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Risk factors of chronic course of anxiety and depressive disorders: a 3-year longitudinal study in the general population

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Abstract

Background

Risk factors of a chronic course of anxiety and depressive disorders were previously studied using a limited definition of recovery, i.e. remission of the index disorder. However, frequently, other mental disorders are present at follow-up. Thus, the course of anxiety and depressive disorders was represented too rosy and the identified determinants may not apply when using a broader, more realistic definition. Additionally, physical health risk factors have often been ignored.

Methods

Data were used from two waves of the Netherlands Mental Health Survey and Incidence Study-2 including 509 respondents with 12-month anxiety disorder (panic disorder, social phobia, agoraphobia or generalized anxiety disorder) or/and major depressive disorder at baseline. Chronic course was defined as (1) presence of index disorder; and (2) presence of any anxiety, mood or substance use disorder (overall course) during the subsequent three years. Regression models were built with sociodemographic, clinical, and lifestyle/physical health indicators. Predictive accuracy was evaluated with area under the curve (AUC).

Results

Chronic course of the index disorder was present among 24.8% of cases, whereas 38.7% had a chronic overall course. The accuracy of prediction of chronic course of the index disorder was suboptimal (AUC = 0.68) compared to prediction of overall course (AUC = 0.75). The main risk factors were baseline number of mental disorders, neuroticism, childhood abuse, parental psychopathology and alcohol use. Lifestyle and physical health indicators were marginally relevant.

Conclusion

Transdiagnostic risk factors are important in predicting overall course of anxiety and depressive disorders but cannot accurately predict chronic course of the index disorder.

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Data availability

The data on which this manuscript is based are not publicly available. However, data from NEMESIS-2 are available upon request. The Dutch ministry of health financed the data and the agreement is that these data can be used freely under certain restrictions and always under the supervision of the Principal Investigator (PI) of the study. Thus, some access restrictions do apply to the data. The PI of the study is second author of this paper and can at all times be contacted to request data. At any time, researchers can contact the PI of NEMESIS-2 and submit a research plan, describing its background, research questions, variables to be used in the analyses, and an outline of the analyses. If a request for data sharing is approved, a written agreement will be signed stating that the data will only be used for addressing the agreed research questions described and not for other purposes.

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Funding

The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) is conducted by the Netherlands Institute of Mental Health and Addiction (Trimbos Institute) in Utrecht. Financial support has been received from the Ministry of Health, Welfare and Sport, with supplementary support from the Netherlands Organization for Health Research and Development (ZonMw) and the Genetic Risk and Outcome of Psychosis (GROUP) investigators. The funding sources had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

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Author notes

  1. Brenda W. J. H. Penninx and Neeltje M. Batelaan equal contributors.

Authors and Affiliations

  1. Amsterdam UMC, location Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health, Mental Health program and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands

    Karin C. P. Remmerswaal, Anton J. L. M. van Balkom, Brenda W. J. H. Penninx & Neeltje M. Batelaan

  2. Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands

    Margreet ten Have & Ron de Graaf

Authors
  1. Karin C. P. Remmerswaal
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  2. Margreet ten Have
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  3. Ron de Graaf
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  4. Anton J. L. M. van Balkom
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  5. Brenda W. J. H. Penninx
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Contributions

KR wrote manuscript, conducted literature searches MH conducted statistical analyses BP and NB designed and supervised the study All authors reviewed the manuscript

Corresponding author

Correspondence to Karin C. P. Remmerswaal.

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Remmerswaal, K.C.P., ten Have, M., de Graaf, R. et al. Risk factors of chronic course of anxiety and depressive disorders: a 3-year longitudinal study in the general population. Soc Psychiatry Psychiatr Epidemiol (2023). https://doi.org/10.1007/s00127-023-02591-0

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