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Depressive episodes–evidence for a causal role of primary anxiety disorders?

Published online by Cambridge University Press:  16 April 2020

Hans-Ulrich Wittchen ,
Katja Beesdo ,
Antje Bittner  and
Renee D. Goodwin
Hans-Ulrich Wittchen*
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Chemnitzerstrasse 46, 01187Dresden, Germany Max Planck Institute of Psychiatry, Munich, Germany
Katja Beesdo
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Chemnitzerstrasse 46, 01187Dresden, Germany
Antje Bittner
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Chemnitzerstrasse 46, 01187Dresden, Germany
Renee D. Goodwin
Affiliation:
Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA
*
*Corresponding author. [email protected] (H.-U.Wittchen).
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Abstract

Anxiety and depressive disorders are common mental disorders in general population, imposing tremendous burden on both affected persons and society. Moreover, comorbidity between anxiety and depressive conditions is high, leading to substantial disability and functional impairment. Findings consistently suggest that anxiety disorders are primary to depression in the majority of comorbid cases. Yet, the question of whether anxiety disorders are risk factors for depression, and potentially even causal risk factors for the first onset of depression, remains unresolved. Recent results have shown that anxiety disorders increase the risk for subsequent depression, and also affect the course of depression, resulting in a poorer prognosis. Further, some results suggest a dose–response-relationship in revealing that a higher number of anxiety disorders and more severe impairment associated with anxiety disorders additionally increase the risk for subsequent depression. The goal of this paper is to review recent literature, summarize implications of previous findings, and suggest directions for future research regarding preventive and intervention strategies.

Keywords

AnxietyDepressionComorbidityRisk factor
Type
Original article
Information
European Psychiatry , Volume 18 , Issue 8 , December 2003 , pp. 384 - 393
Copyright
Copyright © 2003 European Psychiatric Association

