Archives of Women's Mental Health

, Volume 19, Issue 3, pp 491–499 | Cite as

Anxiety and physical health problems increase the odds of women having more severe symptoms of depression

  • Sandra J. Weiss
  • Diana I. Simeonova
  • Mary C. Kimmel
  • Cynthia L. Battle
  • Pauline M. Maki
  • Heather A. Flynn
Original Article


Severely depressed women incur substantial disability and suicide risk, necessitating an understanding of factors that may contribute to severe depression. The purpose of this research was to determine the degree to which age, physical morbidity, anxiety, and hormonal status predict the likelihood of severe depression among women with mood disorders (n = 298). Data arose from a standardized battery of measures in a multi-center clinical registry of patients with mood disorders. The women were being treated at 17 participating sites of the National Network of Depression Centers. Results of logistic regression analyses indicate that a woman’s level of anxiety was the strongest predictor of her likelihood of having severe depression (Exp(B) = 1.33, p = .000), including thoughts of death or suicide. The number of physical health problems that a woman reported was also a significant predictor (Exp(B) = 1.09, p = .04). Neither age nor hormonal status was significant in the final model, although a trend was observed for women with surgically induced menopause to have more severe depression. Findings support the need to work closely with medical practitioners to address physical health problems as part of the treatment plan for depression and to give comorbid anxiety and depression equal priority in symptom management.


Depression Anxiety Physical health Suicidality Hysterectomy 



This study was made possible by a research collaboration supported by the National Network of Depression Centers (NNDC), an inter-dependent consortium of academic depression centers. The data analyses and views expressed in this article are those of the authors and do not necessarily reflect the position of the NNDC.

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures involving women were in accordance with ethical standards of the participating institutions’ research committees.


