Longitudinal Predictive Validity of the DSM-5 Anxious Distress Specifier for Clinical Outcomes in a Large Cohort of Patients With Major Depressive Disorder
Abstract
OBJECTIVE: While the new DSM-5 anxious distress specifier is of great clinical importance, no evidence exists for its longitudinal predictive validity for clinical outcomes in patients with major depressive disorder (MDD). We examined the longitudinal validity of this specifier and validated it against DSM-IV-based comorbid anxiety disorder diagnoses. METHODS: Data are from 1,080 patients with current MDD at baseline (September 2004 to February 2007), of which 911 participated in the 2-year follow-up (September 2006 to April 2009). Patients are from the Netherlands Study of Depression and Anxiety, which is an ongoing longitudinal cohort study, and were sampled from the community, primary care, and outpatient specialized care settings. The specifier was constructed in the existing sample by 5 matching self-report items. Predictive outcomes were 2-year chronicity, time to remission of MDD, and functional disability. Discriminant performance and convergent validity of the specifier were also assessed. RESULTS: The specifier was present in 54.2% of the sample. The specifier significantly outperformed anxiety disorders in predicting chronicity (OR = 1.96, P < .001, vs OR = 1.11, P = .49), time to remission of MDD (HR = 0.75, P = .002, vs HR = 0.94, P = .55), and functional disability (B = 10.03, P < .001, vs B = 2.53, P = .07). The specifier significantly discriminated in clinical characteristics, had convergent validity for anxiety characteristics, and poorly overlapped with DSM-IV-based anxiety disorder diagnoses (Cohen κ = .09). CONCLUSIONS: The short anxious distress specifier outperforms DSM-IV-based anxiety disorder diagnoses as a longitudinal predictor for clinical outcomes in patients with MDD.
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The DSM-5 includes a new anxious distress specifier to acknowledge the clinical significance of prominent anxiety features in MDD.
“The DSM-5 includes a new anxious distress specifier to acknowledge the clinical significance of prominent anxiety features in MDD [22].”
From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [22]
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Malhi, G. S., & Mann, J. J. (2018) · The Lancet · doi:10.1016/s0140-6736(18)31948-2 · Cited by 4,099 · see citing works
Epidemiology of Adult <i>DSM-5</i> Major Depressive Disorder and Its Specifiers in the United States
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.4602 · Cited by 1,737 · see citing works
Malhi, G. S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., et al. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867420979353 · Cited by 614 · see citing works
“The prevalence of the DSM-5 anxious distress specifier in one study of depressed patients was 54% (Gaspersz et al., 2017).”
Backgroundter Meulen, W. G., Draisma, S., van Hemert, A. M., Schoevers, R. A., Kupka, R., Beekman, A. T. F., & Penninx, B. W. J. H. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.02.004 · Cited by 178 · see citing works
Self-citationDepression profilers and immuno-metabolic dysregulation: longitudinal results from the NESDA study.
