Journal
JOURNAL OF AFFECTIVE DISORDERS
Volume 133, Issue 1-2, Pages 76-85Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jad.2011.03.027
Keywords
Depression; Anxiety; Course; Comorbidity; Cohort study; Longitudinal
Categories
Funding
- Astra Zeneca
- Eli Lilly
- GlaxoSmithKline
- Wyeth
- Pfizer
- Servier
- Lundbeck
- Bristol-Meyers Squibb
- Organon
- Netherlands Organisation for Health Research and Development (Zon-Mw) [10-000-1002]
- VU University Medical Center
- GGZ inGeest
- Arkin
- Leiden University Medical Center
- GGZ Rivierduinen
- University Medical Center Groningen
- Lentis
- GGZ Friesland
- GGZ Drenthe
- Scientific Institute for Quality of Healthcare (IQ healthcare)
- Netherlands Institute for Health Services Research (NIVEL)
- Netherlands Institute of Mental Health and Addiction (Trimbos)
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Background: Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. Methods: Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. Results: Course was more favorable for pure depression (n = 267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n = 487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n = 455, median duration >24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. Limitation: Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. Conclusions: Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology. (C) 2011 Elsevier B.V. All rights reserved.
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