What clinical and symptom features and comorbid disorders characterize outpatients with anxious major depressive disorder

A replication and extension

Maurizio Fava, A. John Rush, Jonathan E. Alpert, Cheryl N. Carmin, G. K. Balasubramani, Stephen R. Wisniewski, Madhukar H. Trivedi, Melanie M. Biggs, Kathy Shores-Wilson

Research output: Contribution to journalArticle

118 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)823-835
Number of pages13
JournalCanadian Journal of Psychiatry
Volume51
Issue number13
StatePublished - Nov 2006

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Major Depressive Disorder
Outpatients
Depression
Psychiatry
Hypochondriasis
Agoraphobia
Somatoform Disorders
Panic Disorder
Obsessive-Compulsive Disorder
Therapeutics
Depressive Disorder
Post-Traumatic Stress Disorders
Anxiety Disorders
Hispanic Americans

Keywords

  • Anxiety
  • Anxious depression
  • Depression
  • Features
  • Subtype

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

What clinical and symptom features and comorbid disorders characterize outpatients with anxious major depressive disorder : A replication and extension. / Fava, Maurizio; Rush, A. John; Alpert, Jonathan E.; Carmin, Cheryl N.; Balasubramani, G. K.; Wisniewski, Stephen R.; Trivedi, Madhukar H.; Biggs, Melanie M.; Shores-Wilson, Kathy.

In: Canadian Journal of Psychiatry, Vol. 51, No. 13, 11.2006, p. 823-835.

Research output: Contribution to journalArticle

Fava, Maurizio ; Rush, A. John ; Alpert, Jonathan E. ; Carmin, Cheryl N. ; Balasubramani, G. K. ; Wisniewski, Stephen R. ; Trivedi, Madhukar H. ; Biggs, Melanie M. ; Shores-Wilson, Kathy. / What clinical and symptom features and comorbid disorders characterize outpatients with anxious major depressive disorder : A replication and extension. In: Canadian Journal of Psychiatry. 2006 ; Vol. 51, No. 13. pp. 823-835.
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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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