Lamers, F., Milaneschi, Y., Vinkers, C., Schoevers, R., Giltay, E., & Penninx, B. (2020) · Brain, behavior, and immunity · doi:10.1016/j.bbi.2020.04.002 · Cited by 139 · see citing works
Self-citationGaspersz, R., Nawijn, L., Lamers, F., & Penninx, B. W. J. H. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000376 · Cited by 139 · see citing works
Self-citationMetabolomic and inflammatory signatures of symptom dimensions in major depression
Brydges, C. R., Bhattacharyya, S., Dehkordi, S. M., Milaneschi, Y., Penninx, B., Jansen, R., Kristal, B. S., Han, X., Arnold, M., Kastenmüller, G., et al. (2022) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2022.02.003 · Cited by 108 · see citing works
Self-citationGaspersz, R., Lamers, F., Kent, J. M., Beekman, A. T. F., Smit, J. H., van Hemert, A. M., Schoevers, R. A., & Penninx, B. W. J. H. (2017) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2016.09.018 · Cited by 88 · see citing works
Self-citationThe Role of Anxious Distress in Immune Dysregulation in Patients with Major Depressive Disorder
Gaspersz, R., Lamers, F., Wittenberg, G., Beekman, A. T. F., van Hemert, A. M., Schoevers, R. A., & Penninx, B. W. J. H. (2017) · Translational Psychiatry · doi:10.1038/s41398-017-0016-3 · Cited by 71 · see citing works
“According to the DSM-5 criterion, the anxious distress specifier was present when a participant endorsed ≥2 of the following symptoms: (1) feeling keyed up or tense (IDS item 7); (2) feeling unusually restless (IDS item 24); (3) difficulty concentrating because of worry (IDS item 15); (4) fear that something awful mig…”
BackgroundSelf-citationValidity of the DSM-5 anxious distress specifier for major depressive disorder
Zimmerman, M. A., Martin, J. A., McGonigal, P. T., Harris, L. M., Kerr, S., Balling, C. E., Kiefer, R., Stanton, K. J., & Dalrymple, K. L. (2018) · Depression and Anxiety · doi:10.1002/da.22837 · Cited by 61 · see citing works
Anxious distress in depressed outpatients: Prevalence, comorbidity, and incremental validity
Rosellini, A. J., Bourgeois, M. L., Correa, J. K., Tung, E. S., Goncharenko, S., & Brown, T. A. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.05.006 · Cited by 49 · see citing works
Metabolomic biosignature differentiates melancholic depressive patients from healthy controls
Liu, Y., Yieh, L., Yang, T., Drinkenburg, W. H. I. M., Peeters, P. J., Steckler, T., Narayan, V. A., Wittenberg, G. M., & Ye, J. (2016) · BMC Genomics · doi:10.1186/s12864-016-2953-2 · Cited by 45 · see citing works
“Anxiety during an MDD episode has been widely studied as a predictor of a more severe course of illness, and poorer patient outcomes [18–20].”
BackgroundHopwood, M. (2023) · Neurology and Therapy · doi:10.1007/s40120-023-00469-6 · Cited by 48 · see citing works
“2% of those with MDD had anxious distress using DSM-5 definitions [15].”
MethodPersonalized Psychiatry and Depression: The Role of Sociodemographic and Clinical Variables
Perna, G., Alciati, A., Daccò, S., Grassi, M., & Caldirola, D. (2020) · Psychiatry Investigation · doi:10.30773/pi.2019.0289 · Cited by 47 · see citing works
Zimmerman, M. A., Thompson, J. S., Diehl, J. M., Balling, C. E., & Kiefer, R. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112859 · Cited by 36 · see citing works
Salloum, N. C., D, M. F. M., Hock, R. S., Freeman, M. P., Flynn, M., Hoeppner, B. B., Cusin, C., Iosifescu, D. V., Trivedi, M. H., Sanacora, G., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.09.017 · Cited by 34 · see citing works
“TRD is associated with a reduced quality of life, social and occupational impairment, high rates of medico-psychiatric comorbidities, higher likelihood of prior suicide attempt, and substantially increased resource utilization (Gaspersz et al., 2017; Greden, 2001; Kautzky et al., 2017; Nelsen & Dunner, 1995; Russell e…”
BackgroundLiu, J., Xu, X., Zhu, C.-Q., Luo, L., Wang, Q., Xiao, B., Feng, B., Hu, L., & Liu, L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.565890 · Cited by 33 · see citing works
“It is estimated that 40% to 60% of patients with MDD have anxiety symptoms (57) and anxiety has been identified as one of the core features of MDD (58).”
