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A prospective latent analysis study of Axis I psychiatric co-morbidity of DSM-IV major depressive disorder

Published online by Cambridge University Press:  09 July 2013

T. Melartin ,
O. Mantere ,
M Ketokivi  and
E. Isometsä
T. Melartin
Affiliation:
Mood, Depression and Suicidal Behavior Unit, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
O. Mantere
Affiliation:
Mood, Depression and Suicidal Behavior Unit, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
M Ketokivi
Affiliation:
Operations and Technology Department, IE Business School, Madrid, Spain
E. Isometsä*
Affiliation:
Mood, Depression and Suicidal Behavior Unit, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland Department of Psychiatry, University of Helsinki, Helsinki, Finland
*
*Address for correspondence: E. T. Isometsä, M.D., Ph.D., Professor of Psychiatry, Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, PO Box 22, FI-00014 Helsinki, Finland. (Email: erkki.isometsa@hus.fi)
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Abstract

Background

We tested the degree to which longitudinal observations fit two hypotheses of psychiatric co-morbidity in DSM-IV major depressive disorder (MDD) among adult patients: (1) Axis I co-morbidity is dependent on major depressive episode (MDE) course, and (2) Axis I co-morbidity is independent of MDE course.

Method

In the Vantaa Depression Study (VDS), 269 psychiatric secondary-care patients with a DSM-IV MDD were evaluated with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) at intake and at 6 and 18 months. Three evaluations of co-morbidity were available for 193 out of 259 living patients (75%). A latent curve model (LCM) was used to examine individual-level changes in depressive and anxiety symptoms across time. Outcome of MDD was modeled in terms of categorical DSM-IV diagnosis and Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAMD) scores, and co-morbidity in terms of categorical DSM-IV anxiety and alcohol use disorder (AUD) diagnoses and Beck Anxiety Inventory (BAI) scores.

Results

Depression and anxiety correlated cross-sectionally at baseline. Longitudinally, changes in depression and anxiety correlated in both the 0–6 and 6–18 months time windows. Higher baseline depression raised the likelihood of an AUD at 6 months, and patients with more depressive symptoms in the 0–6 months time window were more likely to have had an AUD at 6 months, which further linked to less improvement in depression symptoms in the 6–18 months time window.

Conclusions

Longitudinal and individual-level courses of both internalizing and externalizing disorders in adult patients with MDD seem to be dependent, albeit to differing degrees, on the course of depressive symptoms.

Keywords

Co-morbiditylatent curve modelsmajor depressive disorderprospective studies
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 5 , April 2014 , pp. 949 - 959
Copyright
Copyright © Cambridge University Press 2013 

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