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Cited by 183Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major DepressionMental Health Treatment and Access

What clinical and symptom features and comorbid disorders characterize outpatients with anxious major depressive disorder: a replication and extension

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Fava, Maurizio, Rush, A John, Alpert, Jonathan E, Carmin, Cheryl N, Balasubramani, GK, Wisniewski, Stephen R, Trivedi, Madhukar H, Biggs, Melanie M +1 more·2006·The Canadian Journal of Psychiatry
DOI 10.1177/070674370605101304
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Abstract

OBJECTIVE: We previously found that 46% of the first 1450 outpatients with depression participating in the multicentre Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project qualified for the designation of anxious depression. This study was designed to replicate and extend our initial findings in a subsequent, larger cohort of outpatient STAR*D participants with nonpsychotic major depressive disorder (MDD). METHODS: Baseline clinical and sociodemographic data were collected on 2337 consecutive STAR*D participants. A baseline 17-item Hamilton Depression Rating Scale Anxiety-Somatization factor score of 7 or higher was designated as anxious depression. We identified concurrent Axis I disorders with the Psychiatric Diagnostic Screening Questionnaire (PDSQ), using a 90% specificity threshold. Depressive symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C30). RESULTS: The prevalence of anxious depression in this population was 45.1%. Patients with anxious MDD were significantly more likely to be in primary care settings and to be women, nonsingle, unemployed, Hispanic, less educated, and suffering from severe depression, both before and after adjustment for overall depression severity. Patients with anxious depression were significantly more likely to meet PDSQ thresholds for generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, agoraphobia, hypochondriasis, and somatoform disorder, both before and after adjusting for baseline depression severity. Individuals with anxious depression were also significantly less likely to endorse IDS-C30 items concerning atypical features and were significantly more likely to endorse items concerning melancholic-endogenous depression features, both before and after adjusting for baseline depression severity. CONCLUSIONS: This study clearly replicates our previous STAR*D findings and supports the notion that anxious depression may be a valid diagnostic subtype of MDD, with distinct psychiatric comorbidities and clinical and sociodemographic features.

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  • Depressed patients with anxiety symptoms measured with the HAM-D ASF or HAM-A generally have greater depression chronicity and severity, higher suicide ideation and risks, and lower quality of life than MDD patients without anxiety.

    “Either measured with the HAM-D ASF score or HAM-A, depressed patients with anxiety symptoms generally have greater depression chronicity and severity [1,5,6], higher suicide ideation and risks [1,8,9], and lower QOL than MDD patients without anxiety.”

    From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [6]

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Research works printed but not linked: 5

  1. Flint AJ, Rifat SL. Anxious depression in elderly patients. Response to antidepressant treatment. Am J Geriat Psychiat 1997;5:107-15.
  2. Russell JM, Koran LM, Rush AJ, Hirschfeld RM, Harrison W, Friedman ES, and others. Effect of concurrent anxiety on response to sertraline and imipramine in patients with chronic depression. Depress Anxiety 2001;13:18 -27.
  3. Melartin TK, Rytsala HJ, Leskela US, Lestela-Mielonen PS, Sokero TP, Isometsa ET. Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care. J Clin Psychiatry 2002;63:126-34.
  4. Rush AJ, Zimmerman M, Wisniewski SR, Fava M, Hollon SD, Warden D, and others. Comorbid psychiatric disorders in depressed outpatients: a preliminary report. J Affect Disorders 2005;87(1):43-55.
  5. Cleary P, Guy W. Factor analysis of the Hamilton Depression Scale. Drug Exp Clin Res 1977;1:115-20.

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Authors
Fava, M., Rush, A. J., Alpert, J. E., Carmin, C. N., Balasubramani, G., Wisniewski, S. R., Trivedi, M. H., Biggs, M. M., & Shores-Wilson, K.
Affiliations
  • Associate Chief of Psychiatry for Clinical Research, Massachusetts General Hospital, Boston, Massachusetts; Director, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts; Professor of Psychiatry, Harvard Medical School, Boston, Massachussets
  • The University of Texas Southwestern Medical Center (US)
  • Massachusetts General Hospital (US)
  • University of Illinois Chicago (US)
  • Research Associate, Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
  • University of Pittsburgh (US)
  • Associate Professor, The University of Texas Southwestern Medical Center, Department of Psychiatry and Department of Family and Community Medicine, Dallas, Texas
ORCID
Venue
The Canadian Journal of Psychiatry
Publisher
SAGE Publications
Published
2006-11
Volume
51
Issue
13
Pages
823-835
ISSN
  • 0706-7437 (ISSN-L)
  • 1497-0015
DOI
10.1177/070674370605101304
OpenAlex
W1505466667
Cited by
183
References
32
Citations by year
2026: 7 · 2025: 5 · 2024: 11 · 2023: 10 · 2022: 10 · 2021: 7 · 2020: 13 · 2019: 9 · 2018: 15 · 2017: 8 · 2016: 9 · 2015: 5 · 2014: 9 · 2013: 9 · 2012: 7
FWCI
10.51
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • The Canadian Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Health and Human Services (N01MH90003)
  • National Institutes of Health (n01mh90003-26-0-0)
  • National Institute of Mental Health (N01‐MH‐90003)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
anxious depression, major depressive disorder, psychiatric comorbidity, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, agoraphobia, health anxiety, somatoform disorders, endogenous depression, atypical depression, depression severity, sociodemographic factors, STAR*D, outpatient depression, diagnostic subtypes
MeSH terms
Adolescent, Adult, Aged, Ambulatory Care, Anxiety Disorders, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Primary Health Care, Prospective Studies, Comorbidity

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