Skip to main content Accessibility help
×
Home

Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression

  • Y. Li (a1), S. Shi (a2) (a3), F. Yang (a3), J. Gao (a4), Youhui Li (a5), M. Tao (a6), G. Wang (a7), K. Zhang (a8), C. Gao (a9), L. Liu (a10), Kan Li (a11), Keqing Li (a12), Y. Liu (a13), Xumei Wang (a14), J. Zhang (a15), L. Lv (a16), Xueyi Wang (a17), Q. Chen (a18), J. Hu (a19), L. Sun (a20), J. Shi (a21), Y. Chen (a22), D. Xie (a1), J. Flint (a1), K. S. Kendler (a23) and Z. Zhang (a24)...

Abstract

Background

Studies conducted in Europe and the USA have shown that co-morbidity between major depressive disorder (MDD) and anxiety disorders is associated with various MDD-related features, including clinical symptoms, degree of familial aggregation and socio-economic status. However, few studies have investigated whether these patterns of association vary across different co-morbid anxiety disorders. Here, using a large cohort of Chinese women with recurrent MDD, we examine the prevalence and associated clinical features of co-morbid anxiety disorders.

Method

A total of 1970 female Chinese MDD patients with or without seven co-morbid anxiety disorders [including generalized anxiety disorder (GAD), panic disorder, and five phobia subtypes] were ascertained in the CONVERGE study. Generalized linear models were used to model association between co-morbid anxiety disorders and various MDD features.

Results

The lifetime prevalence rate for any type of co-morbid anxiety disorder is 60.2%. Panic and social phobia significantly predict an increased family history of MDD. GAD and animal phobia predict an earlier onset of MDD and a higher number of MDD episodes, respectively. Panic and GAD predict a higher number of DSM-IV diagnostic criteria. GAD and blood-injury phobia are both significantly associated with suicidal attempt with opposite effects. All seven co-morbid anxiety disorders predict higher neuroticism.

Conclusions

Patterns of co-morbidity between MDD and anxiety are consistent with findings from the US and European studies; the seven co-morbid anxiety disorders are heterogeneous when tested for association with various MDD features.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression
      Available formats
      ×

Copyright

The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence . The written permission of Cambridge University Press must be obtained for commercial re-use.

Corresponding author

*Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics of Virginia Commonwealth University, Box 980126, Richmond, VA 232980126, USA. (Email: kendler@vcu.edu) [K.S.K.]
(Email: zhangzhen601020@yahoo.com.cn) [Z. Zhang]

