Merikangas, K. R. et al. Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study. Arch. Gen. Psychiatry 60, 993-1000

Mood and Anxiety Disorders Program, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
Archives of General Psychiatry (Impact Factor: 13.75). 11/2003; 60(10):993-1000. DOI: 10.1001/archpsyc.60.9.993
Source: PubMed

ABSTRACT The dearth of long-term follow-up studies of community-based samples and differences in methodology in existing studies highlight the need for research designed to examine the stability, comorbidity, and diagnostic thresholds of depression and anxiety in the community.
Prospective study of a community-based cohort aged 19 and 20 years from the canton of Zurich, Switzerland. Semistructured diagnostic interviews were administered by clinically experienced interviewers at 5 assessment points during a 15-year period. The format of the interview permitted assessment of major mental disorders at both the diagnostic and subthreshold levels.
Comorbid anxiety and depression tended to be far more persistent than either syndrome alone. Individuals with anxiety states alone tended to develop either depression alone or comorbid anxiety and depression as they progressed through adulthood. In contrast, depression alone and depression comorbid with anxiety tended to be more stable than anxiety alone over time. The patterns of stability were similar for subthreshold- and threshold-level disorders.
These findings have important implications for classification and treatment of affective disorders. The greater stability of comorbid anxiety and depression than either disorder alone illustrates the importance of further investigation of comorbid states compared with noncomorbid states in etiologic and treatment research. The persistence of subthreshold-level depression and anxiety from early to mid adulthood also suggests the importance of characterizing the continuum of expression of depression and anxiety rather than adhering to strict diagnostic thresholds.

