Psychological Medicine

Original Articles

Major depression and phobias: the genetic and environmental sources of comorbidity

Kenneth S. Kendlera1 c1, Michael C. Nealea1, Ronald C. Kesslera1, Andrew C. Heatha1 and Lindon J. Eavesa1

a1 Department of Psychiatry and Department of Human Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA; the Institute for Social Research, University of Michigan, Ann Arbor, MI; Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA


In a population based sample of 2163 personally interviewed female twins, substantial comorbidity was observed between DSM-III-R defined major depression (MD) and 4 subtypes of phobia: agoraphobia, social phobia, animal phobia and situational phobia. However, the level of comorbidity of MD with agoraphobia was much greater than that found with the other phobic subtypes. We conducted bivariate twin analyses to decompose the genetic and environmental sources of comorbidity between MD and the phobias. Our results suggest that a modest proportion of the genetic vulnerability to MD also influences the risk for all phobic subtypes, with the possible exception of situational phobias. Furthermore, the magnitude of comorbidity resulting from this shared genetic vulnerability is similar across the phobic subtypes. By contrast, the non-familial environmental experiences which predispose to depression substantially increase the vulnerability to agoraphobia, have a modest impact on the risk for social and situational phobias and no effect on the risk for animal phobias. The increased comorbidity between MD and agoraphobia results, nearly entirely, from individual-specific environmental risk factors for MD which also increase the risk for agoraphobia but not for other phobias.


c1 Address for correspondence: Dr Kenneth S. Kendler, Department of Psychiatry, Medical College of Virginia, Box 710, Richmond, VA 23298–0710, USA.