  1. Anderson RJ, Freedland KE, Lustman PJ (2001) The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 24:1069–1078CrossRefPubMedGoogle Scholar
  2. Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graff R, Vollebergh W et al (2003) The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res 12(1):3–21CrossRefPubMedGoogle Scholar
  3. Antonaci F, Nappi G, Galli F, Manzoni GC, Calabresi P, Costa A (2011) Migraine and psychiatric comorbidity: a review of clinical findings. J Headache Pain 12:115–125CrossRefPubMedPubMedCentralGoogle Scholar
  4. Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA et al (2014) Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association of Psychopharmacology. J Psychopharmacol 28(5):403–439CrossRefPubMedGoogle Scholar
  5. Bebbington P, Dunn G, Jenkins R, Lewis G, Brugha T, Farrell M et al (2003) The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Int Rev Psychiatry 15(1–2):74–83CrossRefPubMedGoogle Scholar
  6. Bennett H, Einarson A, Taddioi A, Koren G, Einarson T (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103(4):698–709CrossRefPubMedGoogle Scholar
  7. Blasco-Fontecilla H, Alegria AA, Delgado-Gomez D, Legido-Gil T, Saiz-Ruiz J, Oquendo MA et al. (2012) Age of first suicide attempt in men and women: an admixture analysis. The Scientific World Journal Article ID: a825189Google Scholar
  8. Bromberger JT, Schott LL, Kravitz HM, Sowers M, Avis NE, Gold EB et al (2010) Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women’s Health Across the Nation (SWAN). Arch Gen Psychiatry 67(6):598–607CrossRefPubMedPubMedCentralGoogle Scholar
  9. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 330(7493):702CrossRefPubMedPubMedCentralGoogle Scholar
  10. Celano C, Huffman J (2011) Depression and cardiac disease: a review. Cardiol Rev 19(3):130–142CrossRefPubMedGoogle Scholar
  11. Centers for Disease Control and Prevention (2012) Web-based injury statistics query and reporting system (WISQARS) [Internet]. Atlanta (GA); Statistics Available from:
  12. Cheatle MD, Wasser T, Foster C, Olugbodi A, Bryan J (2014) Prevalence of suicidal ideation in patients with chronic non-cancer pain referred to a behaviorally based pain program. Pain Physicians 17(30):E359–E367Google Scholar
  13. Chou SP, Huang B, Goldstein R, Grant BF (2013) Temporal associations between physical illnesses and mental disorders—results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Compr Psychiatry 54(6):627–638CrossRefPubMedPubMedCentralGoogle Scholar
  14. Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL (2006) Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry 63(4):385–390CrossRefPubMedGoogle Scholar
  15. Colvin A, Richardson G, Cyranowski J, Youk A, Bromberger J (2014) Does family history of depression predict major depression in midlife women? Study of Women’s Health across the Nation Mental Health Study (SWAN MHS). Arch Womens Ment Health 17:269–278CrossRefPubMedPubMedCentralGoogle Scholar
  16. Delahaije DH, Dirksen CD, Peeters LL, Smits LJ (2013) Anxiety and depression following preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome: a systematic review. Acta Obstet Gynecol Scand 92(7):746–761CrossRefPubMedGoogle Scholar
  17. Dennerstein L, Guthrie JR, Clark M, Lehert P, Henderson VW (2004) A population-based study of depressed mood in middle-aged, Australian-born women. Menopause 11(5):563–568CrossRefPubMedGoogle Scholar
  18. Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP (2014) Stresses and disability in depression across gender. Depression Research and Treatment Article ID:735307:1–8. Available from: 10.1155/2014/735307
  19. Farquhar CM, Harvey SA, Yu Y, Sadler L, Stewart AW (2006) A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy. Am J Obstet Gynecol 194(3):711–717CrossRefPubMedGoogle Scholar
  20. Frasure-Smith N, Lesperance F (2008) Depression and anxiety as predictors of 2 year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry 65(1):62–71CrossRefPubMedGoogle Scholar
  21. Freeman EW, Sammel MD, Lin H, Nelson DB (2006) Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry 63(4):375–382CrossRefPubMedGoogle Scholar
  22. Freeman E, Sammel M, Liu L, Gracia C, Nelson D, Hollander L (2004) Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry 61(1):62–70CrossRefPubMedGoogle Scholar
  23. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083CrossRefPubMedGoogle Scholar
