Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression

Wellcome Trust Center for Human Genetics, Roosevelt Drive, Oxford, UK.
Psychological Medicine (Impact Factor: 5.94). 11/2011; 42(6):1239-48. DOI: 10.1017/S003329171100273X
Source: PubMed


Studies conducted in Europe and the USA have shown that co-morbidity between major depressive disorder (MDD) and anxiety disorders is associated with various MDD-related features, including clinical symptoms, degree of familial aggregation and socio-economic status. However, few studies have investigated whether these patterns of association vary across different co-morbid anxiety disorders. Here, using a large cohort of Chinese women with recurrent MDD, we examine the prevalence and associated clinical features of co-morbid anxiety disorders.
A total of 1970 female Chinese MDD patients with or without seven co-morbid anxiety disorders [including generalized anxiety disorder (GAD), panic disorder, and five phobia subtypes] were ascertained in the CONVERGE study. Generalized linear models were used to model association between co-morbid anxiety disorders and various MDD features.
The lifetime prevalence rate for any type of co-morbid anxiety disorder is 60.2%. Panic and social phobia significantly predict an increased family history of MDD. GAD and animal phobia predict an earlier onset of MDD and a higher number of MDD episodes, respectively. Panic and GAD predict a higher number of DSM-IV diagnostic criteria. GAD and blood-injury phobia are both significantly associated with suicidal attempt with opposite effects. All seven co-morbid anxiety disorders predict higher neuroticism.
Patterns of co-morbidity between MDD and anxiety are consistent with findings from the US and European studies; the seven co-morbid anxiety disorders are heterogeneous when tested for association with various MDD features.

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Available from: Yulong Liu, Sep 10, 2014
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    • "The factor structure of the Beck Depression Scale in Japan is very similar to that seen in Western populations (Kojima et al. 2002). Prior studies in this sample have shown that MD is associated, in a similar manner, with a range of risk factors previously demonstrated in Western samples including childhood sexual abuse (Cong et al. 2011), neuroticism (Xia et al. 2011), stressful life events (Tao et al. 2011) and low parental warmth (Gao et al. 2012), and has similar patterns of co-morbidity with anxiety disorders (Li et al. 2012) and dysthymia (Sang et al. 2011). "
    Y Li · S Aggen · S Shi · J Gao · M Tao · K Zhang · X Wang · C Gao · L Yang · Y Liu · [...] · J Dong · R Pan · W Zhang · Z Shen · Z Liu · D Gu · X Liu · Q Zhang · J Flint · K S Kendler ·
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    ABSTRACT: The symptoms of major depression (MD) are clinically diverse. Do they form coherent factors that might clarify the underlying nature of this important psychiatric syndrome? Method Symptoms at lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾30 years with recurrent DSM-IV MD. Exploratory factor analysis (EFA) and confirmatoryfactor analysis (CFA) were performed in Mplus in random split-half samples. The preliminary EFA results were consistently supported by the findings from CFA. Analyses of the nine DSM-IV MD symptomatic A criteria revealed two factors loading on: (i) general depressive symptoms; and (ii) guilt/suicidal ideation. Examining 14 disaggregated DSM-IV criteria revealed three factors reflecting: (i) weight/appetite disturbance; (ii) general depressive symptoms; and (iii) sleep disturbance. Using all symptoms (n = 27), we identified five factors that reflected: (i) weight/appetite symptoms; (ii) general retarded depressive symptoms; (iii) atypical vegetative symptoms; (iv) suicidality/hopelessness; and (v) symptoms of agitation and anxiety. MD is a clinically complex syndrome with several underlying correlated symptom dimensions. In addition to a general depressive symptom factor, a complete picture must include factors reflecting typical/atypical vegetative symptoms, cognitive symptoms (hopelessness/suicidal ideation), and an agitated symptom factor characterized by anxiety, guilt, helplessness and irritability. Prior cross-cultural studies, factor analyses of MD in Western populations and empirical findings in this sample showing risk factor profiles similar to those seen in Western populations suggest that our results are likely to be broadly representative of the human depressive syndrome.
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    ABSTRACT: Comorbid depression and anxiety disorders are commonly experienced in mothers. Both maternal depression and anxiety as well as their comorbidity has been shown to increase psychopathology in children, however, there is limited research focusing on African American families. The aim of this study is to examine whether comorbid anxiety disorders are associated with maternal depression severity, kinship support, and child behavioral problems in a sample of African American mothers with depression. African American mothers (n = 77) with a past year diagnosis of a depressive disorder and a child between the ages of ages 8-14 were administered a clinician interview and measures of maternal depression severity, kinship support, and child behavior problems (internalizing and externalizing) in a cross-sectional design. Results showed that more than half (58%) of the mothers had a comorbid anxiety disorder and a third had Posttraumatic Stress Disorder (PTSD). Regression analyses showed that comorbid PTSD and Social Phobia were positively associated with maternal depression severity. Maternal comorbid Obsessive Compulsive Disorder (OCD) was associated with child internalizing symptoms. The findings are consistent with other research demonstrating negative outcomes with maternal comorbidity of depression and anxiety, however, there is limited research focused on maternal depression and OCD or PTSD. The study suggests that it is important to consider comorbid anxiety and cultural issues when conceptualizing, studying, and treating mothers with depression and their families.
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Questions & Answers about this publication

  • Béatrice Marianne Ewalds-Kvist added an answer in Intervention Research:
    Does anyone have information on any trans-diagnostic intervention researches carried out in India or Asia?

    Specifically on  CBT for anxiety disorders

    Béatrice Marianne Ewalds-Kvist

    Dear Baijesh,

    Then I got you wrong. Some suggestions: 

    • [Show abstract] [Hide abstract]
      ABSTRACT: Common mental disorders (CMD) is a term used to describe depressive and anxiety disorders. It replaces the old term ‘neuroses’ and is widely used because of the high level of co-morbidity of depression and anxiety, which limits the validity of categorical models of classification of neurotic disorders, particularly in primary care settings. The global public health significance of CMD is highlighted by the fact that in developing countries, depression is the leading cause of years lived with disability in both men and women aged 15–44 years. This oration brings together research evidence, mostly from South Asia, to show that although the aetiology of CMD may lie in the socioeconomic circumstances faced by many patients, biological treatments such as antidepressants may be among the most cost-effective treatments in resource-poor settings. The oration demonstrates the public health implications of CMD by briefly reviewing the burden of CMD in the region and presents evidence linking the risk for CMD associated with two of the region's most important public health risk factors—poverty and gender disadvantage. The oration also presents recent evidence to establish the association of CMD with some of the region's most important public health issues: maternal and child health; and reproductive and sexual health. Next, the evidence for the efficacy of treatments for CMD in developing countries is presented, focusing on a series of recent trials that show that both psychosocial and biological treatments are effective. Finally, the implications for policy and future research are considered.
      Indian Journal of Psychiatry 01/2005; 47(1). DOI:10.4103/0019-5545.46068

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