Abstract
Objectives
Anxiety Disorders (AD) often co-exist with the heterotypic co-morbidity of Major Depressive Disorder (MDD) and Dysthymia (DysD). This study documents the prevalence of concurrent Depressive Disorder and its subtypes among AD, relationship between specific AD and Depressive Disorders, influence of severity of Depressive Disorders (DD) on AD and vice-versa, as well as the effect of age and gender on this co-morbidity.
Methods
In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders, Beck Depression Inventory and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version to collect the required data. Descriptive statistics, Independent t tests and Chi-square tests were done to evaluate the prevalence of concurrent Depressive Disorders among AD, relationship between specific AD and Depressive Disorders, severity of DD, and effect of age and gender on this co-morbidity.
Results
Depressive Disorders were concurrently present in 23.7 % of adolescents with AD, while 13.9 % had concurrently only MDD, 8.3 % had only DysD and 1.5 % had both. More adolescents with AD had multiple mood disorders than otherwise. Twenty percent of adolescents with Panic Disorder, 12.1 % with Generalised anxiety Disorder, 5.3 % with Separation Anxiety Disorder and 12 % with Social Anxiety Disorder had Depressive Disorders. Dysthymic disorder was statistically significantly more among those with PD (P = 0.009). Depressive Disorders were more severe among those with AD (P = 0.001) and the AD was more severe in those with DD (P = 0.01). As the severity of AD increased the severity of the DD also increased (P = 0.001). While DD were more prevalent among the late adolescence (P = 0.001), gender did not have any influence.
Conclusions
The two-way overlap between AD and DD is prevalent. Adolescents with Anxiety Disorders should be screened for Depressive Disorders, and when present should be treated.
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References
Masi G, Millepiedi S, Mucci M, Poli P, Bertini N, Milantoni L. Generalized anxiety disorder in referred children and adolescents. J Am Acad Child Adolesc Psychiatry. 2004;43:752–60.
Angold A, Costello EJ, Erkanli A. Comorbidity. J Child Psychol Psychiatry. 1999;40:57–87.
Seligman LD, Ollendick TH. Comorbidity of anxiety and depression in children and adolescents: An integrative review. Clin Child Fam Psychol Rev. 1998;1:125–44.
Birmaher B, Ryan ND, Williamson DE, Brent DA, Kaufman J. Childhood and adolescent depression: A review of the past 10 years. Part II. J Am Acad Child Adolesc Psychiatry. 1996;35:1575–83.
Costello EJ, Pine DS, Hammen C, March JS, Plotsky PM, Weissman MM, et al. Development and natural history of mood disorders. Biol Psychiatry. 2002;52:529–42.
Middeldorp CM, Cath DC, Van Dyck R, Boomsma DI. The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychol Med. 2005;35:611–24.
Shorter E, Tyrer P. Separation of anxiety and depressive disorders: Blind alley in psychopharmacology and classification of disease. BMJ. 2003;327:158–60.
Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graaf R, Vollebergh W, et al. The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res. 2003;12:3–21.
Roza SJ, Hofstra MB, van der Ende J, Verhulst FC. Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: A 14-year follow-up during childhood, adolescence, and young adulthood. Am J Psychiatry. 2003;160:2116–21.
Sterba SK, Prinstein MJ, Cox MJ. Trajectories of internalizing problems across childhood: Heterogeneity, external validity, and gender differences. Dev Psychopathol. 2007;19:345–66.
Gilliom M, Shaw DS. Codevelopment of externalizing and internalizing problems in early childhood. Dev Psychopathol. 2004;16:313–33.
Foley DL, Goldston DB, Costello JE, Angold A. Proximal psychiatric risk factors for suicidality in youth: The Great Smoky Mountains Study. Arch Gen Psychiatry. 2006;63:1017–24.
Franco X, Saavedra LM, Silverman WK. External validation of comorbid patterns of anxiety disorders in children and adolescents. J Anxiety Disord. 2007;21:717–29.
O’Neil KA, Podell JL, Benjamin CL, Kendall PC. Comorbid depressive disorders in anxiety-disordered youth: Demographic, clinical, and family characteristics. Child Psychiatry Hum Dev. 2010;41:330–41.
Bittner A, Goodwin RD, Wittchen HU, Beesdo K, Höfler M, Lieb R. What characteristics of primary anxiety disorders predict subsequent major depressive disorder? J Clin Psychiatry. 2004;65:618–26.
Achenbach TM, Howell CT, Quay HC, Conners CK. National survey of problems and competencies among four- to sixteen-year-olds: parents’ reports for normative and clinical samples. Monogr Soc Res Child Dev. 1991;56:1–131.
Briggs-Gowan MJ, Carter AS, Skuban EM, Horwitz SM. Prevalence of social-emotional and behavioral problems in a community sample of 1- and 2-year-old children. J Am Acad Child Adolesc Psychiatry. 2001;40:811–9.
Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, et al. National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095–105.
Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. J Am Acad Child Adolesc Psychiatry. 1999;38:1230–6.
Russell PS, Nair MKC, Russell S, Subramaniam VS, Sequeira AZ, Nazeema S, et al. ADad 2: The validation of the SCARED for anxiety disorders among adolescents in a rural community population in India. Indian J Pediatr. 2013; doi:10.1007/s12098-013-1233-2.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:53–63.
Basker M, Moses PD, Russell S, Russell PS. The psychometric properties of beck depression inventory for adolescent depression in a primary-care paediatric setting in India. Child Adolesc Psychiatry Ment Health. 2007;9:8.
Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36:980–8.
Moffitt TE, Harrington H, Caspi A, Kim-Cohen J, Goldberg D, Gregory AM, et al. Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry. 2007;64:651–60.
Essau CA, Conradt J, Petermann F. Course and outcome of anxiety disorders in adolescents. J Anxiety Disord. 2002;16:67–81.
Karlsson L, Pelkonen M, Ruuttu T, Kiviruusu O, Heilä H, Holi M, et al. Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders. Eur Child Adolesc Psychiatry. 2006;15:220–31.
Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol. 2001;110:585–99.
Lewinsohn PM, Holm-Denoma JM, Small JW, Seeley JR, Joiner Jr TE. Separation anxiety disorder in childhood as a risk factor for future mental illness. J Am Acad Child Adolesc Psychiatry. 2008;47:548–55.
Kendall PC, Brady EU. Comorbidity in the anxiety disorders of childhood. In: Craig KD, Dobson KS, eds. Anxiety and Depression in Adults and Children. Newbury Park: Sage Publications; 1995.
Saulsman LM. Depression, anxiety, and the MCMI-III: Construct validity and diagnostic efficiency. J Pers Assess. 2011;93:76–83.
Schoevers RA, Van HL, Koppelmans V, Kool S, Dekker JJ. Managing the patient with co-morbid depression and an anxiety disorder. Drugs. 2008;68:1621–34.
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Supported by an intramural grant from Child Development Centre, Thiruvanathapuram.
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Russell, P.S.S., Nair, M.K.C., Shankar, S.R. et al. ADad 7: Relationship Between Depression and Anxiety Disorders Among Adolescents in a Rural Community Population in India. Indian J Pediatr 80 (Suppl 2), 165–170 (2013). https://doi.org/10.1007/s12098-013-1232-3
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DOI: https://doi.org/10.1007/s12098-013-1232-3