Depression and generalized anxiety disorder - Cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years

被引:459
作者
Moffitt, Terrie E.
Harrington, HonaLee
Caspi, Avshalom
Kim-Cohen, Julia
Goldberg, David
Gregory, Alice M.
Poulton, Richie
机构
[1] Kings Coll London, Inst Psychiat, London WC2R 2LS, England
[2] Duke Univ, Dept Psychol, Durham, NC 27706 USA
[3] Duke Univ, Dept Neurosci, Durham, NC 27706 USA
[4] Duke Univ, Dept Psychiat & Behav Sci, Durham, NC 27706 USA
[5] Duke Univ, Inst Genome Sci & Policy, Durham, NC 27706 USA
[6] Univ Wisconsin, Dept Psychol, Madison, WI 53706 USA
[7] Yale Univ, Dept Psychol, New Haven, CT 06520 USA
[8] Univ London Goldsmiths Coll, Dept Psychol, London SE14 6NW, England
[9] Univ Otago, Dunedin Multidisciplinary Hlth & Dev Res Unit, Dunedin, New Zealand
基金
英国医学研究理事会;
关键词
D O I
10.1001/archpsyc.64.6.651
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Context: The close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize this association in future diagnostic systems. Most information about GAD-MDD comorbidity comes from patient samples and retrospective surveys. Objective: To revisit the sequential and cumulative comorbidity between GAD and MDD using data from a prospective longitudinal cohort. Design: Prospective longitudinal cohort study. Setting: New Zealand. Participants: The representative 1972-1973 Dunedin birth cohort of 1037 members was followed up to age 32 years with 96% retention. Main Outcome Measures: Research diagnoses of anxiety and depression were made at ages 11, 13, 15, 18, 21, 26, and 32 years. Mental health'services were reported on a life history calendar. Results: Sequentially, anxiety began before or concurrently in 37% of depression cases, but depression began before or concurrently in 32% of anxiety cases. Cumulatively, 72% of lifetime anxiety cases had a history of depression, but 48% of lifetime depression cases had anxiety. During adulthood, 12% of the cohort had comorbid GAD + MDD, of whom 66% had recurrent MDD, 47% had recurrent GAD, 64% reported using mental health services, 47% took psychiatric medication, 8% were hospitalized, and 11% attempted suicide. In this comorbid group, depression onset occurred first in one third of the participants, anxiety onset occurred first in one third, and depression and anxiety onset began concurrently in one third. Conclusions: Challenging the prevailing notion that generalized anxiety usually precedes depression and eventually develops into depression, these findings show that the reverse pattern occurs almost as often. The GAD-MDD relation is strong, suggesting that the disorders could be classified in I category of distress disorders. Their developmental relation seems more symmetrical than heretofore presumed, suggesting that MDD is not necessarily primary over GAD in diagnostic hierarchy. This prospective study suggests that the lifetime prevalence of GAD and MDD may be underestimated by retrospective surveys and that comorbid GAD + MDD constitutes a greater mental health burden than previously thought.
引用
收藏
页码:651 / 660
页数:10
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