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References

Andrade, LCaraveo-Anduaga, JJBerglund, PBijl, Rde Graaf, RVollebergh, WAM, et al.The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Meth Psychiatr Res 2003;12:3– 21.CrossRefGoogle ScholarPubMed
Angst, J. Comorbidity of mood disorders: a longitudinal prospective study. Br J Psychiatry 1996;168:31–7.CrossRefGoogle Scholar
Bijl, RVRavelli, AVan Zessen, G. Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998;33:587–95.CrossRefGoogle Scholar
Bittner, AGoodwin, RDWittchen, H-UBeesdo, KHöfler, MLieb, R. What characteristics of primary anxiety disorders predict subsequent major depression? J Clin Psychiatry, submitted for publication.Google Scholar
Blazer, DGHughes, DGeorge, LKSwartz, MBoyer, R. Generalized anxiety disorder. In: Robins, LNRegier, DA, editors. Psychiatric disorders in America: the epidemiologic catchment area study. New York (NY): The Free Press; 1991. p. 180–203.Google Scholar
Breier, ACharney, DSHeninger, GR. The diagnostic validity of anxiety disorders and their relationship to depressive illness. Am J Psychiatry 1985;142:787–97.Google ScholarPubMed
Burke, KCBurke, JDRegier, DARae, DS. Age at onset of selected mental disorders in five community populations. Arch Gen Psychiatry 1990;47:511–8.CrossRefGoogle ScholarPubMed
Carter, RMWittchen, H-UPfister, HKessler, RC. One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depress Anxiety 2001;13:78–88.CrossRefGoogle Scholar
Clarke, GNHornbrook, MLynch, FPolen, MGale, JBeard-slee, WR, et al.A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Arch Gen Psychiatry 2001;58:1127–34.CrossRefGoogle ScholarPubMed
Eaton, WWDryman, AWeissman, MM. Panic and phobia. In: Robins, LNRegier, DA, editors. Psychiatric disorders in America The epidemiologic catchment area study. NewYork (NY): The Free Press; 1991. p. 155–79.Google Scholar
Essau, CAKarpinski, NAPetermann, FConradt, J. Häufigkeit und Komorbidität psychischer Störungen bei Jugendlichen: Ergebnisse der Bremer Jugendstudie. Z Klin Psychol Psychother 1998;46:105– 24.Google Scholar
Essau, CAKarpinski, NAPetermann, F, Häufigkeit Conradt J. Komor-bidität und psychosoziale Beeinträchtigung von Depressiven Störun-gen bei Jugendlichen: Ergebnisse der Bremer Jugendstudie. Z Klin Psychol Psychother 1998;46:316–29.Google Scholar
Gillham, JGReivich, KJ. Prevention of depressive symptoms in school children. A research update: two-year follow-up. Psychol Sci 1999;6: 343–51.Google Scholar
Goodwin, ROlfson, M. Treatment of panic attack and risk of major depressive disorder in the community. Am J Psychiatry 2001;158: 1146–8.CrossRefGoogle Scholar
Goodwin, RD. Anxiety disorders and the onset of depression among adults in the community. Psychol Med 2002;32:1121–4.CrossRefGoogle Scholar
Jacobi, FWittchen, H-UHölting, CHöfler, MPfister, HMüller, N, et al.Prevalence, comorbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med (in press).Google Scholar
Kendler, KS. Major depression and generalised anxiety disorder. Same genes, (partly) different environments-revisited. Br J Psychiatry 1996;168:68–75.Google Scholar
Kendler, KSNeale, MCKessler, RCHeath, ACEaves, LJ. Major depression and generalized anxiety disorder. Same genes, (partly) different environments? Arch Gen Psychiatry 1992;49:716–22.CrossRefGoogle ScholarPubMed
Kendler, KSWalters, EENeale, MCKessler, RCHeath, ACEaves, LJ. The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Arch Gen Psychiatry 1995;52: 374–83.CrossRefGoogle ScholarPubMed
Kessler, RC. The prevalence of psychiatric comorbidity. In: Wetzler, SSanderson, WC, editors. Treatment strategies for patients with psychiatric comorbidity. New York: Wiley; 1997. p. 23–48.Google Scholar
Kessler, RCBerglund, PADeWit, DJÜstün, TBWang, PSWit-tchen, H-U. Distinguishing generalized anxiety disorder from major depression: prevalence and impairment from current pure and comor-bid disorders in the US and Ontario. Int J Meth Psychiatr Res 2002;11:99–111.CrossRefGoogle Scholar
Kessler, RCDuPont, RLBerglund, PWittchen, H-U. Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry 1999;156: 1915–23.Google ScholarPubMed
Kessler, RCMcGonagle, KAZhao, SNelson, CBHughes, MEshleman, S, et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comor-bidity Survey. Arch Gen Psychiatry 1994;51:8–19.CrossRefGoogle Scholar
Kessler, RCNelson, CBMcGonagle, KALiu, JSwartz, MBlazer, DG. Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. Br J Psychiatry 1996;168:17–30.CrossRefGoogle Scholar
Kessler, RCStang, PWittchen, H-UStein, MBWalters, EE. Lifetime comorbidities between social phobia and mood disorders in the US National Comorbidity Survey. Psychol Med 1999;29:555–67.CrossRefGoogle ScholarPubMed
Kraemer, HCKazdin, AEOfford, DRKessler, RCJensen, PSKupfer, DJ. Coming to terms with the terms of risk. Arch Gen Psychiatry 1997;54:337–43.CrossRefGoogle ScholarPubMed
Krueger, RF. The structure of common mental disorders. Arch Gen Psychiatry 1999;56:921–6.CrossRefGoogle ScholarPubMed
Krueger, RF, CaspiA, Moffitt, TESilva, PA. The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study. J Abnorm Psychol 1998;107:216–27.CrossRefGoogle ScholarPubMed
Lewinsohn, PMHops, HRoberts, RESeeley, JRAndrews, JA. Adolescents psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol 1993;102:133–44.CrossRefGoogle ScholarPubMed
