Depression, anxiety and somatic distress: syndromal structure and relationship to onset of clinical disorder

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The project aims to identify the principal dimensions or syndromes underlying symptoms of psychological distress (negative emotional states such as depression, anxiety, stress and fatigue). We plan to use an intensive longitudinal design to examine how these syndromes develop into episodes of clinical disorder. We expect that episodes of disorder will be predicted not only by closely related syndromes, but also by other causally related syndromes - for example, a period of increased anxiety and stress may precipitate a depressive disorder. This information is important for understanding the aetiology of clinical disorders, for refining diagnostic criteria, and for the prediction and prevention of disorder. We also plan to collect information about the degree of disability that people suffer and the type of health services they access at various levels of severity of each syndrome. We expect that subclinical levels of some syndromes will be associated with substantial impairment and service usage, but that for other syndromes impairment will be minimal until clinical levels of severity are reached. This information will give a more complete picture of the community-wide burden of emotional distress, and will be directly relevant to health planning and policy.