Psychological Medicine



Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D


MAURIZIO FAVA a1c1, JONATHAN E. ALPERT a1, CHERYL N. CARMIN a1, STEPHEN R. WISNIEWSKI a1, MADHUKAR H. TRIVEDI a1, MELANIE M. BIGGS a1, KATHY SHORES-WILSON a1, DON MORGAN a1, TERRY SCHWARTZ a1, G. K. BALASUBRAMANI a1 and A. JOHN RUSH a1
a1 Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; University of Illinois at Chicago, Chicago, IL, USA; Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; The University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, TX, USA; Psychiatric Research Institute, University of Kansas, Wichita, KS, USA; University of California at San Diego Outpatient Psychiatric Services, University of California at San Diego, San Diego, CA, USA

Article author query
fava m   [PubMed][Google Scholar] 
alpert je   [PubMed][Google Scholar] 
carmin cn   [PubMed][Google Scholar] 
wisniewski sr   [PubMed][Google Scholar] 
trivedi mh   [PubMed][Google Scholar] 
biggs mm   [PubMed][Google Scholar] 
shores-wilson k   [PubMed][Google Scholar] 
morgan d   [PubMed][Google Scholar] 
schwartz t   [PubMed][Google Scholar] 
balasubramani gk   [PubMed][Google Scholar] 
john rush a   [PubMed][Google Scholar] 

Abstract

Background. Anxious depression, defined as Major Depressive Disorder (MDD) with high levels of anxiety symptoms, may represent a relatively common depressive subtype, with distinctive features.

Objective. The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns.

Method. Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study. A baseline Hamilton Rating Scale for Depression (HAM-D) Anxiety/Somatization factor score of [gt-or-equal, slanted]7 was considered indicative of anxious depression. The types and degree of concurrent psychiatric symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items endorsed by study participants for each diagnostic category. MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology (IDS-C30).

Results. The prevalence of anxious depression in this population was 46%. Patients with anxious MDD were significantly more likely to be older, unemployed, less educated, more severely depressed, and to have suicidal ideation before and after adjustment for severity of depression. As far as concurrent psychiatric symptoms are concerned, patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety, obsessive compulsive, panic, post-traumatic stress, agoraphobia, hypochondriasis, and somatoform disorders before and after adjustment for severity of depression. Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features, and were significantly more likely to endorse items concerning melancholic/endogenous depression features.

Conclusion. This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety (anxious depression).


Correspondence:
c1 Depression Clinical and Research Program, Massachusetts General Hospital – 15 Parkman Street, ACC 812, Boston, MA 02114, USA. (Email: mfava@partners.org)


Metrics