Factors associated with anxiety disorder comorbidity

Molly R Davies; Kiran Glen; Jessica Mundy; Abigail R Ter Kuile; Brett N Adey; Chérie Armour; Elham Assary; Jonathan R I Coleman; Kimberley A Goldsmith; Colette R Hirsch; Matthew Hotopf; Christopher Hübel; Ian R Jones; Gursharan Kalsi; Georgina Krebs; Andrew M McIntosh; Geneviève Morneau-Vaillancourt; Alicia J Peel; Kirstin L Purves; Sang Hyuck Lee; Megan Skelton; Daniel J Smith; David Veale; James T R Walters; Katherine S Young; Johan Zvrskovec; Gerome Breen; Thalia C Eley

doi:10.1016/j.jad.2022.11.051

Factors associated with anxiety disorder comorbidity

J Affect Disord. 2023 Feb 15:323:280-291. doi: 10.1016/j.jad.2022.11.051. Epub 2022 Nov 26.

Authors

Molly R Davies¹, Kiran Glen¹, Jessica Mundy¹, Abigail R Ter Kuile¹, Brett N Adey¹, Chérie Armour², Elham Assary³, Jonathan R I Coleman¹, Kimberley A Goldsmith¹, Colette R Hirsch⁴, Matthew Hotopf⁴, Christopher Hübel⁵, Ian R Jones⁶, Gursharan Kalsi¹, Georgina Krebs⁷, Andrew M McIntosh⁸, Geneviève Morneau-Vaillancourt³, Alicia J Peel³, Kirstin L Purves¹, Sang Hyuck Lee¹, Megan Skelton¹, Daniel J Smith⁸, David Veale⁴, James T R Walters⁶, Katherine S Young¹, Johan Zvrskovec¹, Gerome Breen¹, Thalia C Eley⁹

Affiliations

¹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK.
² Stress, Trauma & Related Conditions (STARC) research lab, School of Psychology, Queen's University Belfast (QUB), Belfast, UK.
³ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK.
⁴ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK.
⁵ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; National Centre for Register-based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark.
⁶ National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, Cardiff, UK.
⁷ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, UK.
⁸ Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
⁹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health and Care Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK. Electronic address: thalia.eley@kcl.ac.uk.

Abstract

Background: Anxiety and depressive disorders often co-occur and the order of their emergence may be associated with different clinical outcomes. However, minimal research has been conducted on anxiety-anxiety comorbidity. This study examined factors associated with anxiety comorbidity and anxiety-MDD temporal sequence.

Methods: Online, self-report data were collected from the UK-based GLAD and COPING NBR cohorts (N = 38,775). Logistic regression analyses compared differences in sociodemographic, trauma, and clinical factors between single anxiety, anxiety-anxiety comorbidity, anxiety-MDD (major depressive disorder) comorbidity, and MDD-only. Additionally, anxiety-first and MDD-first anxiety-MDD were compared. Differences in familial risk were assessed in those participants with self-reported family history or genotype data.

Results: Anxiety-anxiety and anxiety-MDD had higher rates of self-reported anxiety or depressive disorder diagnoses, younger age of onset, and higher recurrence than single anxiety. Anxiety-MDD displayed greater clinical severity/complexity than MDD only. Anxiety-anxiety had more severe current anxiety symptoms, less severe current depressive symptoms, and reduced likelihood of self-reporting an anxiety/depressive disorder diagnosis than anxiety-MDD. Anxiety-first anxiety-MDD had a younger age of onset, more severe anxiety symptoms, and less likelihood of self-reporting a diagnosis than MDD-first. Minimal differences in familial risk were found.

Limitations: Self-report, retrospective measures may introduce recall bias. The familial risk analyses were likely underpowered.

Conclusions: Anxiety-anxiety comorbidity displayed a similarly severe and complex profile of symptoms as anxiety-MDD but distinct features. For anxiety-MDD, first-onset anxiety had an earlier age of onset and greater severity than MDD-first. Anxiety disorders and comorbidity warrant further investigation and attention in research and practice.

Keywords: Affective disorders; Anxiety disorders; Comorbidity; Depressive disorders; Polygenic risk score.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety Disorders / diagnosis
Comorbidity
Depressive Disorder, Major* / diagnosis
Genetic Predisposition to Disease
Humans
Retrospective Studies

Abstract

Publication types

MeSH terms

Grants and funding