Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK.
Stress, Trauma & Related Conditions (STARC) research lab, School of Psychology, Queen's University Belfast (QUB), Belfast, UK.
J Affect Disord. 2023 Feb 15;323:280-291. doi: 10.1016/j.jad.2022.11.051. Epub 2022 Nov 26.
Anxiety and depressive disorders often co-occur and the order of their emergence may be associated with different clinical outcomes. However, minimal research has been conducted on anxiety-anxiety comorbidity. This study examined factors associated with anxiety comorbidity and anxiety-MDD temporal sequence.
Online, self-report data were collected from the UK-based GLAD and COPING NBR cohorts (N = 38,775). Logistic regression analyses compared differences in sociodemographic, trauma, and clinical factors between single anxiety, anxiety-anxiety comorbidity, anxiety-MDD (major depressive disorder) comorbidity, and MDD-only. Additionally, anxiety-first and MDD-first anxiety-MDD were compared. Differences in familial risk were assessed in those participants with self-reported family history or genotype data.
Anxiety-anxiety and anxiety-MDD had higher rates of self-reported anxiety or depressive disorder diagnoses, younger age of onset, and higher recurrence than single anxiety. Anxiety-MDD displayed greater clinical severity/complexity than MDD only. Anxiety-anxiety had more severe current anxiety symptoms, less severe current depressive symptoms, and reduced likelihood of self-reporting an anxiety/depressive disorder diagnosis than anxiety-MDD. Anxiety-first anxiety-MDD had a younger age of onset, more severe anxiety symptoms, and less likelihood of self-reporting a diagnosis than MDD-first. Minimal differences in familial risk were found.
Self-report, retrospective measures may introduce recall bias. The familial risk analyses were likely underpowered.
Anxiety-anxiety comorbidity displayed a similarly severe and complex profile of symptoms as anxiety-MDD but distinct features. For anxiety-MDD, first-onset anxiety had an earlier age of onset and greater severity than MDD-first. Anxiety disorders and comorbidity warrant further investigation and attention in research and practice.
焦虑症和抑郁症常同时发生，其出现顺序可能与不同的临床结局有关。然而，针对焦虑-焦虑共病的研究很少。本研究旨在探讨与焦虑共病及焦虑-重度抑郁症（MDD）时间顺序相关的因素。
本研究通过在线收集英国 GLAD 和 COPING NBR 队列（N=38775）的自我报告数据。采用逻辑回归分析比较了单发性焦虑、焦虑-焦虑共病、焦虑-MDD 共病和 MDD 仅存组在人口统计学、创伤和临床因素方面的差异。同时，还比较了焦虑首发和 MDD 首发的差异。在有家族史或基因型数据的参与者中，评估了家族风险的差异。
焦虑-焦虑和焦虑-MDD 的自我报告焦虑或抑郁障碍诊断率、发病年龄更早、复发率更高，且比单发性焦虑更严重。焦虑-MDD 比 MDD 仅存组的临床严重程度/复杂性更高。焦虑-焦虑的当前焦虑症状更严重，当前抑郁症状更轻，且自我报告焦虑/抑郁障碍诊断的可能性更低。焦虑首发的焦虑-MDD 发病年龄更早，焦虑症状更严重，自我报告诊断的可能性更小。家族风险差异较小。
自我报告、回顾性测量可能会引入回忆偏倚。家族风险分析可能存在检验效能不足。
焦虑-焦虑共病与焦虑-MDD 具有相似严重且复杂的症状特征，但也存在不同之处。对于焦虑-MDD，首发焦虑的发病年龄更早，严重程度更大。焦虑障碍和共病值得在研究和实践中进一步关注。
