Depression-Anxiety Coupling Strength as a predictor of relapse in major depressive disorder: A CAN-BIND wellness monitoring study report
Abstract
Background A critical challenge in the study and management of major depressive disorder (MDD) is predicting relapse. We examined the temporal correlation/coupling between depression and anxiety (called Depression-Anxiety Coupling Strength, DACS) as a predictor of relapse in patients with MDD.Methods We followed 97 patients with remitted MDD for an average of 394 days. Patients completed weekly self-ratings of depression and anxiety symptoms using the Quick Inventory of Depressive Symptoms (QIDS-SR) and the Generalized Anxiety Disorder 7-item scale (GAD-7). Using these longitudinal ratings we computed DACS as random slopes in a linear mixed effects model reflecting individual-specific degree of correlation between depression and anxiety across time points. We then tested DACS as an independent variable in a Cox proportional hazards model to predict relapse.Results A total of 28 patients (29 %) relapsed during the follow-up period. DACS significantly predicted confirmed relapse (hazard ratio [HR] 1.5, 95 % CI [1.01, 2.22], p = 0.043; Concordance 0.79 [SE 0.04]). This effect was independent of baseline depressive or anxiety symptoms or their average levels over the follow-up period, and was identifiable more than one month before relapse onset.Limitations Small sample size, in a single study. Narrow phenotype and comorbidity profiles.Conclusions DACS may offer opportunities for developing novel strategies for personalized monitoring, early detection, and intervention. Future studies should replicate our findings in larger, diverse patient populations, develop individual patient prediction models, and explore the underlying mechanisms that govern the relationship of DACS and relapse.
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The correlation between depressive symptoms (QIDS-SR) and anxiety symptoms (GAD-7) examined longitudinally (depression-anxiety coupling) was a robust predictor of relapse in this cohort.
“we found that the correlation between depressive symptoms (as assessed by the QIDS-SR) and anxiety symptoms (as assessed by the GAD-7) examined longitudinally across time, termed the depression–anxiety coupling, was a robust predictor of relapse in this cohort. 43”
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- Authors
- Nunes, A., Pavlova, B., Cunningham, J. E. A., Nuñez, J.-J., Quilty, L. C., Foster, J. A., Harkness, K. L., Ho, K., Lam, R. W., Li, Q. S., Milev, R., Rotzinger, S., Soares, C. N., Taylor, V. H., Turecki, G., Kennedy, S. H., Frey, B. N., Rudzicz, F., & Uher, R.
- Affiliations
- Dalhousie University (CA)
- University of British Columbia (CA)
- Campbell Family Mental Health Research Institute (CA)
- St. Joseph’s Healthcare Hamilton (CA)
- Queen's University (CA)
- Janssen Research & Development (United States) (US)
- University of Calgary (CA)
- McGill University (CA)
- University of Toronto (CA)
- Corresponding author
- Nunes, Abraham
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2024-09
- Volume
- 361
- Pages
- 189-197
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W4399477114
- Cited by
- 5
- References
- 60
- Citations by year
- 2026: 3 · 2025: 2
- FWCI
- 2.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Brain Institute
- Government of Ontario
- Janssen Research and Development
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, recurrence prediction, comorbid depression and anxiety, remitted depression, early relapse detection, personalized monitoring
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Depression, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Recurrence, Proportional Hazards Models
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