  24. Gerrits M, van Oppen P, Leone S, van Marwijk H, van der Horst H, Penninx B (2014) Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders. BMC Psychiatry 14(1):187CrossRefPubMedPubMedCentralGoogle Scholar
  25. Giardinelli L, Innocenti A, Benni L, Stefanini MC, Lino G, Lunardi C et al (2012) Depression and anxiety in the perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health 15(1):21–30CrossRefPubMedGoogle Scholar
  26. Guitierrez-Lobos K, Scherer M, Anderer P, Katschnig H (2002) The influence of age on the female/male ratio of treated incidence rates in depression. BMC Psychiatry 2:3CrossRefGoogle Scholar
  27. Hinz A, Finck C, Gomez Y, Daig I, Glaesmer H, Singer S (2014) Anxiety and depression in the general population in Colombia: reference values of the Hospital Anxiety and Depression Scale. Soc Psychiatry Psychiatr Epidemiol 49(1):41–49CrossRefPubMedGoogle Scholar
  28. IIgen M, Zivin K, McCammon R, Valenstein M (2008) Pain and suicidal thoughts, plans and attempts in the United States. Gen Hosp Psychiatry 30(67):521–527Google Scholar
  29. Karp JF, Scott J, Houck P, Reynolds CF, Kupfer DJ, Frank E (2005) Pain predicts longer time to remission during treatment of recurrent depression. J Clin Psychiatry 66(5):591–597CrossRefPubMedGoogle Scholar
  30. Katon WJ (2003) Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 54(3):216–226CrossRefPubMedGoogle Scholar
  31. Katon W, Sullivan MD (1990) Depression and chronic medical illness. J Clin Psychiatry 51:3–11PubMedGoogle Scholar
  32. Kazhimannil KA, Pereira M, Harlow B (2009) Association between diabetes and perinatal depression among low-income mothers. JAMA 301(8):842–847CrossRefGoogle Scholar
  33. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR et al (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289(23):3095–3105CrossRefPubMedGoogle Scholar
  34. Koike AK, Unutzer J, Wells KB (2002) Improving the care for depression in patients with comorbid medical illness. Am J Psychiatry 159(10):1738–1745CrossRefPubMedGoogle Scholar
  35. Kroenke K, Spitzer RL, Williams JB, Linzer M, Hahn SR, deGruy FV et al (1994) Physical symptoms in primary care: predictors of psychiatric disorders and functional impairment. Arch Fam Med 3(9):774–779CrossRefPubMedGoogle Scholar
  36. Kroenke K, Spitzer R, Williams J, Lowe B (2010) The patient health questionnaire somatic, anxiety and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 32(4):345–359CrossRefPubMedGoogle Scholar
  37. Lamers F, Oppen PV, Comijs HC, Smit JH, Spinhoven P, van Balkom et al (2011) Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry 72(3):341–348CrossRefPubMedGoogle Scholar
  38. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14CrossRefPubMedPubMedCentralGoogle Scholar
  39. Marcus S, Heringhausen J (2009) Depression in childbearing women: when depression complicates pregnancy. Prim Care 36(1):151–165CrossRefPubMedPubMedCentralGoogle Scholar
  40. Massie MJ (2004) Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004(32):57–71CrossRefGoogle Scholar
  41. Matcham F, Rayner L, Steer S, Hotopf M (2013) The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 52(12):2136–2148CrossRefGoogle Scholar
  42. Moses-Kolko E, Price J, Shah N, Berga S, Sereika SM, Fisher PM et al (2011) Age, sex and reproductive hormone effects on brain serotonin-1A and serotonin-2A receptor binding in a healthy population. Neuropsychopharmacology 36(13):2729–2740CrossRefPubMedPubMedCentralGoogle Scholar
  43. Ohayon M (2004) Specific characteristics of the pain/depression association in the general population. J Clin Psychiatry 65(Suppl 12):5–9PubMedGoogle Scholar
  44. Oquendo MA, Bongiovi-Garcia ME, Galfalvy H, Grunebaum MF, Burke AK, Mann JJ (2007) Sex differences in clinical predictors of suicidal acts after major depression: a prospective study. Am J Psychiatry 164(1):134–141CrossRefPubMedPubMedCentralGoogle Scholar
  45. Otto MW, Smits JA, Reese HE (2005) Combined psychotherapy and pharmacotherapy for mood and anxiety disorders in adults: review and analysis. Clin Psychol Sci Pract 12(1):72–86CrossRefGoogle Scholar
  46. Parker G, Brotchie H (2010) Gender differences in depression. Int Rev Psychiatry 22(5):429–436CrossRefPubMedGoogle Scholar
  47. Poleshuck EL, Bair MJ, Kroenke K, Watts A, Tu X, Giles DE (2009) Pain and depression in gynecology patients. Psychosom 50(3):270–276CrossRefGoogle Scholar
