Child Abuse & Neglect
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 38
- Issue
- 8
- Pages
- 1320-1330
- ISSN
- 0145-2134 (ISSN-L)
- OpenAlex
- W2137565796
- Cited by
- 305
- References
- 57
- Citations by year
- 2026: 21 · 2025: 51 · 2024: 28 · 2023: 38 · 2022: 28 · 2021: 27 · 2020: 30 · 2019: 15 · 2018: 16 · 2017: 22 · 2016: 15 · 2015: 11 · 2014: 2
- FWCI
- 19.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Child Abuse & Neglect (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- VU Research Portal (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, PTSD comorbidity, anxiety disorders, depressive disorders, major depressive disorder, childhood trauma, child sexual abuse, child physical abuse, shared risk factors, neuroticism, extraversion, symptom severity, gender differences, prevalence
- MeSH terms
- Adolescent, Adult, Aged, Child Abuse, Depressive Disorder, Female, Humans, Male, Middle Aged, Netherlands, Psychiatric Status Rating Scales, Risk Factors, Stress Disorders, Post-Traumatic, Cohort Studies, Comorbidity, Prevalence, Logistic Models, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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