title: Mixed anxiety and depressive disorder outcomes: prospective cohort study in primary care.
abstract: BACKGROUND
  Mixed anxiety and depressive disorder (MADD) is common yet ill-defined, with little known about outcomes.
  
  
  OBJECTIVE
  To determine MADD outcomes over 1 year.
  
  
  METHODS
  We recruited 250 adults attending seven London general practices with mild-moderate distress. Three groups were defined using a diagnostic interview: MADD, other ICD-10 psychiatric diagnosis, no psychiatric diagnosis. We assessed symptoms of distress (General Health Questionnaire-28), quality of life (12-item Short Form Health Survey), general practitioner (GP) diagnosis and consultation rate at baseline, 3 months and 1 year.
  
  
  RESULTS
  Two-thirds of participants with MADD had no significant psychological distress at 3 months (61%) or 1 year (69%). However, compared with those with no diagnosis, individuals had twice the risk of significant distress (incidence rate ratio 2.39, 95% CI 1.29-4.42) at 3 months but not 1 year, and persistently lower quality of life (mental health functioning). There was no significant difference in GP consultation rate/diagnosis.
  
  
  CONCLUSIONS
  The majority with MADD improved, but individuals had an increased risk of significant distress at 3 months and a lower quality of life. As we cannot currently predict those with a poorer prognosis these patients should be actively monitored in primary care.
authors.affiliation: Research Department of Primary Care & Population Health, Hampstead Campus, University College London, London, UK. k.walters@ucl.ac.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Walters
authors.forename: Marta
authors.initials: M
authors.lastname: Buszewicz
authors.forename: Scott
authors.initials: S
authors.lastname: Weich
authors.forename: Michael
authors.initials: M
authors.lastname: King
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D055815:Young Adult