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Identification and validation of mixed anxiety–depression

Published online by Cambridge University Press:  08 June 2015

J. M. Hettema ,
S. H. Aggen ,
T. S. Kubarych ,
M. C. Neale  and
K. S. Kendler
J. M. Hettema*
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA
S. H. Aggen
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA
T. S. Kubarych
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA
M. C. Neale
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA
K. S. Kendler
Affiliation:
Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA 23298-0126, USA
*
*Address for correspondence: J. M. Hettema, VCU Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, PO Box 980126, Richmond, VA 23298-0126, USA. (Email: jhettema@vcu.edu)
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Abstract

Background.

Mixed anxiety–depression (MAD) has been under scrutiny to determine its potential place in psychiatric nosology. The current study sought to investigate its prevalence, clinical characteristics, course and potential validators.

Method.

Restricted latent-class analyses were fit to 12-month self-reports of depression and anxiety symptom criteria in a large population-based sample of twins. Classes were examined across an array of relevant indicators (demographics, co-morbidity, adverse life events, clinical significance and twin concordance). Longitudinal analyses investigated the stability of, and transitions between, these classes for two time periods approximately 1.5 years apart.

Results.

In all analyses, a class exhibiting levels of MAD symptomatology distinctly above the unaffected subjects yet having low prevalence of either major depression (MD) or generalized anxiety disorder (GAD) was identified. A restricted four-class model, constraining two classes to have no prior disorder history to distinguish residual or recurrent symptoms from new onsets in the last year, provided an interpretable classification: two groups with no prior history that were unaffected or had MAD and two with prior history having relatively low or high symptom levels. Prevalence of MAD was substantial (9–11%), and subjects with MAD differed quantitatively but not qualitatively from those with lifetime MD or GAD across the clinical validators examined.

Conclusions.

Our findings suggest that MAD is a commonly occurring, identifiable syndromal subtype that warrants further study and consideration for inclusion in future nosologic systems.

Keywords

Anxietydepressiontwin studies
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 14 , October 2015 , pp. 3075 - 3084
Copyright
Copyright © Cambridge University Press 2015 

