PSYCHIATRIC COMORBIDITY DOES NOT ONLY DEPEND ON DIAGNOSTIC THRESHOLDS: AN ILLUSTRATION WITH MAJOR DEPRESSIVE DISORDER AND GENERALIZED ANXIETY DISORDER

Heterogeneity in the co-occurrence of depression and anxiety among adolescents: Results of latent profile analysis

BACKGROUND

Depression and anxiety co-occur frequently and there is heterogeneity in the co-occurrence of such symptoms; however, few previous studies investigated the heterogeneity based on person-centered perspectives in adolescents. The primary aim of our study was to explore it using latent profile analysis (LPA), a person-centered statistical approach.

METHOD

The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used to examine depression and anxiety symptoms in 7422 Chinese adolescents from 23 primary and secondary schools. To investigate latent profiles and assess profile validity, we employed Latent Profile Analysis (LPA), multinomial logistic regression, and analysis of variance.

RESULTS

A three-profile model was suggested as the optimum: low (69.9 %), moderate (21.6 %), and high depression/anxiety (8.5 %). Female with higher negative cognitive bias and higher emotional regulation difficulty are more likely to be categorized in the high depression/anxiety group. Internet addiction, academic "Lying flat" and involution are significantly and positively linked with the severity of anxiety and depression.

LIMITATIONS

Reliance on self-reported measures may lead to response bias; the cross-sectional design limits our ability to study how symptom profiles and category membership change over time.

CONCLUSIONS

Three latent profiles of the co-occurrence of depression and anxiety presented a parallel pattern, which serves as a poignant reminder of the imperative need to identify Chinese adolescents who may be at elevated risk for depression and/or anxiety, and promoting intervention that are meticulously tailored to address the unique symptom presentations of each individual.

Associations between anxiety, depression, and personal mastery in community-dwelling older adults: a network-based analysis

BACKGROUND

In China, about 18.70% of the population aged 60 years and older are at risk of low personal mastery as well as anxiety and depression for a variety of reasons. The purpose of this study was to construct a symptom network model of the relationship between anxiety, depression, and personal mastery in community-dwelling older adults and to identify central and bridge symptoms in this network.

METHODS

Depression, anxiety, and personal mastery were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and Personal Mastery Scale (PMS), respectively. A total of 501 older adults in 16 communities in Changzhou and Zhenjiang, Jiangsu Province, China, were surveyed by using a combination of stratified sampling and convenience sampling methods. The R language was used to construct the network.

RESULTS

(1) The network structure of anxiety-depression-personal mastery was stable, with "Nervousness" (node GAD1, strength = 1.38), "Sad mood" (node PHQ2, strength = 1.22), " Inability to change" (node PMS2, strength = 1.01) and "Involuntarily" (node PMS3, strength = 0.95) as the central symptoms. (2) "Irritability" (node GAD6, bridge strength = 0.743), "Sad mood" (node PHQ2, bridge strength = 0.655), and "Trouble relaxing" (node GAD4, bridge strength = 0.550) were the bridge symptoms connecting anxiety, depressive symptoms, and personal mastery. (3) In the network comparison test (NCT), residence, somatic chronic comorbidity and gender had no significant effect on network structure.

CONCLUSIONS

The construction of the anxiety-depression-personal mastery network structure opens up new possibilities for mechanisms of action and intervention formulation for psychological disorders in community-dwelling older adults. The identification of central symptoms (e.g., nervousness, sad mood, inability to change, involuntarily) and bridge symptoms (e.g., irritability, sad mood, trouble relaxing) in community-dwelling older adults with anxiety, depression, and low sense of mastery can provide a scientific basis for the development of precise interventions.

Bridge connection between depression and anxiety symptoms and lifestyles in Chinese residents from a network perspective

Background

Lifestyle habits are vital components of the culture of mental health treatment settings. We examined the bridge connection between depressive and anxiety symptoms and lifestyles from a network perspective using a population-based study.

Methods

Face-to-face interviews were conducted with a provincially representative sample of 13,768 inhabitants from the Guangdong Sleep and Psychosomatic Health Survey based on standardized evaluation techniques. We identified the central symptoms by expected influence. The interconnection between depression and anxiety symptoms, as well as the bridge connectivity linking depression-anxiety symptoms and lifestyle factors, were assessed using the bridge centrality index. Network stability and sensibility analyses were performed using a case-dropping bootstrap procedure.

Results

The core symptom that exhibited the highest expected influence was fatigue or little energy, followed by uncontrollable worry, trouble relaxing, and sad mood in the depression-anxiety symptoms network, while guilt was the most interconnected symptom and had the highest bridge strength. Surrounding nodes of each node explained an average variance of 57.63%. Additionally, suicidal thoughts were recognized as collective bridging symptoms connecting lifestyle variables in the network integrating depression-anxiety symptoms with lifestyle factors. Current tobacco and alcohol consumption were positively associated with suicidal thoughts and irritability. Habitual diet rhythm and physical exercise frequency were linked to suicidal thoughts, guilt, and poor appetite or overeating. Suicidal thoughts, irritability, and guilt indicated the greatest connectivity with lifestyle factors. All networks had high stability and accuracy.

