1 Brain Dynamics Centre, The Westmead Institute for Medical Research, Sydney, NSW, Australia.
2 Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Aust N Z J Psychiatry. 2019 Aug;53(8):782-793. doi: 10.1177/0004867419835933. Epub 2019 Mar 18.
Major depressive disorder commonly co-occurs with one or more anxiety disorders or with clinically significant levels of anxiety symptoms. Although evidence suggests that anxious forms of depression are prognostic of poorer antidepressant outcomes, there is no clear definition of anxious depression, and inferences about clinical outcomes are thus limited. Our objective was to compare and evaluate definitions of anxious depression and anxiety-related scales according to clinical and antidepressant outcome criteria.
A total of 1008 adults with a current diagnosis of single-episode or recurrent, nonpsychotic, major depressive disorder were assessed at baseline on clinical features. Participants were then randomised to one of three antidepressants and reassessed at 8 weeks regarding remission and response of the 17-item Hamilton Rating Scale Depression (HRSD) and the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR). Anxious depression was defined as major depressive disorder with one or more anxiety disorders or major depressive disorder with a HRSD anxiety/somatisation factor score ⩾7. Anxiety-related scales included the HRSD anxiety/somatisation factor and the 42-item Depression Anxiety Stress Scales (DASS) anxiety and stress subscales.
Anxious depression definitions showed poor agreement (κ = 0.15) and the HRSD anxiety/somatisation factor was weakly correlated with both DASS anxiety ( = 0.24) and stress subscales ( = 0.20). Anxious depression definitions were also associated with few impairments on clinical features and did not predict poorer antidepressant treatment outcome. However, higher DASS anxiety predicted poorer HRSD and QIDS-SR remission, and item-level analysis found higher scores on items 9 (situational anxiety) and 23 (somatic anxiety) of the DASS predicted poorer treatment outcome, even after adjusting for covariates and multiple comparisons.
Common definitions of anxious depression show poor agreement and do not predict poorer treatment outcome. Anxiety symptoms may be better characterised dimensionally using DASS when predicting treatment outcome.
重度抑郁症常与一种或多种焦虑症共病，或伴有明显的焦虑症状。尽管有证据表明，焦虑型抑郁是抗抑郁治疗效果较差的预测因素，但目前尚无焦虑型抑郁的明确定义，因此对临床结局的推断受到限制。我们的目的是比较和评估根据临床和抗抑郁治疗结局标准定义的焦虑型抑郁和与焦虑相关的量表。
共纳入 1008 例当前诊断为单发性或复发性、非精神病性、重度抑郁症的成年人，在基线时评估其临床特征。然后，参与者被随机分配到三种抗抑郁药中的一种，并在 8 周时根据 17 项汉密尔顿抑郁评定量表（HRSD）和 16 项快速抑郁症状评定量表（QIDS-SR）的缓解和反应情况进行重新评估。焦虑型抑郁的定义为：伴有一种或多种焦虑症的重度抑郁症，或伴有 HRSD 焦虑/躯体化因子评分 ⩾7 的重度抑郁症。与焦虑相关的量表包括 HRSD 焦虑/躯体化因子和 42 项抑郁焦虑压力量表（DASS）焦虑和压力子量表。
焦虑型抑郁的定义显示出较差的一致性（κ=0.15），HRSD 焦虑/躯体化因子与 DASS 焦虑（ = 0.24）和压力子量表（ = 0.20）均呈弱相关。焦虑型抑郁的定义与临床特征的损伤也很少相关，不能预测抗抑郁治疗效果较差。然而，DASS 焦虑得分较高预示着 HRSD 和 QIDS-SR 缓解率较差，且 DASS 项目 9（情境焦虑）和项目 23（躯体焦虑）的得分较高预示着治疗结局较差，即使在调整了协变量和多次比较后也是如此。
常见的焦虑型抑郁定义一致性较差，不能预测治疗效果较差。当预测治疗结局时，使用 DASS 对焦虑症状进行维度上的描述可能更好。
