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Cited by 30Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research TopicsMental Health Treatment and Access

Casting wider nets for anxiety and depression: disability-driven cross-diagnostic subtypes in a large cohort

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Wanders, R. B. K., van Loo, H. M., Vermunt, J. K., Meijer, R. R., Hartman, C. A., Schoevers, R. A., Wardenaar, K. J., de Jonge, P.·2016·Psychological Medicine
DOI 10.1017/s0033291716002221
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Abstract

Background: In search of empirical classifications of depression and anxiety, most subtyping studies focus solely on symptoms and do so within a single disorder. This study aimed to identify and validate cross-diagnostic subtypes by simultaneously considering symptoms of depression and anxiety, and disability measures. Method: A large cohort of adults (Lifelines, n = 73 403) had a full assessment of 16 symptoms of mood and anxiety disorders, and measurement of physical, social and occupational disability. The best-fitting subtyping model was identified by comparing different hybrid mixture models with and without disability covariates on fit criteria in an independent test sample. The best model's classes were compared across a range of external variables. Results: The best-fitting Mixed Measurement Item Response Theory model with disability covariates identified five classes. Accounting for disability improved differentiation between people reporting isolated non-specific symptoms [‘Somatic’ (13.0%), and ‘Worried’ (14.0%)] and psychopathological symptoms [‘Subclinical’ (8.8%), and ‘Clinical’ (3.3%)]. Classes showed distinct associations with clinically relevant external variables [e.g. somatization: odds ratio (OR) 8.1–12.3, and chronic stress: OR 3.7–4.4]. The Subclinical class reported symptomatology at subthreshold levels while experiencing disability. No pure depression or anxiety, but only mixed classes were found. Conclusions: An empirical classification model, incorporating both symptoms and disability identified clearly distinct cross-diagnostic subtypes, indicating that diagnostic nets should be cast wider than current phenomenology-based categorical systems.

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Authors
Wanders, R. B. K., van Loo, H. M., Vermunt, J. K., Meijer, R. R., Hartman, C. A., Schoevers, R. A., Wardenaar, K. J., & de Jonge, P.
Affiliations
  • University Medical Center Groningen (NL)
  • Tilburg University (NL)
  • University of Groningen (NL)
Corresponding author
Wanders, R. B. K.
ORCID
Venue
Psychological Medicine
Publisher
Cambridge University Press (CUP)
Published
2016-09-14
Volume
46
Issue
16
Pages
3371-3382
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
DOI
10.1017/s0033291716002221
OpenAlex
W2520965186
Cited by
30
References
65
Citations by year
2026: 2 · 2025: 3 · 2023: 3 · 2022: 5 · 2021: 2 · 2020: 5 · 2019: 4 · 2018: 2 · 2017: 4
FWCI
4.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychological Medicine (publishedVersion)
  • Research portal (Tilburg University) (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
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
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
depression, anxiety, disability, empirical classification, somatization, chronic stress, subclinical symptoms, work disability, social dysfunction, physical disability
MeSH terms
Phobia, Social, Activities of Daily Living, Adolescent, Adult, Aged, Agoraphobia, Anxiety, Anxiety Disorders, Depression, Major Depressive Disorder, Disability Evaluation, Female, Humans, Male, Middle Aged, Netherlands, Social Behavior, Cohort Studies, Panic Disorder, Young Adult

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