References

Hide All
Andreasen, NC, Endicott, J, Spitzer, RL, Winokur, G (1977). The family history method using diagnostic criteria: reliability and validity. Archives of General Psychiatry 34, 12291235.
Andreasen, NC, Rice, J, Endicott, J, Reich, T, Coryell, W (1986). The family history approach to diagnosis: how useful is it? Archives of General Psychiatry 43, 421429.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.
Bienvenu, OJ, Brown, C, Samuels, JF, Liang, KY, Costa, PT, Eaton, WW, Nestadt, G (2001). Normal personality traits and comorbidity among phobic, panic and major depressive disorders. Psychiatry Research 102, 7385.
Bolton, JM, Belik, S-L, Enns, MW, Cox, BJ, Sareen, J (2008). Exploring the correlates of suicide attempts among individuals with major depressive disorder: findings from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry 69, 11391149.
Brown, GW, Harris, TO, Eales, MJ (1993). Aetiology of anxiety and depressive disorders in an inner-city population. 2. Comorbidity and adversity. Psychological Medicine 23, 155165.
Brown, LA, Gaudiano, BA, Miller, IW (2010). The impact of panic-agoraphobic comorbidity on suicidality in hospitalized patients with major depression. Depression and Anxiety 27, 310315.
Brown, TA, Campbell, LA, Lehman, CL, Grisham, JR, Mancill, RB (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology 110, 585599.
Cerdá, M, Sagdeo, A, Johnson, J, Galea, S (2010). Genetic and environmental influences on psychiatric comorbidity: a systematic review. Journal of Affective Disorders 126, 1438.
Claassen, CA, Trivedi, MH, Rush, AJ, Husain, MM, Zisook, S, Young, E, Leuchter, A, Wisniewski, SR, Balasubramani, GK, Alpert, J (2007). Clinical differences among depressed patients with and without a history of suicide attempts: findings from the STAR*D trial. Journal of Affective Disorders 97, 7784.
Clayton, PJ, Grove, WM, Coryell, W, Keller, M, Hirschfeld, R, Fawcett, J (1991). Follow-up and family study of anxious depression. American Journal of Psychiatry 148, 15121517.
Coryell, W, Endicott, J, Winokur, G (1992). Anxiety syndromes as epiphenomena of primary major depression: outcome and familial psychopathology. American Journal of Psychiatry 149, 100107.
Crowe, RR, Noyes, R, Pauls, DL, Slymen, D (1983). A family study of panic disorder. Archives of General Psychiatry 40, 10651069.
Endicott, J, Andreasen, N, Spitzer, RL (1975). Family History-Research Diagnostic Criteria. Biometrics Research, New York State Psychiatric Institute: New York.
Eysenck, HJ, Eysenck, SBG (1975). Manual of the Eysenck Personality Questionnaire. Hodder and Stoughton: London.
Fava, M, Alpert, JE, Carmin, CN, Wisniewski, SR, Trivedi, MH, Biggs, MM, Shores-Wilson, K, Morgan, D, Schwartz, T, Balasubramani, GK, Rush, AJ (2004). Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychological Medicine 34, 12991308.
Fava, M, Rankin, MA, Wright, EC, Alpert, JE, Nierenberg, AA, Pava, J, Rosenbaum, JF (2000). Anxiety disorders in major depression. Comprehensive Psychiatry 41, 97–102.
Fyer, AJ, Mannuzza, S, Gallops, MS, Martin, LY, Aaronson, C, Gorman, JM, Liebowitz, MR, Klein, DF (1990). Familial transmission of simple phobias and fears. A preliminary report. Archives of General Psychiatry 47, 252256.
Garvey, MJ, Tollefson, GD, Tuason, VB (1987). Comparison of major depressions with and without panic attacks. Comprehensive Psychiatry 28, 6567.
Gorwood, P (2004). Generalized anxiety disorder and major depressive disorder comorbidity: an example of genetic pleiotropy? European Psychiatry 19, 2733.
Grunhaus, L, Pande, AC, Brown, MB, Greden, JF (1994). Clinical characteristics of patients with concurrent major depressive disorder and panic disorder. American Journal of Psychiatry 151, 541546.
Hettema, JM (2008). The nosologic relationship between generalized anxiety disorder and major depression. Depression and Anxiety 25, 300316.
Howland, RH, Rush, AJ, Wisniewski, SR, Trivedi, MH, Warden, D, Fava, M, Davis, LL, Balasubramani, GK, McGrath, PJ, Berman, SR (2009). Concurrent anxiety and substance use disorders among outpatients with major depression: clinical features and effect on treatment outcome. Drug and Alcohol Dependence 99, 248260.
Kendler, KS, Gardner, CO, Gatz, M, Pedersen, NL (2007). The sources of co-morbidity between major depression and generalized anxiety disorder in a Swedish national twin sample. Psychological Medicine 37, 453462.
Kendler, KS, Gardner, CO, Neale, MC, Prescott, CA (2001). Genetic risk factors for major depression in men and women: similar or different heritabilities and same or partly distinct genes? Psychological Medicine 31, 605616.
