Two-year course of depressive and anxiety disorders: Results from the Netherlands Study of Depression and Anxiety (NESDA)
Open accessAbstract
Background Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors.Methods Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information.Results Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis.Limitation Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings.Conclusions Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.
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In anxiety disorders, after remission, 14-58% of patients experienced a relapse.
“In anxiety disorders, after remission, 14–58% of patients experienced a relapse [5, 8, 12, 20, 21], with similar relapse rates for subtypes of anxiety disorders [5].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [8]
Section 3.1 reports recurrence after remission in 21.9% of the anxiety-only group and 23.8% of the comorbid group, supporting a rate within the cited range. It does not establish the 14–58% range or report similar relapse rates across anxiety-disorder subtypes; its comparison is between anxiety-only and comorbid groups. (LLM, conf=0.86)
Experimental — accuracy not yet measuredRelapse is prevalent in both anxiety disorders and depressive disorders.
“relapse is prevalent in both anxiety disorders and in depressive disorders [8].”
From Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis (2022) · cites this paper as [8]
Anxiety disorders are characterized by a chronic course.
“They are characterized by a chronic course [53, 54]”
From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [53]
Treatment was not a significant determinant of the 2-year course of anxiety and depression in multivariate analyses also containing clinical information on e.g. severity and duration of symptoms.
“However, treatment was not a significant determinant of the 2-year course of anxiety and depression in multivariate analyses also containing clinical information on e.g. severity and duration of symptoms (Penninx et al. 2011).”
From Experiential avoidance and bordering psychological constructs as predictors of the onset, relapse and maintenance of anxiety disorders: One or many? (2017) · cites this paper as Penninx et al. 2011
The idiom 'thinking too much' denotes a broader mental health syndrome, with manifestations such as sadness, lack of motivation, poor concentration, sleep difficulties and irritability, perhaps similar to the construct of 'common mental disorders'.
“The idiom 'thinking too much' denotes a broader mental health syndrome, with manifestations such as sadness, lack of motivation, poor concentration, sleep difficulties and irritability, perhaps similar to the construct of 'common mental disorders'. 112-117”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [114]
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- Authors
- Penninx, B. W. J. H., Nolen, W. A., Lamers, F., Zitman, F. G., Smit, J. H., Spinhoven, P., Cuijpers, P., de Jong, P. J., van Marwijk, H. W. J., der Meer, K. V., Verhaak, P., Laurant, M. G. H., de Graaf, R., Hoogendijk, W. J., der Wee, N. V., Ormel, J., van Dyck, R., & Beekman, A. T. F.
- Affiliations
- University Medical Center Groningen (NL)
- Amsterdam Neuroscience (NL)
- Leiden University Medical Center (NL)
- Leiden University (NL)
- Vrije Universiteit Amsterdam (NL)
- Netherlands Institute for Health Services Research (NL)
- Radboud University Medical Center (NL)
- Corresponding author
- Penninx, Brenda W.J.H.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 133
- Issue
- 1-2
- Pages
- 76-85
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2155568298
- Cited by
- 354
- References
- 39
- Citations by year
- 2026: 20 · 2025: 18 · 2024: 20 · 2023: 24 · 2022: 32 · 2021: 29 · 2020: 28 · 2019: 21 · 2018: 27 · 2017: 18 · 2016: 24 · 2015: 23 · 2014: 18 · 2013: 17 · 2012: 25
- FWCI
- 28.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Universiteit Leiden (10‐000‐1002)
- ZonMw (10‐000‐1002)
- Vrije Universiteit Amsterdam
- GGZ inGeest
- Rivierduinen
- GGZ Friesland
- GGZ Drenthe
- Nederlands Instituut voor Onderzoek van de Gezondheidszorg (10-000-1002)
- Leids Universitair Medisch Centrum
- Universitair Medisch Centrum Groningen
- 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
- depressive disorders, anxiety disorders, prognosis, chronic depression, chronic anxiety, episode duration, psychiatric classification, prognostic factors, symptom trajectories, primary care, specialist care
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Mental Disorders, Depression, Major Depressive Disorder, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Middle Aged, Netherlands, Prognosis, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk Factors, Severity of Illness Index, Cohort Studies, Comorbidity, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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