Stein Murray B, Heimberg Richard G
Anxiety and Traumatic Stress Disorders Program Department of Psychiatry (0985), University of California San Diego, La Jolla, CA 92093-0985, USA.
J Affect Disord. 2004 Apr;79(1-3):161-6. doi: 10.1016/S0165-0327(02)00457-3.
In most settings, generalized anxiety disorder (GAD) is highly comorbid with major depressive disorder (MDD). This raises uncertainty about the clinical relevance of GAD as a distinct diagnostic entity. The demonstration of functional impairment attached to GAD, independent of that attributable to MDD, would support the importance of GAD as a separate diagnostic category.
The Ontario Health Survey Mental Health Supplement, a survey of more than 8000 residents aged 15-64 of the Canadian province of Ontario, used the University of Michigan Composite International Interview Schedule (also used in the US National Comorbidity Survey) to assign DSM-III-R diagnoses. Several indicators of disability and quality of life were included. Our analytic strategy was to compare these indices in persons with and without GAD, stratified by MDD comorbidity, and adjusting for the effects of relevant sociodemographic factors (e.g., social class, age, gender) and dysthymia. Odds ratios (ORs) are reported; SUDAAN was used to adjust for the sampling framework.
GAD was highly comorbid with MDD on both a lifetime and past-year basis. Both past-year and lifetime MDD and GAD were associated with an increased likelihood of low overall perceived well-being. Both lifetime MDD and GAD were associated with dissatisfaction in one's main activity and with family relationships.
Other comorbid Axis I or II conditions might be confounders with impairment; a lower rate of GAD than in some prior surveys bears consideration.
These observations confirm that GAD is associated with an increased likelihood of poor global well-being and life satisfaction, beyond that associated with MDD. Given the chronicity of GAD relative to the more often episodic course of MDD, the long-term functional benefits of treating GAD may be substantial.
在大多数情况下，广泛性焦虑障碍（GAD）与重度抑郁症（MDD）高度共病。这引发了关于GAD作为一个独特诊断实体的临床相关性的不确定性。证明与GAD相关的功能损害独立于MDD所致的损害，将支持GAD作为一个单独诊断类别的重要性。
安大略省健康调查心理健康补充调查对加拿大安大略省8000多名15 - 64岁居民进行了调查，使用密歇根大学综合国际访谈问卷（美国国家共病调查也使用该问卷）来确定DSM - III - R诊断。纳入了残疾和生活质量的几个指标。我们的分析策略是比较有和没有GAD的人群中的这些指标，按MDD共病情况分层，并对相关社会人口学因素（如社会阶层、年龄、性别）和心境恶劣的影响进行调整。报告优势比（ORs）；使用SUDAAN对抽样框架进行调整。
GAD在终身和过去一年的基础上都与MDD高度共病。过去一年和终身的MDD和GAD都与总体幸福感低的可能性增加相关。终身的MDD和GAD都与对主要活动和家庭关系的不满相关。
其他共病的轴I或轴II疾病可能是损害的混杂因素；GAD的发生率低于一些先前调查的情况值得考虑。
这些观察结果证实，GAD与除MDD相关之外的全球幸福感差和生活满意度低的可能性增加相关。鉴于GAD的慢性病程相对于MDD更常见的发作性病程，治疗GAD可能带来显著的长期功能益处。
