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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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“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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Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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