Home > Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys.

Kessler, RC and Sampson, Nancy A and Berglund, P and Gruber, M J and Al-Hamzawi, Ali and Andrade, L and Bunting, B and Demyttenaere, K and Florescu, S and de Girolamo, G and Gureje, O and He, Y and Hu, C and Huang, Y and Karam, E and Kovess-Masfety, Viviane and Lee, S and Levinson, D and Medina Mora, M E and Moskalewicz, J and Nakamura, Y and Navarro-Mateu, F and Browne, MA Oakley and Piazza, M (2015) Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiology and Psychiatric Sciences , 24 , (3) , pp. 210-226.

Background.
To examine cross-national patterns and correlates of lifetime and 12-month comorbid DSM-IV anxiety disorders among people with lifetime and 12-month DSM-IV major depressive disorder (MDD).

Method.
Nationally or regionally representative epidemiological interviews were administered to 74 045 adults in 27 surveys across 24 countries in the WHO World Mental Health (WMH) Surveys. DSM-IV MDD, a wide range of comorbid DSM-IV anxiety disorders, and a number of correlates were assessed with the WHO Composite International Diagnostic Interview (CIDI).

Results.
45.7% of respondents with lifetime MDD (32.0-46.5% inter-quartile range (IQR) across surveys) had one of more lifetime anxiety disorders. A slightly higher proportion of respondents with 12-month MDD had lifetime anxiety disorders (51.7%, 37.8-54.0% IQR) and only slightly lower proportions of respondents with 12-month MDD had 12-month anxiety disorders (41.6%, 29.9-47.2% IQR). Two-thirds (68%) of respondents with lifetime comorbid anxiety disorders and MDD reported an earlier age-of-onset (AOO) of their first anxiety disorder than their MDD, while 13.5% reported an earlier AOO of MDD and the remaining 18.5% reported the same AOO of both disorders. Women and previously married people had consistently elevated rates of lifetime and 12-month MDD as well as comorbid anxiety disorders. Consistently higher proportions of respondents with 12-month anxious than non-anxious MDD reported severe role impairment (64.4 v. 46.0%; χ 2 1 = 187.0, p < 0.001) and suicide ideation (19.5 v. 8.9%; χ 2 1 = 71.6, p < 0.001). Significantly more respondents with 12-month anxious than non-anxious MDD received treatment for their depression in the 12 months before interview, but this difference was more pronounced in high-income countries (68.8 v. 45.4%; χ 2 1 = 108.8, p < 0.001) than low/middle-income countries (30.3 v. 20.6%; χ 2 1 = 11.7, p < 0.001).

Conclusions.
Patterns and correlates of comorbid DSM-IV anxiety disorders among people with DSM-IV MDD are similar across WMH countries. The narrow IQR of the proportion of respondents with temporally prior AOO of anxiety disorders than comorbid MDD (69.6-74.7%) is especially noteworthy. However, the fact that these proportions are not higher among respondents with 12-month than lifetime comorbidity means that temporal priority between lifetime anxiety disorders and MDD is not related to MDD persistence among people with anxious MDD. This, in turn, raises complex questions about the relative importance of temporally primary anxiety disorders as risk markers v. causal risk factors for subsequent MDD onset and persistence, including the possibility that anxiety disorders might primarily be risk markers for MDD onset and causal risk factors for MDD persistence.


Item Type:Article
Date:2015
Page Range:pp. 210-226
Publisher:Cambridge University Press
Volume:24
Number:3
EndNote:View
Related URLs:
Subjects:G Health and disease > State of health > Mental health
G Health and disease > Substance related disorder > Dual diagnosis (comorbidity)
G Health and disease > Substance related disorder > Substance related mental disorder
J Health care, prevention and rehabilitation > Care by type of problem > Mental health care
VA Geographic area > International aspects
VA Geographic area > Europe > Northern Ireland

Click here to request a copy of this literature (must be logged in)

Repository Staff Only: item control page