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    • "However, the absence of sex differences in these pathways is consistent with the recent study by McLaughlin and King (2015), which did not find sex differences in anxiety or depressive symptom trajectories or their relationship to each other over time. One notable similarity in the present study is the examination of social anxiety and depression at the symptom-level rather than the diagnostic level, which may account for the difference from prior research (Merikangas et al. 2003). Further, this is the first study to evaluate racial differences in the temporal relationship between social anxiety and depressive symptoms. "
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    ABSTRACT: Social anxiety and depressive symptoms dramatically increase and frequently co-occur during adolescence. Although research indicates that general interpersonal stressors, peer victimization, and familial emotional maltreatment predict symptoms of social anxiety and depression, it remains unclear how these stressors contribute to the sequential development of these internalizing symptoms. Thus, the present study examined the sequential development of social anxiety and depressive symptoms following the occurrence of interpersonal stressors, peer victimization, and familial emotional maltreatment. Participants included 410 early adolescents (53 % female; 51 % African American; Mean age =12.84 years) who completed measures of social anxiety and depressive symptoms at three time points (Times 1-3), as well as measures of general interpersonal stressors, peer victimization, and emotional maltreatment at Time 2. Path analyses revealed that interpersonal stressors, peer victimization, and emotional maltreatment predicted both depressive and social anxiety symptoms concurrently. However, depressive symptoms significantly mediated the pathway from interpersonal stressors, peer victimization, and familial emotional maltreatment to subsequent levels of social anxiety symptoms. In contrast, social anxiety did not mediate the relationship between these stressors and subsequent depressive symptoms. There was no evidence of sex or racial differences in these mediational pathways. Findings suggest that interpersonal stressors, including the particularly detrimental stressors of peer victimization and familial emotional maltreatment, may predict both depressive and social anxiety symptoms; however, adolescents who have more immediate depressogenic reactions may be at greater risk for later development of symptoms of social anxiety.
    Journal of Abnormal Child Psychology 07/2015; DOI:10.1007/s10802-015-0049-0 · 3.09 Impact Factor
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    • "However, previous research has demonstrated that contemporary diagnostic systems fail to cover depressive and anxiety states among those who do not meet duration or impairment criteria yet exhibit recurrence, subjective distress and have a history of treatment [2] [3]. The importance of this limitation is further reinforced by general population evidence on the potential impact and stability over time of subthreshold-level depression and anxiety [3] [31] [50] [69]. As a result, general practitioners in the UK and US are now advised to also recognize persistent subthreshold forms of depression [20] [52] [56], for which primary care management may be effective [14] [33]. "
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    ABSTRACT: Distinguishing transient from persistent anxiety and depression symptoms in older people presenting to general practice with musculoskeletal pain is potentially important for effective management. This study sought to identify distinct post-consultation depression and anxiety symptom trajectories in adults aged over 50years consulting general practice for non-inflammatory musculoskeletal pain. Self-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1week of the consultation and at 3, 6 and 12months. Latent class growth analysis was used to identify anxiety and depression symptoms trajectories, which were ascertained with cut-off score ≥8 on Hospital Anxiety and Depression Scale subscales. Associations between baseline characteristics and cluster membership were examined using multivariate multinomial logistic regression analysis (the 3-step approach). Latent class growth analyses determined a 3-cluster anxiety model (n=499) and a 3-cluster depression model (n=501). Clusters identified were: no anxiety problem (44.1%), persistent anxiety problem (33.9%) and transient anxiety symptoms (22.2%); no depression problem (74.1%), persistent depression problem (22.0%) and gradual depression symptom recovery (4.0%). Widespread pain, interference with valued activities, coping by increased behavioral activities, catastrophizing, perceived lack of instrumental support, age ≥70years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters. Older people with non-inflammatory musculoskeletal pain are at high risk of persistent anxiety and/or depression problems. Biopsychosocial factors, such as pain status, coping strategies, instrumental support, performing manual/routine work, being female and age ≥70years, may help identify patients with persistent anxiety and/or depression. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Psychosomatic Research 06/2015; DOI:10.1016/j.jpsychores.2015.05.016 · 2.84 Impact Factor
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    • "Angsterkrankungen haben häufig einen chronischen Verlauf (Merikangas et al., 2003), zudem entwickeln Patienten , die an einer Angsterkrankung leiden, oft komorbide Störungen wie z. B. Depressionen (Merikangas et al., 2003). Eine Angsterkrankung ist häufig mit einer signifikanten Einschränkung von Lebensqualität und sozialer und beruflicher Funktionsfähigkeit verbunden (Olatunji, Cisler & Tolin, 2007; Rufer, Moergeli, Moritz, Drabe & Weidt, 2014). "
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    ABSTRACT: This review summarizes studies on neurobiological effects of psychotherapy or neurobiological predictors of treatment response in anxiety disorders and obsessive-compulsive disorders (OCD). In anxiety disorders, psychotherapy reduced activation in amygdala and prefrontal cortex, which were hyperactive compared to healthy participants. Psychotherapy thus normalized brain activity. In OCD psychotherapy rather influenced orbitofrontal cortex and anterior cingulate as well as in striatal regions, also corresponding to normalization. The here reviewed studies indicated no new, compensatory mechanisms after psychotherapy. The main mechanisms were a normalization of hyper(re)active circuits focusing on the amygdala in anxiety disorders and focusing on orbitofronto-striatal loops in OCD. This reflects the differential neurobiological models underlying these diagnostic groups. These findings could be a basis for future treatments using neurofeedback-supported training as augmentation of psychotherapy in anxiety disorders and OCD. [In dieser Übersicht werden Studien zusammengefasst, die neurobiologische Effekte der Psychotherapie oder neurobiologische Prädiktoren der Therapieresponse bei Angststörungen und Zwangsstörungen untersucht haben. Die Haupteffekte therapeutischer Interventionen bestanden in einer Aktivitäts-Normalisierung von zuvor meist überaktiven Hirnregionen. Bei den Angststörungen reduzierte bzw. normalisierte Psychotherapie die zunächst erhöhte Aktivität in der Amygdala sowie in präfrontalen Regionen. Bei der Zwangsstörung reduzierte bzw. normalisierte Psychotherapie eher die Aktivität im orbitofrontalen Cortex und anterioren Cingulum sowie in den Basalganglien (Striatum). Zusammenfassend scheint ein neurobiologischer Effekt von Psychotherapie bei Angst- und Zwangsstörungen darin zu bestehen, dass sich die im Vergleich zu Gesunden gesteigerte Aktivität spezifischer Netzwerke normalisiert. Es gibt hingegen keine deutlichen Hinweise auf kompensatorische Mechanismen. Dabei zeigen sich Unterschiede zwischen den Angststörungen (Fokus Amygdala) und der Zwangsstörung (Fokus orbitofrontal/striatal). Zukünftig könnten solche Befunde auch eine Basis für Neurofeedback-Training als Ergänzung zur Psychotherapie sein.]
    Zeitschrift für Psychiatrie Psychologie und Psychotherapie 04/2015; 63(2):109-116. DOI:10.1024/1661-4747/a000229 · 1.99 Impact Factor
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