BackgroundHung, C., Liu, C.-Y., Yang, C., & Gan, S. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.08.085 · Cited by 32 · see citing works
What is anxious depression? Overlap and agreement between different definitions
Zimmerman, M. A., Kerr, S., Kiefer, R., Balling, C. E., & Dalrymple, K. L. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.11.028 · Cited by 25 · see citing works
Li, Y. Y., Ni, X. K., You, Y. F., Qing, Y. H., Wang, P. R., Yao, J., Ren, K. M., Zhang, L., Liu, Z. W., Song, T. J., et al. (2021) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2021.634113 · Cited by 25 · see citing works
Nawijn, L., Dinga, R., Aghajani, M., van Tol, M., van der Wee, N. J. A., Wunder, A., Veltman, D. J., & Penninx, B. W. J. H. (2022) · Depression and Anxiety · doi:10.1002/da.23264 · Cited by 23 · see citing works
Self-citationBartoli, F., Bachi, B., Callovini, T., Palpella, D., Piacenti, S., Morreale, M., Lella, M. E. D., Crocamo, C., Carrà, G., & NOMIAC Investigators (2023) · CNS Spectrums · doi:10.1017/s1092852923002377 · Cited by 23 · see citing works
“11 12-14 The clinical management of AD may be made more complex by its interconnection with mixed features, especially in people with bipolar disorder.”
BackgroundAdvance in Diagnosis of Depressive Disorder
Fang, Y., & Wu, Z. (2019) · Advances in experimental medicine and biology · doi:10.1007/978-981-32-9271-0_9 · Cited by 21 · see citing works
Park, S., & Kim, Y. (2019) · Psychiatry Investigation · doi:10.30773/pi.2019.09.07 · Cited by 21 · see citing works
Zimmerman, M. A., Clark, H., McGonigal, P. T., Harris, L. M., Holst, C. G., & Martin, J. A. (2018) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000767 · Cited by 18 · see citing works
“Although both approaches may validly assess anxiety in depressed patients as indicated by their association with outcome, comorbidity, and longitudinal course (Fava et al., 2006, 2008; Gaspersz et al., 2017a, 2017b), they are not interchangeable.”
BackgroundTundo, A., Musetti, L., de Filippis, R., Grande, C. D., Falaschi, V., Proietti, L., & Dell’Osso, L. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.024 · Cited by 17 · see citing works
White matter architecture in major depression with anxious distress symptoms
Heij, J., Penninx, B. W. J. H., van Velzen, L. S., van Tol, M., van der Wee, N. J. A., Veltman, D. J., & Aghajani, M. (2019) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2019.109664 · Cited by 17 · see citing works
Self-citationTundo, A., Musetti, L., Grande, C. D., de Filippis, R., Proietti, L., Marazziti, D., Gibertoni, D., & Dell’Osso, L. (2020) · CNS Spectrums · doi:10.1017/s1092852920000085 · Cited by 16 · see citing works
“They consist in the presence of three or more of the following symptoms during a MDE (in MDD or BD): (1) psychic agitation or inner tension (K1); (2) racing or crowded thoughts (K2); (3) irritability or unprovoked feelings of rage (K3); (4) absence of retardation (K4); (5) talkativeness (K5); (6) dramatic description…”
BackgroundInfluentialCancino, A., Bianchi, M. L., Serrano, C., Ballesteros, S., Cáceres, C., & Vitriol, V. G. (2018) · Depression Research and Treatment · doi:10.1155/2018/1701978 · Cited by 16 · see citing works
“The importance of anxiety in depression is now recognized in the DSM-V [12–14], but current therapeutic guidelines for depression still do not provide a specific indication for recognition and treatment in those patients who present with such comorbidity [9].”
Braund, T. A., Palmer, D. M., Williams, L. M., & Harris, A. W. (2019) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867419835933 · Cited by 15 · see citing works
Otsubo, T., Hokama, C., SANO, N., Watanabe, Y., Kikuchi, T., & Tanaka, K. (2021) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2021.1907415 · Cited by 16 · see citing works
“Several studies conducted after the introduction of the DSM-5 anxious distress specifier criteria provided consistent evidence of poor responses to antidepressants (Ionescu et al. 2014; Gaspersz et al. 2017a).”
BackgroundResultInfluentialHuang, C., Lin, C., Wu, J.-I., & Yang, W. (2019) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyz038 · Cited by 15 · see citing works
Qiao, J., Shiwan, T., Yurong, S., Jiabo, S., Yu, C., Tian, S., Zhijian, Y., & Lü, Q. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05970-2 · Cited by 14 · see citing works
“Anxious depression (AD) is one of the most common subtypes of major depressive disorder (MDD), with a prevalence of 40–60% [1].”