Conclusion

These highlighted core and bridge symptoms could serve as latent targets for the prevention and intervention of comorbid depression and anxiety. It might be crucial for clinical practitioners to design effective and targeted treatment and prevention strategies aiming at specific lifestyles and behaviors.

Subsyndromal generalised anxiety disorder: operationalisation and epidemiology - a systematic literature survey

The diagnosis of anxiety disorders, like other psychiatric disorders also, is operationalised since the introduction of diagnostic manuals. The diagnostic criteria of Generalised Anxiety Disorder (GAD) have been tightened in the last decades. This leads to the exclusion of patients with a high level of anxiety, but not fulfilling certain of the GAD-criteria, from effective treatment. Such so-called subsyndromal, subthreshold or subclinical GAD-states, however, often exhibit a comparable burden of disease like the full syndromal disorder and often tend to develop into the full syndromal disorder. The purpose of this review is - beside systematically reporting the papers found in respective data bases from 2013 onwards - to summarise the relevant data regarding definitions, epidemiology and consequences of subsyndromal anxiety states in order to give a comprehensive review.

Subthreshold lifetime depression and anxiety are associated with increased lifetime suicide attempts: A Korean nationwide study

BACKGROUND

Subthreshold depression and anxiety are highly prevalent and known to be associated with functional limitations and future onset of major depression or anxiety disorders. However, studies regarding suicidality at subthreshold levels of depression and anxiety are limited.

METHODS

A total of 17,639 Koreans aged from 18 to 64 responded to the Korean version of the WHO-composite international diagnostic interview (K-CIDI) version 2.1 between 2006 and 2016. Prevalence of subthreshold depression and anxiety, and information on lifetime suicide attempt (SA) were assessed. Multivariable logistic regression was performed to calculate the risk of SA by the level of depression or anxiety.

RESULTS

The risk of lifetime SA increased incrementally according to the level of depression and anxiety. In the subthreshold depression group, individuals with subthreshold anxiety increased the odds about threefold (OR = 3.15, 95% CI 3.12-3.18) and the threshold anxiety disorder group increased the odds about fivefold (OR = 5.33, 95% CI 5.27-5.38) for SA, compared to the group without any level of anxiety. In threshold depressive disorder, the subthreshold anxiety group showed about 1.8-fold higher odds (OR = 1.76, 95% CI 1.75-1.77) and the threshold anxiety disorder group showed threefold higher odds (OR = 2.93, 95% CI 2.92-2.95) for SA compared to the group without any level of anxiety.

CONCLUSIONS

Subthreshold levels of depression and anxiety were prevalent among Koreans and were associated with an increased prevalence of lifetime SA. A detailed assessment of depression and anxiety symptoms according to their level should be performed on a diagnostic continuum to prevent suicide.

Heterogeneity in the co-occurrence of depression and anxiety symptoms among youth survivors: A longitudinal study using latent profile analysis

AIM

Depression and anxiety are both common psychological outcomes triggered via trauma-related experience. The current study aimed to identify the prevalence of depression and anxiety among youth survivors, explore the heterogeneity patterns of depression and anxiety symptoms in the chronic phase, and integrate early available information to predict patterns.

METHODS

The study is a longitudinal study conducted at 2 weeks and 12 months after the Lushan earthquake. Finally, 1725 children and adolescents' survivors who accomplished both two-time stages assessments were included. The heterogeneous patterns of depression and anxiety symptoms assessed by latent profile analysis (LPA) were used to predict heterogeneity patterns of depression and anxiety symptoms by early attained variables.

RESULTS

A three-class solution characterized mild depression/mild anxiety (64.3%), moderate depression/moderate anxiety (25.9%), and high depression/high anxiety (9.8%) parallel patterns was the most suitable model in our research. Demographic characteristics, earthquake-related exposures, sleep, and somatic symptoms were variables that can be used to predict the parallel profiles.

CONCLUSIONS

Detection of heterogeneity patterns, especially for youth survivors at high risk, based on the self-reported measurement attained at the early stage, is feasible. Our study may promote operational strategies by enabling targeted intervention.

Comorbidity between depression and anxiety: assessing the role of bridge mental states in dynamic psychological networks

BACKGROUND

Comorbidity between depressive and anxiety disorders is common. A hypothesis of the network perspective on psychopathology is that comorbidity arises due to the interplay of symptoms shared by both disorders, with overlapping symptoms acting as so-called bridges, funneling symptom activation between symptom clusters of each disorder. This study investigated this hypothesis by testing whether (i) two overlapping mental states "worrying" and "feeling irritated" functioned as bridges in dynamic mental state networks of individuals with both depression and anxiety as compared to individuals with either disorder alone, and (ii) overlapping or non-overlapping mental states functioned as stronger bridges.

