Depression and generalized anxiety disorder - Cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years
Depression and generalized anxiety disorder - Cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years
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DOI：
10.1001/archpsyc.64.6.651
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发表时间：
2007-06-01
影响因子：
--
通讯作者：
Poulton, Richie
中科院分区：
文献类型：
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作者：
Moffitt, Terrie E.;Harrington, HonaLee;Poulton, Richie
背景：广泛性焦虑症(GAD)和严重抑郁障碍(MDD)之间的密切联系引发了如何在未来的诊断系统中描述这种联系的问题。大多数关于GAD-MDD共病的信息来自患者样本和回顾调查。目的：使用前瞻性纵向队列数据重温GAD和MDD之间的序贯和累积共病。设计：前瞻性纵向队列研究。地点：新西兰。参与者：对具有代表性的1972-1973年Dunedin出生队列1037名成员进行了32岁的随访，保留率为96%。主要观察指标：研究诊断焦虑和抑郁的年龄分别为11岁、13岁、15岁、18岁、21岁、26岁和32岁。结果：37%的抑郁症患者在焦虑之前或同时开始焦虑，而32%的焦虑患者在焦虑之前或同时开始抑郁。总体而言，72%的终生焦虑病例有抑郁史，但48%的终生抑郁病例有焦虑。成年后12%患有GAD和MDD，其中66%为复发性MDD，47%为复发性GAD，报告使用精神卫生服务，47%服用精神药物，8%住院，11%自杀未遂。在这一共病组中，三分之一的参与者首先出现抑郁，三分之一的参与者首先出现焦虑，三分之一的参与者同时出现抑郁和焦虑。结论：这些发现挑战了普遍焦虑通常先于抑郁并最终发展为抑郁的流行观念，这些发现表明相反的模式几乎同样频繁地发生。GAD与MDD的相关性很强，提示这些障碍可以被归类为I类苦恼障碍。它们的发育关系似乎比迄今认为的更对称，这表明在诊断层次上，MDD不一定是GAD的首要疾病。这项前瞻性研究表明，回顾调查可能低估了GAD和MDD的终生患病率，GAD和MDD并存构成了比之前认为的更大的心理健康负担。
Context: The close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize this association in future diagnostic systems. Most information about GAD-MDD comorbidity comes from patient samples and retrospective surveys.Objective: To revisit the sequential and cumulative comorbidity between GAD and MDD using data from a prospective longitudinal cohort.Design: Prospective longitudinal cohort study.Setting: New Zealand.Participants: The representative 1972-1973 Dunedin birth cohort of 1037 members was followed up to age 32 years with 96% retention.Main Outcome Measures: Research diagnoses of anxiety and depression were made at ages 11, 13, 15, 18, 21, 26, and 32 years. Mental health'services were reported on a life history calendar.Results: Sequentially, anxiety began before or concurrently in 37% of depression cases, but depression began before or concurrently in 32% of anxiety cases. Cumulatively, 72% of lifetime anxiety cases had a history of depression, but 48% of lifetime depression cases had anxiety. During adulthood, 12% of the cohort had comorbid GAD + MDD, of whom 66% had recurrent MDD, 47% had recurrent GAD, 64% reported using mental health services, 47% took psychiatric medication, 8% were hospitalized, and 11% attempted suicide. In this comorbid group, depression onset occurred first in one third of the participants, anxiety onset occurred first in one third, and depression and anxiety onset began concurrently in one third.Conclusions: Challenging the prevailing notion that generalized anxiety usually precedes depression and eventually develops into depression, these findings show that the reverse pattern occurs almost as often. The GAD-MDD relation is strong, suggesting that the disorders could be classified in I category of distress disorders. Their developmental relation seems more symmetrical than heretofore presumed, suggesting that MDD is not necessarily primary over GAD in diagnostic hierarchy. This prospective study suggests that the lifetime prevalence of GAD and MDD may be underestimated by retrospective surveys and that comorbid GAD + MDD constitutes a greater mental health burden than previously thought.