Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D.
BACKGROUND
Anxious depression, defined as Major Depressive Disorder (MDD) with high levels of anxiety symptoms, may represent a relatively common depressive subtype, with distinctive features.


OBJECTIVE
The objective of this study was to determine the prevalence of anxious depression and to define its clinical correlates and symptom patterns.


METHODS
Baseline clinical and sociodemographic data were collected on 1450 subjects participating in the STAR*D study. A baseline Hamilton Rating Scale for Depression (HAM-D) Anxiety/ Somatization factor score of > or =7 was considered indicative of anxious depression. The types and degree of concurrent psychiatric symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ), by recording the number of items endorsed by study participants for each diagnostic category. MDD symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology (IDS-C30).


RESULTS
The prevalence of anxious depression in this population was 46 %. Patients with anxious MDD were significantly more likely to be older, unemployed, less educated, more severely depressed, and to have suicidal ideation before and after adjustment for severity of depression. As far as concurrent psychiatric symptoms are concerned, patients with anxious depression were significantly more likely to endorse symptoms related to generalized anxiety, obsessive compulsive, panic, post-traumatic stress, agoraphobia, hypochondriasis, and somatoform disorders before and after adjustment for severity of depression. Anxious-depression individuals were also significantly less likely to endorse IDS-C30 items concerning atypical features, and were significantly more likely to endorse items concerning melancholic/endogenous depression features.


CONCLUSIONS
This study supports specific clinical and sociodemographic correlates of MDD associated with high levels of anxiety (anxious depression).
Fava
Maurizio
M
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. mfava@partners.org
Alpert
Jonathan E
JE
Carmin
Cheryl N
CN
Wisniewski
Stephen R
SR
Trivedi
Madhukar H
MH
Biggs
Melanie M
MM
Shores-Wilson
Kathy
K
Morgan
Don
D
Schwartz
Terry
T
Balasubramani
G K
GK
Rush
A John
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D010555:Personality Inventory; D011320:Primary Health Care; D011446:Prospective Studies; D013001:Somatoform Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D013223:Statistics as Topic; D016896:Treatment Outcome
D000928:Antidepressive Agents