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Comorbidity of anxiety and depression in children and adolescents: 20 years after
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Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.
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“Studies indicated that the relationship between the two disorders is based on the common presence of internalizing factors (i.e. neuroticism, rumination).47,62”
From Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review (2022) · cites this paper as [62]
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“When persistent, internalizing problems often result in emerging psychiatric disorders affecting young people’s daily lives, their future, and society [1-3,6].”
From A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study (2022) · cites this paper as [2]
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“Internalizing problems, such as anxiety and mood problems, have a substantial impact on young people’s lives. These internalizing problems are often associated with school dropout, reduced social functioning, loneliness, unemployment, and reduced quality of life [1-3].”
From A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study (2022) · cites this paper as [2]
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“Given that youth depression and anxiety symptoms highly correlate8 and can be treated by combined interventions, we examined the overall effects of all interventions on symptoms of anxiety and depression in a common analysis.34”
From Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials (2018) · cites this paper as [8]
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“Of the 44 documents, 31 were empirical/quantitative studies30–60 and 13 were reviews.61–73”
From Factors associated with gender and sex differences in anxiety prevalence and comorbidity: A systematic review (2022) · cites this paper as [62]
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“children with a history of anxiety, who may be at increased risk for developing depressive disorders in adolescence compared to children without a history of anxiety (Brady and Kendall, 1992; Orvaschel et al., 1995; Cummings et al., 2014)”
From Neural Activation to Parental Praise Interacts With Social Context to Predict Adolescent Depressive Symptoms (2019) · cites this paper as Cummings et al., 2014
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“According to a UNICEF report in 2019, 20% of adolescents suffer mental health problems.[5]”
From The effect of counseling based on acceptance and commitment therapy on anxiety, depression, and quality of life among female adolescent students (2022) · cites this paper as [5]
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“as well as internalizing symptoms (Ramchandani et al. 2005) which are highly comorbid (Cummings et al. 2014).”
From The effects of paternal depression on child and adolescent outcomes: A systematic review (2016) · cites this paper as Cummings et al. 2014
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Metadata
- Authors
- Cummings, C. M., Caporino, N. E., & Kendall, P. C.
- Affiliations
- Temple University (US)
- Venue
- Psychological Bulletin
- Published
- 2014-05
- Volume
- 140
- Issue
- 3
- Pages
- 816-845
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- PMC
- PMC4006306
- OpenAlex
- W2117486684
- Cited by
- 1,028
- References
- 391
- Citations by year
- 2026: 92 · 2025: 112 · 2024: 116 · 2023: 99 · 2022: 103 · 2021: 105 · 2020: 92 · 2019: 81 · 2018: 76 · 2017: 55 · 2016: 49 · 2015: 33 · 2014: 15
- FWCI
- 35.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH063747 and MH086438)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- comorbid depression and anxiety, children and adolescents, diathesis, social anxiety disorder, separation anxiety disorder, generalized anxiety disorder, gender differences, suicidality, developmental changes, risk factors, treatment outcomes
- MeSH terms
- Adolescent, Antidepressive Agents, Anxiety Disorders, Child, Depressive Disorder, Female, Humans, Male, Sex Factors, Comorbidity, Cognitive Behavioral Therapy, Suicidal Ideation
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