BackgroundAssociation between anxious distress in a major depressive episode and bipolarity
Sugawara, H., Tsutsumi, T., Inada, K., Ishigooka, J., Hashimoto, M., Takebayashi, M., & Nishimura, K. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s188947 · Cited by 14 · see citing works
“The severity of depression was associated with the presence of ANXD in both the present and previous studies.(13,14,17) In the present study, mixed features and suicide attempts were significantly more common in the group with ANXD than in the group without ANXD, and these results did not change when only subjects wit…”
ResultDioli, C., Patrício, P., Pinto, L., Marie, C., Morais, M., Vyas, S., Bessa, J. M., Pinto, L., & Sotiropoulos, I. (2021) · Cell Proliferation · doi:10.1111/cpr.13027 · Cited by 13 · see citing works
Romeo, Z., Biondi, M., Oltedal, L., & Spironelli, C. (2024) · Depression and Anxiety · doi:10.1155/2024/6673522 · Cited by 12 · see citing works
“However, anxious symptoms during MDD have been found in 50-60% of cases [40, 41]; hence, our pure MDD subjects were allowed to exhibit anxiety symptoms as long as the criteria for a secondary diagnosis were not ful fi lled.”
Vitriol, V. G., Cancino, A., Serrano, C., Ballesteros, S., & Potthoff, S. (2018) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017901814010078 · Cited by 12 · see citing works
“The importance of anxiety in depression has been recognized and incorporated into the DSM V anxious subtype of depression [54].”
BackgroundJialin, A., Zhang, H.-G., Wang, X., Wang, J., Zhao, X.-Y., Wang, C., Cao, M.-N., Li, X., Li, Y., Cao, L.-L., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.116 · Cited by 11 · see citing works
Depression in DSM-5: Changes, Controversies, and Future Directions
Park, S., & Kim, Y. (2017) · Springer eBooks · doi:10.1007/978-981-10-6577-4_1 · Cited by 11 · see citing works
Li, Q. S., Tian, C., McIntyre, M. H., Sun, Y., Hinds, D. A., & Narayan, V. A. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.06.011 · Cited by 11 · see citing works
Tesfaye, M., Jaholkowski, P. P., Shadrin, A. A., van der Meer, D., Hindley, G., Holen, B., Parker, N., Parekh, P., Birkenæs, V., Rahman, Z., et al. (2024) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13742 · Cited by 14 · see citing works
“84,86 Our fi ndings suggest that concurrent ANX across diagnostic categories can partly be attribited to shared genetic under-pinnings.”
Fiorillo, A., Albert, U., Dell’Osso, B. M., Pompili, M., Sani, G., & Sampogna, G. (2024) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2024.152502 · Cited by 9 · see citing works
Ota, K., Shinzato, H., Otsuka, N., Zamami, Y., Kurihara, K., Futenma, K., Kondo, T., & Takaesu, Y. (2025) · Scientific Reports · doi:10.1038/s41598-025-92437-3 · Cited by 9 · see citing works
“Another study indicated that AD is likely associated with suicidal behavior 9 .”
Brem, M. J., Coop Gordon, K., & Stuart, G. L. (2020) · Clinical Case Studies · doi:10.1177/1534650119883351 · Cited by 8 · see citing works
“Given the persistence of symptoms following front-line MDD treatments for individuals with mixed anxiety and depression (Fava et al., 2008; Gaspersz et al., 2016), investigations of alternative treatment approaches that maintain behavior change beyond termination are warranted.”