  48. Potvin O, Bergua V, Swendsen J, Mellon C, Tzourio C, Ritchie K et al (2013) Anxiety and 10-year risk of incident and recurrent depressive symptomatology in older adults. Depression Anxiety 30(6):554–563CrossRefPubMedGoogle Scholar
  49. Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295CrossRefPubMedGoogle Scholar
  50. Rocca WA, Grossardt BR, Geda YE, Gostout BS, Bower JH, Maraganore DM et al (2008) Long-term risk of depressive and anxiety symptoms after early bilateral oophorectomy. Menopause 15(6):1050–1059CrossRefPubMedGoogle Scholar
  51. Roy T, Lloyd CE (2012) Epidemiology of depression and diabetes: a systematic review. J Affect Disord 142:S8–S21CrossRefPubMedGoogle Scholar
  52. Roy-Byrne PP, Stang P, Wittchen HU, Ustun B, Walters EE, Kessler RC (2000) Lifetime panic-depression comorbidity in the National Comorbidity Survey: association with symptoms, impairment, course and help-seeking. Br J Psychiatry 176(3):229–235CrossRefPubMedGoogle Scholar
  53. Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN et al (2003) The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry 54(5):573–583CrossRefPubMedGoogle Scholar
  54. SAMHSA’s National Survey on Drug Use and Health (NSDUH) [Internet] (2015) Bethesda (MD): National Institute of Mental Health. Available from:
  55. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN (2003) The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum 49(2):156–163CrossRefPubMedGoogle Scholar
  56. Schaffer A, Levitt AJ, Bagby RM, Kennedy SH, Levitan RD, Joffe RT (2000) Suicidal ideation in major depression: sex differences and impact of comorbid anxiety. Can J Psychiatry 45(9):822–826PubMedGoogle Scholar
  57. Schmid P, Rubinow D (2006) Reproductive ageing, sex steroids and depression. J Br Menopause Soc 12(4):178–185CrossRefGoogle Scholar
  58. Schofield CA, Battle CL, Howard M, Ortiz-Hernandez S (2014) Symptoms of anxiety disorders in a perinatal psychiatric sample: a chart review. J Nerv Ment Dis 202(2):154–160CrossRefPubMedGoogle Scholar
  59. Shah A (2012) Suicide rates: age-associated trends and their correlates. J Inj Violence Res 4(2):79–86CrossRefPubMedPubMedCentralGoogle Scholar
  60. Stegmann ME, Ormel J, de Graaf R, Haro JM, de Girolamo G, Demyttenaere K et al (2010) Functional disability as an explanation of the associations between chronic physical conditions and 12-month major depressive episode. J Affect Disord 124(1):38–44CrossRefPubMedPubMedCentralGoogle Scholar
  61. Stolwijk C, van Tubergen A, Ramiro S, Essers I, Blaauw M, van der Heijde D et al (2014) Aspects of validity of the self-administered comorbidity questionnaire in patients with ankylosing spondylitis. Rheumatology (Oxford) 53(6):1054–1064CrossRefGoogle Scholar
  62. Trivedi MH (2004) The link between depression and physical symptoms. Prim Care Companion. J Clin Psychiatry 6(Suppl 1):12–16Google Scholar
  63. Weiss S, Haber J, Horowitz J, Stuart G, Wolfe B (2009) The inextricable nature of mental and physical health: implications for integrative care. J Am Psychiatr Nurs Assoc 15:371–382CrossRefGoogle Scholar
  64. Woods N, Smith-DiJulio K, Percival D, Tao E, Mariella A, Mitchell S (2008) Depressed mood during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause 15(2):223–232CrossRefPubMedGoogle Scholar
  65. World Health Organization (WHO) [Internet] (2012) Depression Fact Sheet Number 369, Available from:
  66. Yates WR, Mitchell J, Rush AJ, Trivedi MH, Wisniewski SR, Warden D et al (2004) Clinical features of depressed outpatients with and without co-occurring general medical conditions in STAR*D. Gen Hosp Psychiatry 26(6):421–429CrossRefPubMedGoogle Scholar
  67. Zimmerman M, Chelminski I (2003) Clinician recognition of anxiety disorders in depressed outpatients. J Psychiatr Res 37(4):325–333CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Sandra J. Weiss
    • 1
  • Diana I. Simeonova
    • 2
  • Mary C. Kimmel
    • 3
  • Cynthia L. Battle
    • 4
  • Pauline M. Maki
    • 5
  • Heather A. Flynn
    • 6
  1. 1.Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Psychiatry and Behavioral SciencesEmory UniversityAtlantaUSA
  3. 3.Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Psychiatry and Human BehaviorBrown University and Butler Hospital Psychosocial Research ProgramProvidenceUSA
  5. 5.Departments of Psychiatry and PsychologyUniversity of Illinois at ChicagoChicagoUSA
  6. 6.Department of Behavioral Science and Social MedicineFlorida State UniversityTallahasseUSA

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