Abstract
ObjectiveStudies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. We explored predictors of complete remission (no depression nor anxiety diagnoses at follow-up) and of the course of comorbid anxiety symptoms. We additionally tested the hypothesis that the course of anxiety disorders and symptoms in depressed patients is explained by negative life-events in the presence of high neuroticism or a low sense of mastery. MethodsAn observational study of 270 patients (≥60 years) diagnosed with major depressive disorder and 2-year follow-up data, who participated in the Netherlands Study of Depression in Older persons (NESDO). Sociodemographic, somatic, psychiatric, and treatment variables were first explored as possible predictors. A multiple logistic regression analysis was used to examine their predictive value concerning complete remission. Subsequently, negative life-events, personality and their interaction were tested as potential predictors. Linear Mixed Models were used to assess whether the personality traits modified the effect of early and recent life-events, and time and their interactions on the course of the anxiety symptoms. ResultsA total of 135 of 270 patients achieved complete remission. Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission: 38 of 103 (37.0%) versus 97 of 167 (58.1%). The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted nonremission. In line with our hypothesis, a less favorable course of self-reported anxiety symptoms was associated with more recent negative life-events, but only among patients with a high level of neuroticism or a low level of mastery. ConclusionComorbid anxiety in depression as a negative impact on complete remission at 2-year follow-up. The course of anxiety severity seems dependent on the interaction of personality traits and life-events.
Highlights
Comorbid anxiety in depression is common[1] and several studies demonstrated the negative effect of comorbid anxiety on depression treatment outcome.[2]
Studies traditionally focus on the diagnosis of interest, namely depression, while for patients a meaningful remission means a complete remission of both depression and anxiety diagnoses
Regarding the measurement of comorbid anxiety, we previously showed that depressed patients with a comorbid anxiety disorder are a different group of patients compared to depressed patients with a high level of anxiety symptoms with minimal overlap between both groups.[3−5]
Summary
Comorbid anxiety in depression is common[1] and several studies demonstrated the negative effect of comorbid anxiety on depression treatment outcome.[2]. Studies traditionally focus on the diagnosis of interest, namely depression, while for patients a meaningful remission means a complete remission of both depression and anxiety diagnoses. Predictors of complete remission in depressed older adults, taking into account remission of comorbid anxiety disorders, are still unknown. These predictors include a greater medical disease burden, presence of specific depressive symptoms (anhedonia and neurovegetative), smoking, low self-esteem, and interpersonal difficulties.[6, 7] Few studies have traced the course of anxiety symptoms and its determinants in community-dwelling older adults. A more unfavorable course of anxiety symptoms after 6 years has been associated with female gender and higher levels of neuroticism at baseline[8, 9] Only one study has focused on the course of anxiety symptoms in depressed older adults. Higher levels of worry and lower levels of cognitive control predicted persistent and severe levels of anxiety symptoms.[10]
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