Magee, WJEaton, WWWittchen, H-UMcGonagle, KKessler, RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996;53:159–68.CrossRefGoogle ScholarPubMed
Massion, AOWarshaw, MGKeller, MB. Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Am J Psychiatry 1993;150:600–7.Google ScholarPubMed
Merikangas, KRAngst, JEaton, WCanino, G, Rubio-Stipec, MWacker, H, et al.Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: results of an international task force. Br J Psychiatry 1996;168:58–67.CrossRefGoogle Scholar
Meyer, CRumpf, H-JHapke, UDilling, HJohn, U. Lebenszeit-prävalenz psychischer Störungen in der erwachsenen Allgemeinbev-ölerung. Ergebnisse der TOCAS-Studie. Nervenarzt 2000;71:535–42.Google Scholar
Oldehinkel, AJWittchen, H-USchuster, P. Prevalence, 20-month incidence and outcome of unipolar depressive disorders in a community sample of adolescents. Psychol Med 1999;29:655–68.CrossRefGoogle Scholar
Pattison, CLynd-Stevenson, RM. The prevention of depressive symptoms in children: the immediate and long-term outcomes of a school-based program. Behav Change 2001;18:78–102.CrossRefGoogle Scholar
Regier, DARae, DSNarrow, WEKaelber, CTSchatzberg, AF. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. Br J Psychiatry 1998;173:24–8.CrossRefGoogle Scholar
Rice, DPMiller, LS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry 1998;173:4–9.CrossRefGoogle Scholar
Robins, LNRegier, DA. Psychiatric disorders in Amerika: the Epide-miologic Catchment Area Study. New York (NY): The Free Press; 1991.Google Scholar
Schuster, P. Depressionen bei Jugendlichen und jungen Erwachsenen. Eine klinisch-epidemiologische Analyse. Stuttgart: Schattauer Verlag; 2001 Mit einem Geleitwort von Prof. Dr. Dipl.-Psych. Hans-Ulrich Wittchen.Google Scholar
Stein, MBFuetsch, MMüller, NHöfler, MLieb, RWittchen, H-U. Social anxiety disorder and the risk of depression. A prospective community study of adolescents and young adults. Arch Gen Psychiatry 2001;58:251–6.Google ScholarPubMed
Turner, RJGil, AG. Psychiatric and substance use disorders in south Florida: racial/ethnic and gender contrasts in a young adult cohort. Arch Gen Psychiatry 2002;59:43–50.CrossRefGoogle Scholar
Vega, WAKolody, BAguilar-Gaxiola, SAlderete, ECatalano, RCaraveo-Anduaga, J. Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural mexican americans in California. Arch Gen Psychiatry 1998;55:771–8.CrossRefGoogle Scholar
Vollebergh, WAMIedema, JBijl, RVde Graaf, RSmit, FOrmel, J. The structure and stability of common mental disorders. Arch Gen Psychiatry 2001;58:597–603.CrossRefGoogle ScholarPubMed
Weissman, MMBland, RCCanino, GJFaravelli, CGreenwald, SHwu, H-G, et al.The cross-national epidemiology of panic disorder. Arch Gen Psychiatry 1997;54:305–9.CrossRefGoogle ScholarPubMed
Wittchen, H-U. Der Langzeitverlauf unbehandelter Angststörungen: Wie häufig sind Spontanremissionen? Verhaltensther 1991;1:273–82.Google Scholar
Wittchen, H-U. What is comorbidity—fact or artefact? Br J Psychiatry 1996;168:7–8.CrossRefGoogle Scholar
Wittchen, H-U. The many faces of social anxiety disorder. Int Clin Psychopharmacol 2000;15:7–12.CrossRefGoogle ScholarPubMed
Wittchen, H-UCarter, RMPfister, HMontgomery, SAKessler, RC. Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey. Int Clin Psychopharmacol 2000;15:319–28.CrossRefGoogle ScholarPubMed
Wittchen, H-UFehm, L. Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatr Clin North Am 2001;24:617–41.CrossRefGoogle ScholarPubMed
Wittchen, H-UHöfler, MMerikangas, KR. Toward the identification of core psychopathological processes? Arch Gen Psychiatry 1999;56: 929–31.CrossRefGoogle ScholarPubMed
Wittchen, H-UHoyer, J. Generalized anxiety disorder: nature and course. J Clin Psychiatry 2001;62:15–9.Google ScholarPubMed
Wittchen, H-UKessler, RCBeesdo, KKrause, PHöfler, MHoyer, J. Generalized anxiety and depression in primary care: prevalence, recognition and management. J Clin Psychiatry 2002;63:24–34.Google ScholarPubMed
Wittchen, H-UKessler, RCPfister, HLieb, R. Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand 2000;102:14–23.CrossRefGoogle Scholar
Wittchen, H-ULecrubier, YBeesdo, KNocon, A. Relationships among anxiety disorders: patterns and implications. In: Nutt, DJBallenger, JC, editors. Anxiety disorders. Oxford: Blackwell Science; 2003. p. 25–37.Google ScholarPubMed
Wittchen, H-ULieb, RPfister, HSchuster, P. The waxing and waning of mental disorders: evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry 2000;41:122–32.CrossRefGoogle ScholarPubMed
Wittchen, H-ULieb, RSchuster, POldehinkel, AJ. When is onset? Investigations into early developmental stages of anxiety and depressive disorders. In: Rapoport, JL, editor. Childhood onset of “adult” psychopathology, clinical and research advances. Washington: American Psychiatric Press; 1999. p. 259–302.Google Scholar
Wittchen, H-UMühlig, SPezawas, L. Natural course and burden of bipolar disorders. Int J Neuropharmacol 2003;6:145–54.Google ScholarPubMed
Wittchen, H-UNelson, CBLachner, G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psy-chol Med 1998;28:109–26.CrossRefGoogle ScholarPubMed
Wittchen, H-UZhao, SKessler, RCEaton, WW. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:355–64.CrossRefGoogle ScholarPubMed
Wunderlich, UBronisch, TWittchen, H-U. Comorbidity patterns in adolescents and young adults with suicide attempts. Eur Arch Psychiatry Clin Neurosci 1998;248:87–95.CrossRefGoogle Scholar
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