title: Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study.
abstract: OBJECTIVE
  The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia.
  
  
  METHODS
  Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence.
  
  
  RESULTS
  Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia.
  
  
  CONCLUSIONS
  These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.
authors.affiliation: Department of Psychiatry and Human Behavior, Brown University, RI 02906, USA. Steven_Bruce_PhD@Brown.edu
authors.forename: Steven E
authors.initials: SE
authors.lastname: Bruce
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Yonkers
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.forename: Jane L
authors.initials: JL
authors.lastname: Eisen
authors.forename: Risa B
authors.initials: RB
authors.lastname: Weisberg
authors.forename: Maria
authors.initials: M
authors.lastname: Pagano
authors.forename: M Tracie
authors.initials: MT
authors.lastname: Shea
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D016584:Panic Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D010698:Phobic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011336:Probability; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis