title: Does relational dysfunction mediate the association between anxiety disorders and later depression? Testing an interpersonal model of comorbidity.
abstract: BACKGROUND
  Anxiety disorders tend to precede onset of comorbid depression. Several researchers have suggested a causal role for anxiety in promoting depressive episodes, but few studies have identified specific mechanisms. The current study proposes an interpersonal model of comorbidity, where anxiety disorders disrupt interpersonal functioning, which in turn elevates risk for depression.
  
  
  METHODS
  At age 15 (T1), 815 adolescents oversampled for maternal depression completed diagnostic interviews, social chronic stress interviews, and self-report measures. At age 20 (T2), participants repeated all measures and reported on self-perceived interpersonal problems. At approximately age 23 (T3), a subset of participants (n = 475) completed a self-report depressive symptoms measure.
  
  
  RESULTS
  Consistent with other samples, anxiety disorders largely preceded depressive disorders. Low sociability and interpersonal oversensitivity mediated the association between T1 social anxiety disorder and later depression (including T2 depressive diagnosis and T3 depressive symptoms), controlling for baseline. Interpersonal oversensitivity and social chronic stress similarly mediated the association between generalized anxiety disorder before age 15 and later depression.
  
  
  CONCLUSIONS
  Interpersonal dysfunction may be one mechanism through which anxiety disorders promote later depression, contributing to high comorbidity rates.
authors.affiliation: Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, New York; Department of Psychology, University of California, Los Angeles, California.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Starr
authors.forename: Constance
authors.initials: C
authors.lastname: Hammen
authors.forename: Nicole Phillips
authors.initials: NP
authors.lastname: Connolly
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008960:Models, Psychological; D010698:Phobic Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology; D055815:Young Adult
keywords: comorbidity; depressive disorder; generalized anxiety disorder; interpersonal relations; social anxiety disorder; social phobia
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