McLean Hospital Depression Research Facility: Early-onset phobic disorders and adult-onset major depression

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA 94305-5717, USA.
The British journal of psychiatry. Supplement 02/1998; 173(34):29-34.
Source: PubMed


This study explores the temporal relationship between anxiety and major depressive disorders in a cohort of patients with current major depression.
Current prevalence and lifetime history of specific anxiety disorders were assessed using the Structured Clinical Interview for DSM-III-R Diagnosis (SCID-P) in 85 patients with DSM-III-R major depression. Consensus DSM-III-R diagnoses were assigned by at least two psychiatrists or psychologists.
Twenty-nine per cent met criteria for at least one current anxiety disorder and 34% had at least one anxiety disorder at some point in their lives. The mean (s.d.) age of onset of anxiety disorder in the depressed patients with comorbid social or simple phobia (15 (9) years) was significantly younger than was that of their major depression (25 (9) years). In contrast, the mean (s.d.) age of onset of anxiety in patients with comorbid panic or OCD (20 (8) years) was similar to that seen for their major depression (21 (9) years). In patients with major depression with comorbid anxiety disorders, both the social phobia (10 of 13) and simple phobia (4 of 4) were more commonly reported to start at least two years prior to their major depression in contrast to depressives with comorbid panic (3 of 10 subjects)-Fisher's exact test, P = 0.01.
Early-onset social and simple phobias appear to be risk factors for later onset of major depression.

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    • "In approximately two thirds of cases of major depressive disorder, anxiety preceded the depression and persisted after it (Kovacs et al., 1989). Phobias appear to be risk factors for later development of major depression (Schatzberg et al., 1998), whilst panic disorder has been associated with a high risk of attempted and completed suicides ( Johnson, Weissman, & Klerman, 1992). "

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    • "Another characteristic feature of specific phobia is its early onset during childhood and adolescence [3, 19, 27]. Moreover, retrospective age at onset reports have found that in people with specific phobia and comorbid disorders, specific phobia tends to develop first [13, 22, 25]. Thus, specific phobias apparently increase the chance to develop other mental disorders. "
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    ABSTRACT: Although specific phobia is characterized by an early age at onset and by high rates of comorbidity, few studies have examined comorbid relationships prospectively. The present study investigated the association between specific phobia and the risk of a broad range of psychopathology among young women in the community. Data came from the Dresden Predictor Study in which 1,538 German women (18-25 years) completed a diagnostic interview at two time points. Women with specific phobia had a twofold increase in odds of developing any anxiety disorder, generalized anxiety disorder, depression, and any somatoform disorder during 17 months, compared to women without specific phobia. Except for depression, these associations persisted after adjustment for all comorbid mental disorders. Specific phobia thus appears to be a risk factor for a variety of problems. The result further underpins the necessity for early intervention for specific phobia to prevent later mental health problems.
    Social Psychiatry and Psychiatric Epidemiology 12/2010; 45:1161-6. DOI:10.1007/s00127-009-0159-5 · 2.54 Impact Factor
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    • "Especially depressive disorders as well as other anxiety disorders and substance abuse have consistently been found to be associated with social phobia (Faravelli et al., 2000; Bisserbe et al., 1996; Degonda and Angst, 1993; Schneier et al., 1992; Lépine and Lellouch, 1995; Pini et al., 1997; Magee et al., 1996; Regier et al., 1998). Inspections of the temporal patterns show that social phobia precedes the onset of major depression in the majority of cases (de Graaf et al., 2003; Kessler et al., 1996; Schatzberg et al., 1998; Weiller et al., 1996). Additionally, social phobia has been found not only to precede depression temporally, but also to be associated with a more malignant course of an already existing depression (shorter interval between two episodes, more depressive symptoms; Stein et al., 2001). "
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    ABSTRACT: This paper provides a critical review of the prevalence of social phobia in European countries, a description of associated disability and burden and of clinical correlates and risk factors associated with social phobia. On the basis of a comprehensive literature search we identified 21 community studies and two primary care studies. The median lifetime and 12-month prevalence rates of social phobia in community samples referring to DSM-III-R and DSM-IV criteria were 6.65% and 2.0%, respectively. Younger individuals showed the highest rates, and women were more frequently affected than men. Social phobia was shown to be a persistent condition with a remarkably high degree of comorbid conditions, associated impairment and disability. Research deficits lie in a lack of data for most EU countries and in a lack of studies in children and the elderly. No data are available addressing met and unmet needs for intervention and costs, and data for vulnerability and risk factors of malignant course are scarce.
    European Neuropsychopharmacology 09/2005; 15(4):453-62. DOI:10.1016/j.euroneuro.2005.04.002 · 4.37 Impact Factor
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