title: Psychosocial features associated with lifetime comorbidity of major depression and anxiety disorders among a community sample of mid-life women: the SWAN mental health study.
abstract: BACKGROUND
  In clinical samples, comorbidity between depressive and anxiety disorders is associated with greater symptom severity and elevated suicide risk. Less is known, however, regarding the long-term psychosocial impact that a lifetime history of both major depressive disorder (MDD) and one or more anxiety disorders has in community samples. This report evaluates clinical, psychological, social, and stress-related characteristics associated with a lifetime history of MDD and anxiety.
  
  
  METHODS
  Data from 915 women aged 42-52 who were recruited as part of the the Study of Women's Health across the Nation (SWAN) Mental Health Study were used to examine clinical and psychosocial features across groups of women with a lifetime history of MDD alone, anxiety alone, both MDD and anxiety, or neither MDD nor anxiety.
  
  
  RESULTS
  As compared with women with a history of either MDD or anxiety alone, women with a comorbid history were more likely to report recurrent MDD, multiple and more severe lifetime anxiety disorders, greater depressive and anxiety symptoms, diminished social support, and more past-year distressing life events. Exploratory analyses indicated that women with a comorbid history also report more childhood abuse/neglect and diminished self-esteem, as compared with women with a history of either disorder alone.
  
  
  CONCLUSIONS
  Midlife women with a comorbid history that includes both MDD and anxiety disorders report diminished social support, more symptomatic distress, and a more severe and recurrent psychiatric history. Future research is needed to clarify the biological and psychosocial risk factors associated with this comorobid profile, and to develop targeted interventions for this at-risk group. Depression and Anxiety 00:1-8, 2012. © 2012 Wiley Periodicals, Inc.
authors.affiliation: Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. cyranowskijm@upmc.edu
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cyranowski
authors.forename: Laura L
authors.initials: LL
authors.lastname: Schott
authors.forename: Howard M
authors.initials: HM
authors.lastname: Kravitz
authors.forename: Charlotte
authors.initials: C
authors.lastname: Brown
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Thurston
authors.forename: Hadine
authors.initials: H
authors.lastname: Joffe
authors.forename: Karen A
authors.initials: KA
authors.lastname: Matthews
authors.forename: Joyce T
authors.initials: JT
authors.lastname: Bromberger
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D001008:Anxiety Disorders / Q000145:classification / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000145:classification / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012649:Self Concept; D012720:Severity of Illness Index; D012944:Social Support; D013315:Stress, Psychological