BackgroundFennema, D., Barker, G. J., O'Daly, O., Duan, S., Carr, E., Goldsmith, K., Young, A. H., Moll, J., & Zahn, R. (2023) · NeuroImage: Clinical · doi:10.1016/j.nicl.2023.103453 · Cited by 7 · see citing works
Beckmann, F., Gruber, H., Seidenbecher, S., Schirmer, S. T., Metzger, C. D., Tozzi, L., & Frodl, T. (2024) · European Journal of Neuroscience · doi:10.1111/ejn.16249 · Cited by 8 · see citing works
Wu, H., Lu, B., Xiang, N., Qiu, M., Da, H., Xiao, Q., Zhang, Y., & Shi, H. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.07.031 · Cited by 8 · see citing works
Wang, Y., Zhang, X., Liu, Y., Jiang, F., Liu, Y., Xu, F., Duan, X., Li, Q., Zhao, W., Xu, R., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.019 · Cited by 9 · see citing works
Takeshima, M. (2018) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12660 · Cited by 8 · see citing works
Dsm-5 Anxious Distress Specifier in Patients with Bipolar Depression
Zimmerman, M. A., Kerr, S., Balling, C. E., Kiefer, R., & Dalrymple, K. L. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200216 · Cited by 7 · see citing works
“22,23 21-27 In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the prevalence and correlates of the DSM-5 anxious distress specifier in patients with bipolar depression.”
Zhang, D., Zhao, B., Sun, X., Ding, K., Sun, J., & Tao, S. (2024) · Trials · doi:10.1186/s13063-024-08157-y · Cited by 7 · see citing works
“Earlier studies [4, 23] have shown that the ADS exhibits satisfactory internal consistency (Cronbach’s = 0.71) and predictive validity for subsequent course and treatment response in depressed patients [24].”
BackgroundInfluentialTundo, A., Musetti, L., Betrò, S., Cambiali, E., de Filippis, R., Marazziti, D., Mucci, F., Proietti, L., & Dell’Osso, L. (2023) · European Psychiatry · doi:10.1192/j.eurpsy.2023.2445 · Cited by 6 · see citing works
Mapping the Presence of Anxiety Symptoms in Adults With Major Depressive Disorder
Ge, F., Jiang, J., Wang, Y., Wan, M., & Zhang, W. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.595418 · Cited by 6 · see citing works
“Secondly, from the viewpoint of network structure, we can intervene mental disorders from the following aspects: (1) symptoms (nodes) interventions: direct intervention of one or more symptoms; (2) network interventions: intervention symptom-symptom connections (61); (3) bridge symptoms: intervention of bridge symptom…”
BackgroundTrying to describe mixed anxiety and depression: Have we lost our way?
Mulder, R., Bassett, D. L., Morris, G., Hamilton, A., Baune, B. T., Boyce, P. M., Hopwood, M., Parker, G. B., Porter, R., Singh, A., et al. (2019) · Depression and Anxiety · doi:10.1002/da.22961 · Cited by 6 · see citing works
“Thus far, the prevalence of the DSM‐5 anxious depressive specifier in patients with major depression has only been reported in one study which found that 54% of outpatients with major depression fulfilled criteria (Gaspersz et al. 2017).”
BackgroundResultInfluentialNunes, 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., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.06.023 · Cited by 5 · see citing works
Rafiei, D., Pol, M. D., Meyer, J. H., Desmond, K. L., Ross, R. A., Boileau, I., Warsh, J. J., Rusjan, P., Vasdev, N., Aloysius, R., et al. (2025) · Neuropsychopharmacology · doi:10.1038/s41386-025-02150-y · Cited by 4 · see citing works
Wang, Y.-C., Lin, H.-T., Lu, M., Huang, M., Chen, C.-H., Wu, T., Wang, S. Z., Mao, W., Kuo, P., & Chen, H. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00129 · Cited by 5 · see citing works
Perlman, K., Mehltretter, J., Benrimoh, D. A., et al. (2024) · medRxiv · doi:10.1101/2024.02.19.24303015 · Cited by 4 · see citing works
Does the presence of multiple sclerosis impact on symptom profile in depressed patients?