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1992). Major depression and generalized anxiety disorder. Same genes, (partly) different environments? Archives of General Psychiatry 49, 716722.
Kendler, KS, Prescott, CA (2006). Genes, Environment, and Psychopathology: Understanding the Causes of Psychiatric and Substance Use Disorders, 1st edn. Guilford Press: New York.
Kendler, KS, Prescott, CA, Myers, J, Neale, MC (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry 60, 929937.
Kendler, KS, Silberg, J, Neale, M, Kessler, R, Heath, A, Eaves, L (1991). The family history method: whose psychiatric history is measured? American Journal of Psychiatry 148, 15011504.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 30953105.
Kessler, RC, DuPont, RL, Berglund, P, Wittchen, HU (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. American Journal of Psychiatry 156, 19151923.
Kessler, RC, Nelson, CB, McGonagle, KA, Liu, J, Swartz, M, Blazer, DG (1996). Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. British Journal of Psychiatry Supplement 30, 1730.
Kessler, RC, Stang, PE, Wittchen, HU, Ustun, TB, Roy-Burne, PP, Walters, EE (1998). Lifetime panic–depression comorbidity in the National Comorbidity Survey. Archives of General Psychiatry 55, 801808.
Khan, AA, Jacobson, KC, Gardner, CO, Prescott, CA, Kendler, KS (2005). Personality and comorbidity of common psychiatric disorders. British Journal of Psychiatry: Journal of Mental Science 186, 190196.
Lamers, F, van Oppen, P, Comijs, HC, Smit, JH, Spinhoven, P, van Balkom, AJLM, Nolen, WA, Zitman, FG, Beekman, ATF, Penninx, BWJH (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). Journal of Clinical Psychiatry 72, 341348.
Maier, W, Minges, J, Lichtermann, D (1995). The familial relationship between panic disorder and unipolar depression. Journal of Psychiatric Research 29, 375388.
Middeldorp, CM, Cath, DC, Van Dyck, R, Boomsma, DI (2005). The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychological Medicine 35, 611624.
Perroud, N, Uher, R, Hauser, J, Rietschel, M, Henigsberg, N, Placentino, A, Kozel, D, Maier, W, Mors, O, Souery, D, Dmitrzak-Weglarz, M, Jorgensen, L, Kovacic, Z, Giovannini, C, Mendlewicz, J, Zobel, A, Strohmaier, J, McGuffin, P, Aitchison, KJ, Farmer, A (2010). History of suicide attempts among patients with depression in the GENDEP project. Journal of Affective Disorders 123, 131137.
Pini, S, Cassano, GB, Simonini, E, Savino, M, Russo, A, Montgomery, SA (1997). Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. Journal of Affective Disorders 42, 145153.
Placidi, GP, Oquendo, MA, Malone, KM, Brodsky, B, Ellis, SP, Mann, JJ (2000). Anxiety in major depression: relationship to suicide attempts. American Journal of Psychiatry 157, 16141618.
R Development Core Team (2011). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Vienna, Austria (http://www.r-project.org/). Accessed 25 February 2011.
Reich, J, Warshaw, M, Peterson, LG, White, K, Keller, M, Lavori, P, Yonkers, KA (1993). Comorbidity of panic and major depressive disorder. Journal of Psychiatric Research 27, Suppl. 1, 2333.
Rhebergen, D, Batelaan, NM, de Graaf, R, Nolen, WA, Spijker, J, Beekman, ATF, Penninx, BWJH (2011). The 7-year course of depression and anxiety in the general population. Acta Psychiatrica Scandinavica 123, 297306.
Roy, A (1993). Features associated with suicide attempts in depression: a partial replication. Journal of Affective Disorders 27, 3538.
Roy, MA, Walsh, D, Kendler, KS (1996). Accuracies and inaccuracies of the family history method: a multivariate approach. Acta Psychiatrica Scandinavica 93, 224234.
Sareen, J, Houlahan, T, Cox, BJ, Asmundson, GJG (2005). Anxiety disorders associated with suicidal ideation and suicide attempts in the National Comorbidity Survey. Journal of Nervous and Mental Disease 193, 450454.
Spinhoven, P, de Rooij, M, Heiser, W, Smit, JH, Penninx, BWJH (2009). The role of personality in comorbidity among anxiety and depressive disorders in primary care and specialty care: a cross-sectional analysis. General Hospital Psychiatry 31, 470477.
Weissman, MM, Bland, RC, Canino, GJ, Faravelli, C, Greenwald, S, Hwu, H-G, Joyce, PR, Karam, EG, Lee, C-K, Lellouch, J, Lépine, J-P, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, H-U, Yeh, E-K (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276, 293299.
Weissman, MM, Wickramaratne, P, Adams, PB, Lish, JD, Horwath, E, Charney, D, Woods, SW, Leeman, E, Frosch, E (1993). The relationship between panic disorder and major depression. A new family study. Archives of General Psychiatry 50, 767780.
Zimmerman, M, Chelminski, I (2003). Clinician recognition of anxiety disorders in depressed outpatients. Journal of Psychiatric Research 37, 325333.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed