Depressive and anxiety disorders in concert–A synthesis of findings on comorbidity in the NESDA study
•Comorbidity of depressive and anxiety disorder is the rule, not the exemption.•Over time, transitions are common between depressive and anxiety disorders.•Risk factors for comorbidity are childhood trauma, neuroticism, and age of onset.•Findings do not support a strong (neuro)biological basis speci...
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| Published in: | Journal of affective disorders 2021-04, Vol.284, p.85-97 |
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| Main Authors: | , , , , , , |
| Format: | Article |
| Language: | eng |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | •Comorbidity of depressive and anxiety disorder is the rule, not the exemption.•Over time, transitions are common between depressive and anxiety disorders.•Risk factors for comorbidity are childhood trauma, neuroticism, and age of onset.•Findings do not support a strong (neuro)biological basis specific to comorbidity.•Comorbidity coincides with worst functional, somatic, and psychiatric outcomes.
Comorbidity of depressive and anxiety disorders is common and remains incompletely comprehended. This paper summarizes findings from the Netherlands Study of Depression and Anxiety (NESDA) regarding prevalence, temporal sequence, course and longitudinal patterns; sociodemographic, vulnerability and neurobiological indicators; and functional, somatic and mental health indicators of comorbidity.
Narrative synthesis of earlier NESDA based papers on comorbidity (n=76).
Comorbidity was the rule in over three-quarter of subjects with depressive and/or anxiety disorders, most often preceded by an anxiety disorder. Higher severity and chronicity characterized a poorer comorbidity course. Over time, transitions between depressive and anxiety disorders were common. Consistent comorbidity risk indicators in subjects with depressive and anxiety disorders were childhood trauma, neuroticism and early age of onset. Psychological vulnerabilities, such as trait avoidance tendencies, were more pronounced in comorbid than in single disorders. In general, there were few differences in biological markers and neuroimaging findings between persons with comorbid versus single disorders. Most functional, somatic, and other mental health indicators, ranging from disability to cardiovascular and psychiatric multimorbidity, were highest in comorbid disorders.
The observational design of NESDA limits causal inference. Attrition was higher in comorbid relative to single disorders.
As compared to single disorders, persons with comorbid depressive and anxiety disorders were characterized by more psychosocial risk determinants, more somatic and other psychiatric morbidities, more functional impairments, and poorer outcome. These results justify specific attention for comorbidity of depressive and anxiety disorders, particularly in treatment settings. |
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| ISSN: | 0165-0327 1573-2517 |