Boeschoten, R., Schaakxs, R., Dekker, J., Uitdehaag, B., Beekman, A., Smit, J., Penninx, B., & van Oppen, P. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.10.006 · Cited by 3 · see citing works
Self-citationConceptualization of comorbid anxiety and depressive disorders and approaches to their managing
Malygin, Y. V., Orlova, A. S., & Vl, M. (2022) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202212206148 · Cited by 3 · see citing works
Tesfaye, M., Jahołkowski, P., Shadrin, A., van der Meer, D., Hindley, G., Holen, B., Parker, N., Parekh, P., Birkenæs, V., Rahman, Z., et al. (2023) · medRxiv · doi:10.1101/2023.09.01.23294920 · Cited by 1 · see citing works
Schmidt, M. E., Gargano, C., Zhou, X., Palmer, J. A., Saad, Z. S., Vieta, E., Drevets, W. C., Stuyckens, K., & Pandina, G. (2026) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2026.112771 · Cited by 2 · see citing works
Comorbidity Alters the Genetic Relationship Between Anxiety Disorders and Major Depression
Tesfaye, M., Shadrin, A. A., Parker, N., Jaholkowski, P. P., Parekh, P., Kutrolli, G., Birkenæs, V., Bakken, N. R., Ask, H., Hindley, G., et al. (2026) · Biological Psychiatry · doi:10.1016/j.biopsych.2026.04.026 · Cited by 2 · see citing works
Laszcz, J., Wang, C., Riva‐Posse, P., Kim, J., Tsygankova, V., Mandell, A., Rice, H., Hermida, A. P., Kitay, B. M., Crowell, A. L., et al. (2025) · Journal of Ect · doi:10.1097/yct.0000000000001113 · Cited by 3 · see citing works
Dsm-5 Anxious Distress Specifier in Patients with Bipolar Depression
Zimmerman, M., Kerr, S., Balling, C. E., Kiefer, R., & Dalrymple, K. L. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200304 · Cited by 5 · see citing works
“22,23 21-27 In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the prevalence and correlates of the DSM-5 anxious distress specifier in patients with bipolar depression.”
Huang, W., Duan, N., Ji, Y., Qian, R. L., Zheng, H., Wang, K., Zu, M., & Tian, Y. (2026) · Neuropsychobiology · doi:10.1159/000550252 · Cited by 1 · see citing works
Sayed, S. E., Gomaa, S., Hazmi, A. A., Sonbol, H. M., & ElKalla, I. (2023) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-023-00634-6 · Cited by 1 · see citing works
“The score of DADSI as a measurement of anxious distress specifier was high in the lower level of education, in divorced and widowed patients and smokers which is in agreement with previous studies conducted in depressed patients with high anxious distress specifier [8, 25, 26].”
ResultZimmerman, M. A., Kerr, S., Balling, C. E., Kiefer, R., & Dalrymple, K. L. (2020) · Annals of Clinical Psychiatry · doi:10.1177/104012372003200103 · Cited by 1 · see citing works
Nawijn, L., Dinga, R., Aghajani, M., van der Wee, N. J. A., van Tol, M., Veltman, D. J., & Penninx, B. W. J. H. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.10.075
Self-citationAnxiety Symptoms in Depression: Contemporary Treatment Approaches
Su, T. (2023) · Neurology and Therapy · doi:10.1007/s40120-023-00468-7
Tamada, Y., Inoue, T., Sekine, A., Toda, H., Takeshima, M., Sasaki, M., Fujimura, Y., & Ohmae, S. (2024) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70022
“…severity of depression, 15 more frequent hospitalizations, 15 higher rate of suicidal ideation, 15 lower coping ability, 16 higher frequency of antidepressant side effects, 17 lower response to antidepressants, 17 and higher chronicity of illness 18 than MDD patients without anx-ious distress.”
