Category: Adult Depression / Dysthymia
In DSM-5, depressive disorders now include an anxious distress specifier (AD) to capture clinically important symptoms of anxiety in patients with mood disorders. This change was based on evidence that anxious depression is associated with a worse clinical course and poorer treatment outcomes (Ionescu et al., 2014). To date, only a handful of studies have examined the prevalence, clinical correlates, or predictive utility of AD. A limitation of each of these studies is that AD was not diagnosed as a DSM-5 specifier using a clinical interview. Instead, cases of AD have been identified using questionnaire items as proxies for AD symptoms (Gaspersz et al., 2016, 2017; McIntyre et al., 2016) or, in one case, a self-report measure of AD (Zimmerman et al., 2013). This study is the first to examine the prevalence and validity of AD as assessed by a clinical diagnostic interview in a sample of outpatients with unipolar mood disorders. The study aims were to: (1) estimate the prevalence of AD and its associations with comorbid emotional disorders, and (2) test the incremental validity of AD over DSM diagnoses in predicting the severity of emotional disorder symptoms and functional impairment. For instance, it was hypothesized that AD would be positively associated with comorbid generalized anxiety disorder (GAD) and panic disorder (PD) (i.e., due to symptom overlap with AD). It was also hypothesized that AD would predict unique variance in emotional disorder symptom severity and functional impairment above and beyond comorbid diagnoses.
The sample was 237 outpatients presenting for assessment and treatment at an emotional disorders specialty clinic who were diagnosed with major depressive disorder (n = 130) or persistent depressive disorder (n = 107). Individuals were assessed using the Anxiety and Related Disorders Interview Schedule for DSM-5 and several well-established questionnaires (e.g., Beck Depression/Anxiety Inventories, Panic Disorder Severity Scale, Work and Social Adjustment Scale). Two-thirds (66.2%) of the sample was assigned the AD specifier. The vast majority of patients (93.7%) had a comorbid emotional disorder diagnosis (i.e., any anxiety, obsessive-compulsive, or trauma/stress disorder). Cross-tabulations revealed that patients with AD were significantly more likely than those without AD to have a GAD diagnosis. However, AD was not significantly associated with comorbid PD, or any other comorbid anxiety or emotional disorder diagnosis. Hierarchical multiple regressions were conducted to determine if the AD specifier explained significant unique variance in several psychopathology outcomes (i.e., questionnaires), beyond dummy codes representing comorbid GAD, PD, and any other anxiety or emotional disorder. Controlling for comorbidity, AD was significantly associated with higher severity of depression, panic, generalized anxiety, and negative affectivity, and greater functional impairment (ΔR2 ranged from 3.4% to 13.5%). The results will be discussed with regard to their clinical implications and future research on using the AD specifier to optimize mental health screening and predict long-term emotional disorder outcomes.
Michelle Bourgeois– Graduate Student, Boston University Department of Psychological and Brain Sciences, Boston, Massachusetts
Esther Tung– Boston University
Jeannette Correa– Doctoral Student, Boston University, boston, Massachusetts
Svetlana Goncharenko– Boston University
Anthony J. Rosellini– Boston University
Timothy Brown– Boston University
Boston University Department of Psychological and Brain Sciences