Comorbid Anxiety Depression Research Articles

Comorbid Depressive and Anxiety Symptomatology in Older Adults: The Role of Aging Self-Stereotypes, Loneliness, and Feelings of Guilt Associated with Self-Perception as a Burden.

The main objective of this study was to analyze the differences between older adults' symptom profiles (subclinical, anxiety, depressive, and comorbid) in negative aging self-stereotypes, loneliness, and feelings of guilt associated with self-perception as a burden. Participants were 310 community-dwelling people aged 60 years and over. The sample was grouped into four symptom profiles of older adults: anxiety, depressive, comorbid anxiety-depression, and subclinical symptoms. We carried out multinomial logistic regression analyses to analyze the role of assessed variables in the explanation of the four symptom profiles. Older adults who reported a comorbid symptomatology presented higher negative aging self-stereotypes and feelings of loneliness than the other three profiles. Compared with the subclinical profile, older adults who reported clinical symptomatology (anxiety, depressive, and comorbid profile) presented higher feelings of guilt associated with self-perception as a burden. The findings of this study suggest potential associations that may contribute to understanding and treating comorbid anxiety and depressive symptoms in older adults.

Gastric Motor Functions in Patients With Mood Disorders and Functional Gastroduodenal Symptoms.

Functional gastroduodenal symptoms (FGDSs) may result from perturbations in gastric emptying (GE) and gastric accommodation (GA), which are variably affected by acute stress. This study aimed to examine whether individuals who have both mood disorder and FGDS exhibit differences in GE and GA using standardized, validated, and reproducible noninvasive methods. Using a data retrieval program, 1554 individuals at a single center were identified after having undergone measurements of GE by scintigraphy of a 99mTc-radiolabeled egg (320 kcal, 30% fat meal) and GA by single-photon emission computed tomography to assess the underlying pathophysiology in FGDS. An extensive medical record review identified 267 of these individuals as having diagnoses of depression, anxiety, or comorbid anxiety/depression (CAD). Differences in GE and GA as related to the presence of anxiety or depressive disorders were analyzed using one-way analysis of variance on ranks and Mann-Whitney tests for the two-group comparisons. Sixty-three patients with anxiety, 134 with depression, and 70 with CAD were identified. GE at 1 hour was slower (p = .04) and GE at 2 hours numerically decreased (p = .07) for depression compared with anxiety. GA was diminished for CAD compared with anxiety (p = .04) and depression (p = .009). There were no differences in fasting gastric volume or GE at 4 hours. In this study examining GE and GA in anxiety and depressive disorders among patients with FGDS, the combined presence of anxiety and depression was associated with impaired GA compared with patients with depression or anxiety alone, and early GE seemed to be slower in those with depression compared with patients with anxiety.

The association between the socioeconomic status and anxiety-depression comorbidity in patients with psoriasis: a nationwide population-based study.

Numerous studies have indicated that comorbid anxiety and depression are associated with a more severe course of illness. Yet generally, the study of the effect of psoriasis on patients' mental health has considered anxiety and depression to be separate states. To measure the association between psoriasis and anxiety, depression and anxiety-depression co-occurrence among patients according to their socioeconomic statuses (SES). A nationwide population-based study of psoriasis patients and age and gender frequency-matched controls (n=255862) was designed. Diagnostic data were obtained from Clalit Health Services, the largest managed care organization in Israel. This database was established using continuous real-time input from healthcare providers, pharmacies, medical care facilities and administrative computerized operating systems. After controlling for demographic and clinical variables, psoriasis was associated with anxiety (OR 1.11, 95% CI 1.01-1.23, P<0.05), depression (OR 1.17, 95% CI 1.08-1.26, P<0.001), and anxiety and depression co-occurrence (OR 1.32, 95% CI 1.21-1.45, P<0.001) among patients with low SES, yet was associated only with anxiety (OR 1.15 95% CI 1.04-1.27, P<0.001) but not depression or comorbid anxiety-depression among patients with high SES. Survival analyses indicated that between the ages of 40 and 60, the cumulative probability of psoriasis patients with low SES to suffer from anxiety, depression and their co-occurrence inclined more sharply with age as compared to psoriasis patients with high SES. As psoriasis patients with low SES are prone to suffer from more severe courses of anxiety and depression, the choice of treatment of psoriasis should address the SES as well as the underlying psychiatric disease.