BackgroundShi, L., Jia, F., Liu, J., Deng, H., Yang, L., Ren, W., Zhang, X., Du, X., & Zhang, X. (2025) · Research Square · doi:10.21203/rs.3.rs-6106188/v1
Juan, Q., Shiwan, T., Yurong, S., Jiabo, S., Yu, C., Shui, T., Zhijian, Y., & Qing, L. (2024) · Figshare · doi:10.6084/m9.figshare.26753731
Juan, Q., Shiwan, T., Yurong, S., Jiabo, S., Yu, C., Shui, T., Yao, Z., & Qing, L. (2024) · Figshare · doi:10.6084/m9.figshare.26378025
Juan, Q., Shiwan, T., Yurong, S., Jiabo, S., Yu, C., Shui, T., Zhijian, Y., & Qing, L. (2024) · Figshare · doi:10.6084/m9.figshare.26378134
Zhang, D., Zhao, B., Sun, X., Ding, K., Sun, J., & Tao, S. (2024) · Figshare · doi:10.6084/m9.figshare.26720745
Juan, Q., Shiwan, T., Yurong, S., Jiabo, S., Yu, C., Shui, T., Zhijian, Y., & Qing, L. (2024) · Figshare · doi:10.6084/m9.figshare.26753737
Zhang, D., Zhao, B., Sun, X., Ding, K., Sun, J., & Tao, S. (2024) · Figshare · doi:10.6084/m9.figshare.26720742
Juan, Q., Shiwan, T., Yurong, S., Jiabo, S., Yu, C., Shui, T., Zhijian, Y., & Qing, L. (2024) · Figshare · doi:10.6084/m9.figshare.26753734
Hu, J., Ma, J., Xuan, X., et al. (2026) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2026.112804
Activation Syndrome in Patients Diagnosed With Major Depressive Disorder for the First Time
Gökçen, O., Karataş, K. S., Akkuş, M., Dönmez, F., & Konak, M. A. (2026) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001871
Takeshima, M., & Inoue, T. (2026) · Bipolar Disorders · doi:10.1111/bdi.70106
Chronic stress and glucocorticoid actions in brain plasticity and Tau pathology
Dioli, C. (2021) · theses.fr (ABES) · doi:10.70675/b812791ezcc0az4036zb746z0d9b5daacfab
McIntyre, R. S., Kato, M., Thase, M. E., Therrien, F., Marrache, A. M., Ikehara, K., Ardic, F. C., & Boucher, M. (2026) · CNS Drugs · doi:10.1007/s40263-026-01315-7
“…for MDD with anxiety symptoms used in this review, the DSM-5 specifier for anxious distress may be of most importance as it is considered clinically relevant in the acute and maintenance phases of treatment and can be used to plan treat-ment and monitor anxiety symptoms over time [34, 145, 146].”
Reliability and validity of the DSM-5 anxious distress specifier interview
Zimmerman, M., Clark, H., McGonigal, P., Harris, L., Holst, C. G., & Martin, J. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.02.010 · Cited by 45 · see citing works
Maneeton, N., Suttajit, S., Maneeton, B., Likhitsathian, S., Eurviyanukul, K., Udomratn, P., Chan, E. S.-Y., Si, T.-M., Sulaiman, A. H., Chen, C.-H., et al. (2017) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2017.1335344 · Cited by 14 · see citing works
“higher depression severity, lower remission rates and greater frequency of antidepressant side effects (8).”
Background
- Authors
- Gaspersz, R., Lamers, F., Kent, J. M., Beekman, A. T. F., Smit, J. H., van Hemert, A. M., Schoevers, R. A., & Penninx, B. W. J. H.
- Affiliations
- Amsterdam Public Health (NL)
- Janssen Research & Development (United States) (US)
- University Medical Center Groningen (NL)
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2016-03-29
- Volume
- 78
- Issue
- 02
- Pages
- 207-213
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2332123187
- Cited by
- 88
- References
- 0
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 17 · 2023: 8 · 2022: 3 · 2021: 7 · 2020: 9 · 2019: 12 · 2018: 10 · 2017: 7 · 2016: 2
- FWCI
- 14.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- 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
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- DSM-5, major depressive disorder, anxiety comorbidity, predictive validity, chronicity, remission, functional disability, convergent validity, discriminant validity, NESDA
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Chronic Disease, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Longitudinal Studies, Male, Middle Aged, Psychometrics, Reproducibility of Results, Cohort Studies, Comorbidity, Outcome Assessment, Health Care, Diagnostic and Statistical Manual of Mental Disorders, Young Adult
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