Characterizing anxiety subtypes and the relationship to behavioral phenotyping in major depression: Results from the EMBARC study
Open accessAbstract
The current study aimed to characterize the multifaceted nature of anxiety in patients with major depression by evaluating distinct anxiety factors. We then related these derived anxiety factors to performance on a Flanker Task of cognitive control, in order to further validate these factors. Data were collected from 195 patients with nonpsychotic chronic or recurrent major depression or dysthymic disorder. At baseline, participants completed self-report measures of anxiety, depression, and other related symptoms (mania, suicidality) and clinicians administered a structured diagnostic interview and the Hamilton Rating Scale for Depression, including anxiety/somatization items. Four discrete factors (State Anxiety, Panic, Neuroticism/Worry, and Restlessness/Agitation) emerged, with high degrees of internal consistency. Discriminant and convergent validity analyses also yielded findings in the expected direction. Furthermore, the neuroticism/worry factor was associated with Flanker Task interference, such that individuals higher on neuroticism/worry responded more incorrectly (yet faster) to incongruent vs. congruent trials whereas individuals higher on the fear/panic factor responded more slowly, with no accuracy effect, to the Flanker Task stimuli. These results parse anxiety into four distinct factors that encompass physiological, psychological, and cognitive components of anxiety. While state anxiety, panic and neuroticism/worry are related to existing measures of anxiety, the Restlessness/Agitation factor appears to be a unique measure of general anxious arousal. Furthermore, two factors were independently validated through the Flanker Task. These results suggest that these anxiety domains have distinct behavioral profiles and could have differential responses to distinct treatments.
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- Authors
- Trombello, J. M., Pizzagalli, D. A., Weissman, M. M., Grannemann, B. D., Cooper, C. M., Greer, T. L., Malchow, A. L., Jha, M. K., Carmody, T. J., Kurian, B. T., Webb, C. A., Dillon, D. G., McGrath, P. J., Bruder, G., Fava, M., Parsey, R. V., McInnis, M. G., Adams, P., & Trivedi, M. H.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Harvard University (US)
- New York State Psychiatric Institute (US)
- Stony Brook University (US)
- University of Michigan (US)
- Corresponding author
- Trivedi, Madhukar H.
- ORCID
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 102
- Pages
- 207-215
- ISSN
- 0022-3956 (ISSN-L)
- PMC
- PMC6097520
- OpenAlex
- W2796276840
- Cited by
- 16
- References
- 35
- Citations by year
- 2026: 1 · 2025: 4 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 2
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- National Institute of Mental Health of the National Institutes of Health (U01MH092221, U01MH092250)
- EMBARC National Coordinating Center
- Targacept, Inc
- Pfizer, Inc
- Johnson & Johnson
- Evotec
- Rexahn
- Naurex
- Forest Pharmaceuticals
- National Institute of Mental Health
- New York State Department of Mental Hygiene
- Research Foundation for Mental Hygiene
- Forest Research Laboratories
- Sunovion Pharmaceuticals, and Naurex Pharmaceuticals
- Abbott Laboratories
- Acadia Pharmaceuticals
- Alkermes, Inc
- American Cyanamid
- Aspect Medical Systems
- AstraZeneca
- Avanir Pharmaceuticals
- AXSOME Therapeutics
- BioResearch
- BrainCells Inc
- Bristol-Myers Squibb
- CeNeRx BioPharma
- Cephalon
- Cerecor
- Clintara, LLC
- Covance
- Covidien
- Eli Lilly and Company
- EnVivo Pharmaceuticals, Inc
- Euthymics Bioscience, Inc
- Forest Pharmaceuticals, Inc
- FORUM Pharmaceuticals
- Ganeden Biotech, Inc
- GlaxoSmithKline
- Harvard Clinical Research Institute
- Hoffman-LaRoche
- Icon Clinical Research
- i3 Innovus/Ingenix
- Janssen R&D, LLC
- Jed Foundation
- Johnson & Johnson Pharmaceutical Research & Development
- Lichtwer Pharma GmbH
- Lorex Pharmaceuticals
- Lundbeck Inc
- MedAvante
- Methylation Sciences Inc
- National Alliance for Research on Schizophrenia & Depression
- National Center for Complementary and Alternative Medicine
- National Coordinating Center for Integrated Medicine
- National Institute of Drug Abuse
- Neuralstem, Inc
- NeuroRx
- Novartis AG
- Organon Pharmaceuticals
- PamLab, LLC
- Pfizer Inc
- Pharmacia-Upjohn
- Pharmaceutical Research Associates., Inc
- Pharmavite® LLC
- PharmoRx Therapeutics
- Photothera
- Reckitt Benckiser
- Roche Pharmaceuticals
- RCT Logic, LLC
- Sanofi-Aventis US LLC
- Shire
- Solvay Pharmaceuticals, Inc
- Stanley Medical Research Institute
- Synthelabo
- Takeda Pharmaceuticals
- Tal Medical
- Wyeth-Ayerst Laboratories
- Adamed, Co
- Advanced Meeting Partners
- American Psychiatric Association;
- American Society of Clinical Psychopharmacology
- Belvoir Media Group
- Boehringer Ingelheim GmbH
- Cephalon, Inc
- CME Institute/Physicians Postgraduate Press, Inc
- Imedex, LLC
- MGH Psychiatry Academy/Primedia
- MGH Psychiatry Academy/Reed Elsevier
- PharmaStar
- United BioSource,Corp
- National Institute on Drug Abuse
- National Alliance for Research on Schizophrenia and Depression
- Sackler Foundation
- Templeton Foundation
- Abbott Laboratories Inc
- Akzo
- Allergan Sales LLC
- Alkermes, Arcadia Pharmaceuticals Inc
- Axon Advisors, Brintellix
- Bristol-Myers Squibb Company
- Cephalon Inc
- Eli Lilly & Company
- Fabre Kramer Pharmaceuticals Inc
- Global Medical Education Inc
- Health Research Associates
- Lundbeck, MedAvante Medscape
- Medtronic, Merck, Mitsubishi Tanabe Pharma Development America Inc
- MSI Methylation Sciences Inc
- Nestle Health Science-PamLab Inc
- Naurex, Neuronetics, One Carbon Therapeutics Ltd
- Otsuka Pharmaceuticals, Pamlab, Parke-Davis Pharmaceuticals Inc
- PgxHealth
- Phoenix Marketing Solutions
- Rexahn Pharmaceuticals
- Ridge Diagnostics
- Roche Products Ltd
- Sepracor
- SHIRE Development
- Sierra, SK Life and Science
- Sunovion, Takeda
- Tal Medical/Puretech Venture
- Targacept, Transcept, VantagePoint, Vivus, and Wyeth-Ayerst Laboratories
- Agency for Healthcare Research and Quality
- Cyberonics Inc
- National Alliance for Research in Schizophrenia and Depression
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- anxiety subtypes, major depressive disorder, dysthymia, state anxiety, panic, flanker task, cognitive control, anxiety factors
- MeSH terms
- Neuroticism, Adult, Antidepressive Agents, Anxiety, Major Depressive Disorder, Depressive Disorder, Major, Electroencephalography, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Self Report
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