Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
J Affect Disord. 2013 May;147(1-3):180-5. doi: 10.1016/j.jad.2012.10.031. Epub 2012 Dec 4.
The chronic course of anxiety disorders and its high burden of disease are partly due to the recurrence of anxiety disorders after remission. However, knowledge about recurrence rates and predictors of recurrence is scarce. This article reports on recurrence rates of anxiety disorders and investigates predictors of recurrence from a broad range of socio-demographic characteristics, illness-related and psychosocial putative predictors.
Baseline and 2-year follow-up data were derived from the Netherlands Study of Depression and Anxiety (NESDA). Participants who had at least one lifetime anxiety disorder (panic disorder with or without agoraphobia, agoraphobia alone, social phobia or generalized anxiety disorder), but were remitted at baseline (N=429) were included. Recurrence of anxiety disorders during the 2-year follow-up period was assessed using the Composite International Diagnostic Interview, version 2.1.
Recurrence rates among pure and multiple anxiety disorders did not differ significantly and the overall recurrence rate of anxiety disorders was 23.5%. In those recurring, the incidence of a new anxiety disorder was common (32.7%). Disability and anxiety sensitivity remained predictive of recurrence of anxiety disorders in multivariable regression analysis.
The included participants had more severe symptoms at baseline than the non-response group and lifetime anxiety diagnoses were assessed, retrospectively.
Recurrence of anxiety disorders is common and clinicians should be aware of the diagnostic instability within anxiety disorders. Disability and anxiety sensitivity are independent predictors of recurrence of anxiety disorders. Altering these predictors in regular cognitive behavioural therapy could contribute to the reduction of recurrence.
焦虑障碍的慢性病程及其高疾病负担部分归因于缓解后焦虑障碍的复发。然而，关于复发率和复发预测因素的知识却很少。本文报告了焦虑障碍的复发率，并从广泛的社会人口学特征、与疾病相关和心理社会潜在预测因素调查了复发的预测因素。
本研究的数据来自荷兰抑郁和焦虑研究（NESDA）。在基线时有至少一种终身焦虑障碍（伴有或不伴有广场恐怖症的惊恐障碍、单纯广场恐怖症、社交恐惧症或广泛性焦虑障碍）但已缓解的参与者（N=429）被纳入研究。使用复合国际诊断访谈，版本 2.1 评估了在 2 年随访期间焦虑障碍的复发情况。
单纯和多种焦虑障碍的复发率没有显著差异，焦虑障碍的总体复发率为 23.5%。在复发的患者中，新发焦虑障碍的发病率很常见（32.7%）。在多变量回归分析中，残疾和焦虑敏感仍然是焦虑障碍复发的预测因素。
纳入的参与者在基线时的症状比无应答组更严重，并且使用回顾性方法评估了终身焦虑诊断。
焦虑障碍的复发很常见，临床医生应注意焦虑障碍中的诊断不稳定。残疾和焦虑敏感是焦虑障碍复发的独立预测因素。在常规认知行为治疗中改变这些预测因素可能有助于减少复发。
