Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
Center for Anxiety and Related Disorders, Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
J Psychiatr Res. 2018 Aug;103:54-60. doi: 10.1016/j.jpsychires.2018.05.006. Epub 2018 May 8.
The goals of this study were to estimate the prevalence of the DSM-5 anxious distress specifier (AD) among depressed outpatients, to examine associations of AD with comorbid diagnoses, and to test the incremental validity of AD over comorbidity in predicting functional impairment and severity of anxiety and depression symptoms. The sample was 237 outpatients diagnosed with major depressive disorder (MDD) or persistent depressive disorder (PDD), with and without AD, using the Anxiety and Related Disorders Interview Schedule for DSM-5. Outpatients also completed self-report questionnaires assessing functional impairment and anxiety, stress, and depression symptom severity. Two-by-two contingency tables were used to examine the associations of AD with comorbidity. Two-thirds (66.2%) of outpatients were assigned AD, with similar rates among those with MDD and PDD. Outpatients with AD were significantly more likely than those without AD to have a comorbid GAD diagnosis (OR = 2.47). Hierarchical multiple regressions were used to test the incremental validity of AD in predicting functional impairment and symptom outcomes beyond comorbid disorders. Controlling for comorbid disorders, AD was significantly associated with more severe functional impairment, autonomic arousal, stress, panic, generalized anxiety, and depression. The strongest incremental association were observed between AD and autonomic arousal (f = 0.12-0.18) and generalized anxiety (f = 0.17). These findings add to a growing literature that AD is common among outpatients and associated with important clinical outcomes, suggesting that AD should be routinely assessed in patients with mood disorders.
本研究的目的是估算 DSM-5 焦虑困扰特征（AD）在抑郁门诊患者中的患病率，检验 AD 与合并诊断的关联，并检验 AD 对预测功能障碍以及焦虑和抑郁症状严重程度的补充有效性。使用焦虑及相关障碍访谈表 DSM-5 对 237 名被诊断为重度抑郁障碍（MDD）或持续性抑郁障碍（PDD）且存在或不存在 AD 的门诊患者进行样本采集。门诊患者还完成了评估功能障碍以及焦虑、压力和抑郁症状严重程度的自我报告问卷。使用二项式列联表检验 AD 与合并症的关联。三分之二（66.2%）的门诊患者被分配到 AD，其中 MDD 和 PDD 的比例相似。患有 AD 的门诊患者比没有 AD 的患者更有可能合并广泛性焦虑症诊断（OR=2.47）。使用分层多元回归检验 AD 在预测功能障碍和症状结局方面对合并症的补充有效性。在控制合并症的情况下，AD 与更严重的功能障碍、自主唤醒、压力、惊恐、广泛性焦虑和抑郁显著相关。AD 与自主唤醒（f=0.12-0.18）和广泛性焦虑（f=0.17）之间存在最强的增量关联。这些发现增加了越来越多的文献，即 AD 在门诊患者中很常见，并且与重要的临床结局相关，这表明在心境障碍患者中应常规评估 AD。