METHODS

Data come from the Netherlands Study of Depression and Anxiety (NESDA). A total of 143 participants met criteria for comorbid depression and anxiety (65%), 40 participants for depression-only (18.2%), and 37 for anxiety-only (16.8%) during any NESDA wave. Participants completed momentary assessments of symptoms (i.e., mental states) of depression and anxiety, five times a day, for 2 weeks (14,185 assessments). First, dynamics between mental states were modeled with a multilevel vector autoregressive model, using Bayesian estimation. Summed average lagged indirect effects through the hypothesized bridge mental states were compared between groups. Second, we evaluated the role of all mental states as potential bridge mental states.

RESULTS

While the summed indirect effect for the bridge mental state "worrying" was larger in the comorbid group compared to the single disorder groups, differences between groups were not statistically significant. The difference between groups became more pronounced when only examining individuals with recent diagnoses (< 6 months). However, the credible intervals of the difference scores remained wide. In the second analysis, a non-overlapping item ("feeling down") acted as the strongest bridge mental state in both the comorbid and anxiety-only groups.

CONCLUSIONS

This study empirically examined a prominent network-approach hypothesis for the first time using longitudinal data. No support was found for overlapping mental states "worrying" and "feeling irritable" functioning as bridge mental states in individuals vulnerable for comorbid depression and anxiety. Potentially, bridge mental state activity can only be observed during acute symptomatology. If so, these may present as interesting targets in treatment, but not prevention. This requires further investigation.

Concurrent environmental enrichment and chronic restraint stress: Effects on innate anxiety and depressive-like behavior in male adolescent mice

Adolescence is a period that exhibits both vulnerability and adaptation to environmental stimulus. This study explored the co-existence effect of environmental enrichment (EE) and restraint stress (RS) on innate anxiety and depressive-like behavior in adolescent mice. Male ICR mice were treated with daily EE and RS (4 h/d or 8 h/d) for 2 or 4 weeks from early adolescence (postnatal day 30) and emotional behaviors were evaluated 24 h after the end of treatment. 4 weeks of 8 h RS treatment decreased immobility time in forced swimming test, demonstrating an antidepressant-like effect. For 2 weeks of treatment, 8 h RS significantly reduced the time spent in the lighted compartment of the light-dark box, indicating an increased anxiety level. These results show that under the present experimental design, RS treatment with different duration could have different effect on mice emotion-related behavior, but there was no interaction between EE and RS.

Prevalence, risk factors and multi-group latent class analysis of lifetime anxiety disorders comorbid depressive symptoms

BACKGROUND

Previous studies about comorbidity have primarily focused on disorders based on diagnostic criteria instead of symptoms. This study aimed to describe the prevalence and risk factors of anxiety comorbid depression based on a population-based sample in Chifeng City Inner Mongolia and explored the gender differences of depressive subtypes in anxiety patients.

METHODS

This study was a cross-sectional study conducted among 6376 community residents. Logistics analysis and multiple-group latent class analysis was used in exploring the risk factors and subtypes of anxiety comorbid depressive symptoms.

RESULTS

A total of 4528 respondents were interviewed in this study. The lifetime prevalence estimates for anxiety in the total sample was 5.70%. Among residents who had ever had anxiety, most of them reported having depressive symptoms while 15.79% of them met the criteria of MDD. Logistics analysis showed childhood adversities were associated with anxiety comorbid depressive symptoms. The results of multiple-group latent class analysis showed that the latent class probabilities were different between males and females.

CONCLUSION

The prevalence rates of comorbidity were similar to the reports of previous regional surveys in China with statistically significant differences of comorbidity occurring between males and females. Precision prevention should therefore be targeted towards different kinds of populations.

Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder

The comorbidity of major depressive disorder (MDD) and generalized anxiety disorder (GAD) is common and often predicts poorer outcomes than either disorder alone. This study aimed to examine the prevalence of comorbid GAD and its association with quality of life (QOL) among MDD patients. A total of 1225 psychiatric outpatients were screened using the Hospital Anxiety and Depression Scale (HADS). Those who scored ≥8 on the HADS were interviewed using DSM-IV criteria by two senior psychiatrists. Patients diagnosed with MDD were further assessed using the 9-item Patient Health Questionnaire, Social Support Rating Scale, Pittsburgh Sleep Quality Index, and World Health Organization QOL Scale, brief version (WHOQOL-BREF). Ultimately, 667 patients were diagnosed with MDD, of 71.7% of whom had GAD. Compared to those with MDD alone, comorbid patients had lower scores on the physical (38.64 ± 10.35 vs.36.54 ± 12.32, P = 0.026) and psychological (35.54 ± 12.98 vs. 30.61 ± 14.66, P < 0.001) domains of the WHOQOL-BREF. The association between comorbid GAD and poor QOL on the two domains remained statistically significant in the multiple linear regression (unstandardized coefficients: −1.97 and −4.65, P < 0.001). In conclusion, the prevalence of comorbid GAD in MDD patients is high, and co-occurring GAD may exacerbate impaired physical and psychological QOL in Chinese MDD patients.