Category: Adult Anxiety
Background: Research has demonstrated that: 1) anxiety disorders are highly comorbid with depression; and 2) features present in depression such as rumination and insomnia are often also present in anxiety disorder populations, although the presence of these associated features in different anxiety disorders has been less widely examined.
Aims: This study sought to investigate the presence of depression, using the Beck Depression Inventory-II (BDI-II), and depressive features such as insomnia, using the Insomnia Severity Index (ISI), and rumination, using the Rumination subscale of the Rumination/Reflection Questionnaire (RRQ) in a naturalistic sample of individuals presenting for treatment with primary anxiety disorders, to determine if these symptoms were differentially associated with the presence of various anxiety disorders.
Methods: 251 patients presented for treatment at a fee-for-service anxiety disorders clinic. At the intake assessment, patients completed self-report questionnaires assessing for a variety of symptoms: 43.4% (n=109) presented with a primary diagnosis of obsessive-compulsive disorder (OCD), 18.3% (n=46) with generalized anxiety disorder (GAD), 15.9% (n=40) with post-traumatic stress disorder (PTSD), 13.5% (n=34) with social anxiety disorder (SAD), and 8.7% (n=22) with panic disorder (PD). A one-way analysis of variance was conducted to compare the effect of diagnostic group on baseline depression, insomnia, and rumination.
Results: There was a significant effect of diagnostic group on depression, F(4,237)=3.716, p = .006. Post-hoc LSD tests showed that patients with primary PTSD had significantly greater depression compared to primary OCD (mean difference (MD) = 7.30, p = .001), GAD (MD = 8.55, p = .001), and PD (MD = 9.11, p = .004).
There was also a significant effect of diagnostic group on insomnia, F(4,231)=5.006, p = .001. Post-hoc LSD tests showed that patients with primary PTSD had significantly greater insomnia compared to primary OCD (MD = 5.64, p = .000), GAD (MD = 4.66, p = .002), SAD (MD = 4.87, p = .002), and PD (MD = 6.07, p = .001).
There was no significant effect of diagnostic group on rumination. However, post-hoc LSD tests indicated that patients with PD had significantly less rumination than OCD (MD = -4.49, p = .017), GAD (MD = -4.22, p = .010), and SAD (MD = -5.69, p = .010).
Conclusion: Similar to previous findings, anxiety disorder diagnosis was associated with differing levels of depressive symptoms and associated features. As expected, PTSD was associated with greater insomnia and depression overall. However, it was unexpected that no significant differences emerged between GAD and other anxiety disorder groups in rumination. Implications of these findings for treatment are discussed.
Julie Petersen– Research Assistant, Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, Pennsylvania
Anu Asnaani– Assistant Professor in Clinical Psychology, University of Pennsylvania School of Medicine and Center for the Treatment and Study of Anxiety, Philadelphia, Pennsylvania
Center for the Treatment and Study of Anxiety, University of Pennsylvania