What Characteristics of Primary Anxiety Disorders Predict Subsequent Major Depressive Disorder?
Abstract
OBJECTIVE: The goal of this study was to examine the associations between specific anxiety disorders and the risk of major depressive disorder and to explore the role of various clinical characteristics of anxiety disorders in these relationships using a prospective, longitudinal design. METHOD: The data are from a 4-year prospective, longitudinal community study, which included both baseline and follow-up survey data on 2548 adolescents and young adults aged 14 to 24 years at baseline. DSM-IV diagnoses were made using the Munich-Composite International Diagnostic Interview. RESULTS: The presence at baseline of any anxiety disorder (odds ratio [OR] = 2.2 [95% CI = 1.6 to 3.2]) and each of the anxiety disorders (specific phobia, OR = 1.9 [95% CI = 1.3 to 2.8]; social phobia, OR = 2.9 [95% CI = 1.7 to 4.8]; agoraphobia, OR = 3.1 [95% CI = 1.4 to 6.7]; panic disorder, OR = 3.4 [95% CI = 1.2 to 9.0]; generalized anxiety disorder, OR = 4.5 [95% CI = 1.9 to 10.3]) was associated with a significantly (p <.05) increased risk of first onset of major depressive disorder. These associations remained significant after we adjusted for mental disorders occurring prior to the onset of the anxiety disorder, with the exception of the panic disorder association. The following clinical characteristics of anxiety disorders were associated with a significantly (p <.05) increased risk of developing major depressive disorder: more than 1 anxiety disorder, severe impairment due to the anxiety disorder, and comorbid panic attacks. In the final model, which included all clinical characteristics, severe impairment remained the only clinical characteristic that was an independent predictor of the development of major depressive disorder (OR = 2.2 [95% CI = 1.0 to 4.4]). CONCLUSION: Our findings suggest that anxiety disorders are risk factors for the first onset of major depressive disorder. Although a number of clinical characteristics of anxiety disorders appear to play a role in the association between anxiety disorders and depression, severe impairment is the strongest predictor of major depressive disorder.
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The present study found that earlier anxiety symptoms were implicated in the development of later depressive symptoms.
“Consistent with past research (Bittner et al., 2004; Gallerani et al., 2010), the present study found that earlier anxiety symptoms were implicated in the development of later depressive symptoms (see Figure 1).”
From Prospective Relations between Family Conflict and Adolescent Maladjustment: Security in the Family System as a Mediating Process (2015) · cites this paper as Bittner et al., 2004
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Koyuncu, A., Ertekin, E., Binbay, Z., Özyıldırım, İ., Yüksel, Ç., & Tükel, R. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.08.016 · Cited by 43 · see citing works
Bridging Anxiety and Depression: A Network Approach in Anxious Adolescents
Dobson, E. T., Croarkin, P. E., Schroeder, H. K., Varney, S. T., Mossman, S. A., Cecil, K. M., & Strawn, J. R. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.11.027 · Cited by 44 · see citing works
Measurement invariance of the depressive symptoms scale during adolescence
Brunet, J., Sabiston, C. M., Chaiton, M., Low, N. C., Contreras, G. A., Barnett, T. A., & O’Loughlin, J. L. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-95 · Cited by 40 · see citing works
Kim, J. H. J., Tsai, W., Kodish, T., Trung, L. T., Lau, A. S., & Weiss, B. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109763 · Cited by 38 · see citing works
“Longitudinal studies demonstrate that impairment from preceding symptoms strongly predicts future depression for adolescents [58]; likewise, somatic symptoms impairing social rolefulfillment may later create feelings of uncertainty, failure, or a desire to withdraw from others.”
Emmrich, A., Beesdo‐Baum, K., Gloster, A. T., Knappe, S., Höfler, M., Arolt, V., Deckert, J., Gerlach, A. L., Hamm, A. O., Kircher, T. T. J., et al. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000335246 · Cited by 38 · see citing works
Self-citationFunctioning and validity of A Computerized Adaptive Test to measure anxiety (A-CAT)
Becker, J., Fliege, H., Kocalevent, R., Bjørner, J. B., Rose, M., Walter, O., & Klapp, B. F. (2008) · Depression and Anxiety · doi:10.1002/da.20482 · Cited by 37 · see citing works
Manassis, K., Russell, K. F., & Newton, A. S. (2010) · Evidence-Based Child Health A Cochrane Review Journal · doi:10.1002/ebch.508 · Cited by 36 · see citing works
Associations of specific phobia and its subtypes with physical diseases: an adult community study
Witthauer, C., Ajdacic‐Gross, V., Meyer, A. H., Vollenweider, P., Waeber, G., Preisig, M., & Lieb, R. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0863-0 · Cited by 35 · see citing works
Self-citation
- Authors
- Bittner, A., Goodwin, R. D., Wittchen, H.-U., Beesdo, K., Höfler, M., & Lieb, R.
- Affiliations
- Technische Universität Dresden (DE)
- Max Planck Society (DE)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2004-05-15
- Volume
- 65
- Issue
- 5
- Pages
- 618-626
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2045928247
- Cited by
- 272
- References
- 0
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 7 · 2023: 10 · 2022: 11 · 2021: 20 · 2020: 14 · 2019: 10 · 2018: 7 · 2017: 17 · 2016: 15 · 2015: 19 · 2014: 17 · 2013: 15 · 2012: 15
- FWCI
- 15.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Max Planck Institute for Plasma Physics (submittedVersion)
- Funders
- U.S. Public Health Service (64736)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- major depressive disorder, depression onset, risk factors, comorbidities, functional disability, panic attacks, specific phobia, social anxiety disorder, agoraphobia, panic disorder, generalized anxiety disorder, adolescents and young adults, transition from adolescence to young adulthood
- MeSH terms
- Adolescent, Adult, Agoraphobia, Anxiety Disorders, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Phobic Disorders, Prognosis, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Severity of Illness Index, Comorbidity, Panic Disorder, Diagnostic and Statistical Manual of Mental Disorders
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