Psychological Medicine

  • Psychological Medicine / Volume 42 / Issue 06 / June 2012, pp 1239-1248
  • Copyright © Cambridge University Press 2011 The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence <>. The written permission of Cambridge University Press must be obtained for commercial re-use.
  • DOI: (About DOI), Published online: 30 November 2011

Original Articles

Patterns of co-morbidity with anxiety disorders in Chinese women with recurrent major depression

Y. Lia1, S. Shia2a3, F. Yanga3, J. Gaoa4, Youhui Lia5, M. Taoa6, G. Wanga7, K. Zhanga8, C. Gaoa9, L. Liua10, Kan Lia11, Keqing Lia12, Y. Liua13, Xumei Wanga14, J. Zhanga15, L. Lva16, Xueyi Wanga17, Q. Chena18, J. Hua19, L. Suna20, J. Shia21, Y. Chena22, D. Xiea1, J. Flinta1, K. S. Kendlera23 c1 and Z. Zhanga24 c2

a1 Wellcome Trust Center for Human Genetics, Roosevelt Drive, Oxford, UK;

a2 Fudan University Affiliated Huashan Hospital, Shanghai, People's Republic of China;

a3 Shanghai Jiao Tong University School of Medicine Affiliated Shanghai Mental Health Center, Shanghai, People's Republic of China;

a4 Zhejiang Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, People's Republic of China;

a5 No. 1 Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China;

a6 Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China;

a7 Beijing Anding Hospital, Capital Medical University, Xicheng District, Beijing, People's Republic of China;

a8 No. 1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China;

a9 No. 1 Hospital of Medical College of Xian Jiaotong University, Xi'an, Shaanxi, People's Republic of China;

a10 Shandong Mental Health Center, Jinan, Shandong, People's Republic of China;

a11 Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, People's Republic of China;

a12 Hebei Mental Health Center, Baoding, Hebei, People's Republic of China;

a13 The First Hospital of China Medical University, He Ping District, Shenyang, Liaoning, People's Republic of China;

a14 ShengJing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China;

a15 No. 3 Affiliated Hospital of Sun Yat-sen University, Tian He District, Guangzhou, Guangdong, People's Republic of China;

a16 Psychiatric Hospital of Henan Province, No. 388 Jian She Zhong Lu, Xinxiang, Henan, 453002, People's Republic of China;

a17 The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China;

a18 Dalian No. 7 People's Hospital and Dalian Mental Health Center, Gan Jing Zi District, Dalian, Liaoning, People's Republic of China;

a19 No. 1 Mental Health Center Affiliated Harbin Medical University, Nangang District, Harbin, Heilongjiang, People's Republic of China;

a20 Jilin Brain Hospital, Siping, Jilin, People's Republic of China;

a21 Xi'an Mental Health Center, Qujiang Xin District, Xi'an, Shaanxi, People's Republic of China;

a22 Clinical Trial Service Unit, Richard Doll Building, Roosevelt Drive, Oxford, UK;

a23 Virginia Institute for Psychiatric and Behavioral Genetics of Virginia Commonwealth University, Richmond, VA, USA;

a24 No. 4 Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China


Background Studies conducted in Europe and the USA have shown that co-morbidity between major depressive disorder (MDD) and anxiety disorders is associated with various MDD-related features, including clinical symptoms, degree of familial aggregation and socio-economic status. However, few studies have investigated whether these patterns of association vary across different co-morbid anxiety disorders. Here, using a large cohort of Chinese women with recurrent MDD, we examine the prevalence and associated clinical features of co-morbid anxiety disorders.

Method A total of 1970 female Chinese MDD patients with or without seven co-morbid anxiety disorders [including generalized anxiety disorder (GAD), panic disorder, and five phobia subtypes] were ascertained in the CONVERGE study. Generalized linear models were used to model association between co-morbid anxiety disorders and various MDD features.

Results The lifetime prevalence rate for any type of co-morbid anxiety disorder is 60.2%. Panic and social phobia significantly predict an increased family history of MDD. GAD and animal phobia predict an earlier onset of MDD and a higher number of MDD episodes, respectively. Panic and GAD predict a higher number of DSM-IV diagnostic criteria. GAD and blood-injury phobia are both significantly associated with suicidal attempt with opposite effects. All seven co-morbid anxiety disorders predict higher neuroticism.

Conclusions Patterns of co-morbidity between MDD and anxiety are consistent with findings from the US and European studies; the seven co-morbid anxiety disorders are heterogeneous when tested for association with various MDD features.

(Received August 06 2011)

(Revised October 17 2011)

(Accepted October 31 2011)

(Online publication November 30 2011)


c1 Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics of Virginia Commonwealth University, Box 980126, Richmond, VA 232980126, USA. (Email: [K.S.K.]

c2 (Email: [Z. Zhang]