Plasma cytokine abnormalities in drug-naïve, comorbidity-free obsessive–compulsive disorder

Growing evidence in the last decade suggest significant role of immune alterations in the pathogenesis of obsessive–compulsive disorder (OCD). Cytokines, mediators of inflammation, alter the neurotransmitter concentration and result in a hyposerotonergic and hyperglutamatergic state implicated in pathogenesis of OCD. However, only few studies have examined cytokine abnormalities in OCD with inconsistent results possibly due to confounding effects of medications and comorbid anxiety–depression. We examined 20 comorbidity free, drug free OCD patients and 20 age and sex matched healthy controls. Clinical severity was assessed using Yale Brown Obsessive Compulsive Scale, Hamilton anxiety rating scale, Hamilton depression rating scale and Clinical Global Impression. Levels of different cytokines, Interleukin (IL)-2, IL-4, IL-6, IL-10, Tumor necrosis factor (TNF)-α and Interferon (IFN)-γ were assessed using Cytometric Bead Array. OCD patients had significantly greater plasma levels of IL-2, IL-4, IL-6, IL-10 and TNF-α levels than controls but not IFN-γ. Reanalysis of data with only drug naïve patients (excluding 4 drug free patients) did not alter the results. Presence of these abnormalities in drug-naïve patients suggests the possible role of cytokines in the pathogenesis of OCD. Study findings have potential clinical utility in development of novel therapeutic options targeting cytokine aberrations in OCD.

Correction for "'Caseness' for Depression and Anxiety in a Depressed Outpatient Population

To examine the diagnostic status of patients enrolled in the Factors Influencing Depression Endpoints Research (FINDER) study and symptomatic outcomes and baseline characteristics associated with remission 6 months after commencing antidepressant therapy. Status of clinically diagnosed depressed patients was based on self-rated Hospital Anxiety and Depression Scale (HADS) scores. Five diagnostic categories were defined: noncaseness, mixed anxiety-depression (subthreshold depressive and anxious symptomatology), caseness for depression, caseness for anxiety, and caseness for comorbid anxiety-depression. Assessments included the Somatic Symptom Inventory and health-related quality of life (HRQoL) using the Medical Outcomes Study 36-item Short-Form Health Survey. Remission rates (based on HADS noncaseness for both depression and anxiety) and their associations with baseline characteristics were investigated. Patients were enrolled between May 2004 and September 2005. Of the 3,353 patients enrolled, 66.4% met the HADS criteria for probable depressive disorder and 74.1% met the HADS criteria for probable anxiety disorder. Somatic symptom severity (painful and nonpainful) was highest and HRQoL was lowest in the comorbid anxiety-depression group. After 6 months, remission rates were 50.2% for caseness for depression, 40.4% for caseness for anxiety, and 40.6% for caseness for comorbid anxiety-depression. A lower number of previous depressive episodes, shorter current episode duration, lower painful and nonpainful somatic symptom scores, being married, a higher educational level, and working for pay were most consistently associated with higher remission rates. Physicians do not always differentiate between anxiety and depressive symptoms when making a clinical diagnosis of depression. At baseline, most enrolled patients had significant emotional depressive and anxious symptoms, as well as significant nonpainful and painful somatic symptomatology, and these factors were associated with outcome.

The association between hypertension and depression and anxiety disorders: results from a nationally-representative sample of South African adults.

ObjectiveGrowing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa.MethodsData come from a nationally-representative survey of adults (n = 4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between self-reported hypertension and anxiety disorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions.ResultsOverall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12-month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12-month anxiety disorders [Odds ratio (OR) = 1.55, 95% Confidence interval (CI) = 1.10–2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxiety disorders (OR = 2.25, 95% CI = 1.46–3.45), but not 12-month depressive disorders or comorbid anxiety-depression.ConclusionsThese are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders.

