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A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population

The HUNT study

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Abstract

Background

Our aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level status after 4 years in a general population sample.

Methods

Prospective cohort study. Based on the total score on the Hospital Anxiety and Depression rating scale (HADS-T) in HUNT 2 (1995–1997), three groups were identified: Level 3 (n = 654, score ≥ 25 points), Level 2 (n = 654, score 19–24 points), and Level 1 (n = 1,308, score < 19 points). The groups were followed up with a mailed questionnaire after 4 years.

Results

Among the 1,326 (53% response rate) who participated in the follow-up, 816 (62%) had not changed symptom level. The number of participants that had crossed the HADS-T caseness level (19 points) was the same in both directions. In non-cases at baseline (Level 1), lack of friends (OR 2.34, 95% CI 1.28–4.27, P = 0.006) and previous episodes of depression (OR 2.90, 95% CI 1.76–4.78, P < 0.001) predicted HADS-T caseness at follow-up, while higher educational level (OR 0.66, 95% CI 0.46–0.96, P = 0.028) protected from developing caseness level of anxiety and depression. In HADS-T cases (Levels 2 and 3) at baseline, previous episode(s) of depression (OR 0.36, 95% CI 0.19–0.68, P = 0.002) and being unemployed (OR 0.58, 95% CI 0.34–1.00, P = 0.050) predicted HADS-T caseness at follow-up, whereas a higher educational level (OR 1.83, 95% CI 1.24–2.70, P = 0.002) was associated with remission from HADS-T caseness after 4 years.

Conclusions

Though symptom fluctuation was considerable, conventional HADS-T caseness (≥19 points) was a reliable and valid predictor for high long-term symptom stability of anxiety and depression in our general population sample.

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Acknowledgments

Nord-Trøndelag Health Study (The HUNT Study) is a collaboration between HUNT Research Centre, Faculty of Medicine at the Norwegian University of Science and Technology (NTNU, Verdal), Norwegian Institute of Public Health, and Nord-Trøndelag County Council. The Norwegian Research Council and Health Mid-Norway supplied a research fellow grant for Ottar Bjerkeset, MD, PhD. This study was supported by grants from Sommer’s foundation, Haldis and Josef Andresen’s legacy, and Dedichen’s legacy. We thank Bitte Dillan, Guri H. Kvarme, and Erling Jermstad for their help with organising the data collection and punching the data.

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Authors and Affiliations

  1. Dept. of Psychiatry, Levanger Hospital, Nord-Trøndelag Health Trust, 7600, Levanger, Norway

    Ottar Bjerkeset MD, PhD, Hans M. Nordahl PhD & Sara Larsson MA

  2. HUNT Research Center, Dept. of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Ottar Bjerkeset MD, PhD

  3. Dept. of Psychology, Norwegian University of Science and Technology, Trondheim, Norway

    Hans M. Nordahl PhD

  4. Dept. of Clinical Cancer Research, The Norwegian Radiumhospital, University of Oslo, Oslo, Norway

    Alv A. Dahl MD, PhD

  5. Dept. of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway

    Olav Linaker MD, PhD

  6. Dept. of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Olav Linaker MD, PhD

Authors
  1. Ottar Bjerkeset MD, PhD
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  2. Hans M. Nordahl PhD
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  3. Sara Larsson MA
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  4. Alv A. Dahl MD, PhD
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  5. Olav Linaker MD, PhD
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Correspondence to Ottar Bjerkeset MD, PhD.

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Bjerkeset, O., Nordahl, H.M., Larsson, S. et al. A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population. Soc Psychiat Epidemiol 43, 192–199 (2008). https://doi.org/10.1007/s00127-007-0289-6

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  • DOI: https://doi.org/10.1007/s00127-007-0289-6

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