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References

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, revised third edn. American Psychiatric Association: Washington, DC.Google Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, fourth edn. American Psychiatric Association: Washington, DC.Google Scholar
Barkow, K, Heun, R, Wittchen, HU, Bedirhan, UT, Gansicke, M, Maier, W (2004). Mixed anxiety–depression in a 1 year follow-up study: shift to other diagnoses or remission? Journal of Affective Disorders 79, 235–239.CrossRefGoogle ScholarPubMed
Bauer, DJ, Curran, PJ (2004). The integration of continuous and discrete latent variable models: potential problems and promising opportunities. Psychological Methods 9, 3–29.Google Scholar
Das-Munshi, J, Goldberg, D, Bebbington, PE, Bhugra, DK, Brugha, TS, Dewey, ME, Jenkins, R, Stewart, R, Prince, M (2008). Public health significance of mixed anxiety and depression: beyond current classification. British Journal of Psychiatry 192, 171–177.Google Scholar
Eaves, LJ, Eysenck, HJ, Martin, NG, Jardine, R, Heath, AC, Feingold, L, Young, PA, Kendler, KS (1989). Genes, Culture and Personality: An Empirical Approach. Academic Press: London.Google Scholar
Fagerstrom, KO, Schneider, NG (1989). Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine 12, 159–182.CrossRefGoogle ScholarPubMed
Finch, WH, Bronk, KC (2011). Conducting confirmatory latent class analysis using Mplus. Structural Equation Modeling: A Multidisciplinary Journal 18, 132–151.Google Scholar
Goldberg, DP (2014). Anxious forms of depression. Depression and Anxiety 31, 344–351.Google Scholar
Haslam, N (2003). Categorical versus dimensional models of mental disorder: the taxometric evidence. Australian and New Zealand Journal of Psychiatry 37, 696–704.Google Scholar
Hettema, JM, Prescott, CA, Kendler, KS (2001). A population-based twin study of generalized anxiety disorder in men and women. Journal of Nervous and Mental Disease 189, 413–420.Google Scholar
Hoijtink, H (2001). Confirmatory latent class analysis: model selection using Bayes factors and (pseudo) likelihood ratio statistics. Multivariate Behavioral Research 36, 563–588.Google Scholar
Kendler, KS, Bulik, CM, Silberg, J, Hettema, JM, Myers, J, Prescott, CA (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Archives of General Psychiatry 57, 953–959.Google Scholar
Kendler, KS, Gardner, CO, Prescott, CA (2001). Panic syndromes in a population-based sample of male and female twins. Psychological Medicine 31, 989–1000.Google Scholar
Kendler, KS, Karkowski, LM, Prescott, CA (1998). Stressful life events and major depression: risk period, long-term contextual threat, and diagnostic specificity. Journal of Nervous and Mental Disease 186, 661–669.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1992). Childhood parental loss and adult psychopathology in women. A twin study perspective. Archives of General Psychiatry 49, 109–116.Google Scholar
Kendler, KS, Prescott, CA (1999). A population-based twin study of lifetime major depression in men and women. Archives of General Psychiatry 56, 39–44.CrossRefGoogle ScholarPubMed
Lam, TP, Goldberg, DP, Dowell, AC, Fortes, S, Mbatia, JK, Minhas, FA, Klinkman, MS (2013). Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: an international focus group study. Family Practice 30, 76–87.CrossRefGoogle ScholarPubMed
Leoutsakos, JM, Zandi, PP, Bandeen-Roche, K, Lyketsos, CG (2010). Searching for valid psychiatric phenotypes: discrete latent variable models. International Journal of Methods in Psychiatric Research 19, 63–73.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (2010). Mplus User's Guide. Muthén & Muthén: Los Angeles, CA.Google Scholar
Neale, MC, Boker, SM, Xie, G, Maes, HH (2003). Mx: Statistical Modeling. Department of Psychiatry, Virginia Commonwealth University Medical School: Richmond, VA.Google Scholar
Nyland, KL, Asparouhov, T, Muthén, BO (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal 14, 535–569.Google Scholar
Piccinelli, M, Rucci, P, Ustun, B, Simon, G (1999). Typologies of anxiety, depression and somatization symptoms among primary care attenders with no formal mental disorder. Psychological Medicine 29, 677–688.Google Scholar
SAS (2010). SAS Institute. SAS/STAT Software, version 9.3. SAS Institute Inc.: Cary, NC.Google Scholar
Schmidt, NB, Kotov, R, Bernstein, A, Zvolensky, MJ, Joiner, TE Jr, Lewinsohn, PM (2007). Mixed anxiety depression: taxometric exploration of the validity of a diagnostic category in youth. Journal of Affective Disorders 98, 83–89.Google Scholar
Solomon, A, Haaga, DA, Arnow, BA (2001). Is clinical depression distinct from subthreshold depressive symptoms? A review of the continuity issue in depression research. Journal of Nervous and Mental Disease 189, 498–506.Google Scholar
Spijker, J, Batelaan, N, de, Graaf R, Cuijpers, P (2010). Who is MADD? Mixed anxiety depressive disorder in the general population. Journal of Affective Disorders 121, 180–183.CrossRefGoogle ScholarPubMed
Stein, MB, Kirk, P, Prabhu, V, Grott, M, Terepa, M (1995). Mixed anxiety–depression in a primary-care clinic. Journal of Affective Disorders 34, 79–84.CrossRefGoogle Scholar
Sullivan, PF, Prescott, CA, Kendler, KS (2002). The subtypes of major depression in a twin registry. Journal of Affective Disorders 68, 273–284.CrossRefGoogle Scholar
Usall, J, Marquez, M (1999). Mixed anxiety and depression disorder: a naturalistic study. Actas españolas de psiquiatría 27, 81–86.Google Scholar
Weisberg, RB, Maki, KM, Culpepper, L, Keller, MB (2005). Is anyone really M.A.D.?: the occurrence and course of mixed anxiety–depressive disorder in a sample of primary care patients. Journal of Nervous and Mental Disease 193, 223–230.Google Scholar
Wittchen, HU, Essau, CA (1993). Comorbidity and mixed anxiety–depressive disorders: is there epidemiologic evidence? Journal of Clinical Psychiatry 54 (Suppl.), 9–15.Google Scholar
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organization: Geneva.Google Scholar
Zinbarg, RE, Barlow, DH, Liebowitz, M, Street, L, Broadhead, E, Katon, W, Roy-Byrne, P, Lepine, JP, Teherani, M, Richards, J (1994). The DSM-IV field trial for mixed anxiety–depression. American Journal of Psychiatry 151, 1153–1162.Google Scholar
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