Smoking in relation to anxiety and depression: Evidence from a large population survey: The HUNT study

Smoking is reported to be associated with depression and anxiety. The present study (a) examines these associations taking comorbidity into account, (b) investigates possible confounders, (c) examines how former smokers compared to current and never-smokers in terms of anxiety and depression, and if anxiety and depression decline by time since cessation. Participants (66%) aged 20–89 years in a population-based health survey ( N = 60,814) were screened employing the HADS. (a) The association with smoking was strongest in comorbid anxiety depression, followed by anxiety, and only marginal in depression. Associations were stronger in females and younger participants. (b) Variables partly accounting for the association comprised somatic symptoms, socio-demographics, alcohol problems, and low physical activity. (c) Anxiety and depression were most common in current smokers, followed by quitters, and then never-smokers. No decline in anxiety or depression was found with time since cessation. Previous studies of associations between depression and smoking might have overestimated the association when ignoring comorbid anxiety.

Altered Emotional Processing in Pediatric Anxiety, Depression, and Comorbid Anxiety-Depression

The goal of this study was to examine some of the mechanisms underlying emotion regulation in childhood affective disorders by examining the impact of distracting emotional information during performance on a working memory task ("Emotional n-back" or E-n-back). The sample included 75 children (38 girls and 37 boys) between 8 and 16 years of age meeting criteria for: Anxiety disorder (ANX, n = 17), Major depressive disorder (MDD, n = 16), Comorbid anxiety and depression (CAD, n = 24), or Low-risk normal control (LRNC, n = 18). Results showed that the MDD and CAD groups had significantly longer reaction times on negative emotional backgrounds compared to neutral backgrounds, whereas the LRNC group had significantly longer reaction times on positive backgrounds. These results suggest altered processing of emotional information particularly associated with depression. Because the E-n-back task engages higher-order cognitive processes, these results suggest that these alterations in processing emotional information also interfere with the cognitive processes that govern how attentional resources are allocated. Further, research is needed to replicate this study and delineate underlying neural mechanisms.

Why do people with anxiety disorders become depressed? A prospective‐longitudinal community study

To examine the temporal relationships of anxiety and depressive disorders, their risk factors and to explore why people with anxiety develop depression. Data from an original 4-5-year prospective-longitudinal community study (N= 3,021) of adolescents and young adults with DSM-IV anxiety and depressive disorders identified with the Composite International Diagnostic Interview are used to examine risk factors, as well as course and outcome. (i) Anxiety disorders, except for panic disorder, are almost always primary conditions. (ii) Over the follow-up period, rates of comorbid anxiety-depression increased substantially and resulted in increased impairment and disabilities. (iii) Predictors for first onset of 'pure' depressive and 'pure' anxiety disorders revealed recognizable differences. (iv) Baseline clinical characteristics of anxiety disorders were significantly associated with an increased risk to develop major depression over the follow-up period. Findings suggest that most anxiety disorders are primary disorders that substantially increase the risk for secondary depression.

Multivariate Modeling of Anxiety and Depression in Community-Dwelling Elderly Persons

A sample of community-dwelling geriatric primary care patients were given survey measuring which demographic, medical, and environmental factors predict higher levels of state anxiety, trait anxiety, depression, and comorbid anxiety-depression. The authors used multivariate linear regression methods to predict scores for the outcome measures. Younger age, more stressful life events, increasing medical comorbidity, and fewer years of formal education predicted higher levels of state anxiety. Lower perceived health status, and comparative health status, and benzodiazepine use predicted higher trait anxiety scores. Older age, male gender, benzodiazepine use, more stressful life events, worse comparative health status, and less social support predicted higher depression scores. More stressful life events, less social support, poorer perceived general health status, and benzodiazepine use predicted higher comorbid anxiety-depression scores. The authors discuss the utility of developing clinical models to predict anxiety and depression in geriatric patients. Anxiety and depressive symptoms are distinguished by different psychosocial, clinical, and environmental factors, even in a sample of older subjects, who, by all measures, have good physical and psychological health.