Moscati Arden, Flint Jonathan, Kendler Kenneth S
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.
Wellcome Trust Centre for Human Genetics, Oxford, UK.
Depress Anxiety. 2016 Feb;33(2):120-7. doi: 10.1002/da.22432. Epub 2015 Sep 29.
Anxiety and depression display frequent comorbidity. Individuals with comorbid disorders also often have more extreme symptomatology than those with single disorders. This correlation between comorbidity and severity poses an interesting question: Are comorbid forms of anxiety and depression essentially just more severe versions of the pure disorders?
In a large major depression (MD) case-control sample of individuals from the China, Oxford and VCU Experimental Research on Genetic Epidemiology project, we examined the patterns of lifetime anxiety comorbidity (including generalized anxiety disorder--GAD, panic disorder, and five phobia subtypes) among MD cases (N = 5,864) in this population. Binary and multinomial logistic regression was used to estimate associations between risk factors and outcomes including MD as well as latent class membership, which were compared using continuation ratios.
We found a five-class solution to fit best, and each resulting class had a distinct pattern of association with the tested risk factors. The use of continuation ratios suggests that a class characterized by high endorsement of GAD is comparable to a more severely affected "pure MD" group. The other three classes (characterized by agoraphobia, various specific phobias, and by high endorsement of all comorbid anxiety disorders, respectively) appear to differ meaningfully from MD alone.
Risk for MD resulting from environmental and psychosocial factors may also predispose individuals to GAD, and less consistently, other anxiety disorders. Presentations of MD with certain phobias display distinguishably different patterns of risk, however, and are therefore likely qualitatively distinct.
焦虑症和抑郁症常常合并出现。患有共病的个体通常也比患有单一疾病的个体具有更极端的症状表现。共病与严重程度之间的这种关联提出了一个有趣的问题：焦虑症和抑郁症的共病形式本质上是否只是单纯疾病的更严重版本？
在中国、牛津和弗吉尼亚联邦大学基因流行病学实验研究项目的一个大型重度抑郁症（MD）病例对照样本中，我们研究了该人群中MD病例（N = 5864）的终生焦虑症共病模式（包括广泛性焦虑症——GAD、惊恐障碍和五种恐惧症亚型）。使用二元和多项逻辑回归来估计风险因素与包括MD以及潜在类别归属在内的结果之间的关联，并使用连续比例进行比较。
我们发现五类解决方案拟合效果最佳，并且每个所得类别与测试的风险因素都有独特的关联模式。连续比例的使用表明，以高度认可GAD为特征的类别与受影响更严重的“单纯MD”组相当。其他三类（分别以广场恐惧症、各种特定恐惧症以及高度认可所有共病焦虑症为特征）似乎与单纯的MD有显著差异。
环境和心理社会因素导致的MD风险可能也会使个体易患GAD，以及不太一致地易患其他焦虑症。然而，伴有某些恐惧症的MD表现出明显不同的风险模式，因此可能在性质上有所不同。
