title: Comorbid Anxiety and Depression and Their Impact on Cardiovascular Disease in Type 2 Diabetes: The Fremantle Diabetes Study Phase II.
abstract: The aims were to determine whether anxious depression, defined by latent class analysis (LCA), predicts cardiovascular outcomes in type 2 diabetes and to compare the predictive power of anxious depression with Diagnostic & Statistical Manual Versions IV and 5 (DSM-IV/5) categories of depression and generalized anxiety disorder (GAD).
  
  
  
  Prospective observational study of 1,337 type 2 participants. Baseline assessment with the 9-item Patient Health Questionnaire and the GAD Scale; LCA-defined groups with minor or major anxious depression based on anxiety and depression symptoms. Cox modeling used to compare the independent impact of: (1) LCA anxious depression, (2) DSM-IV/5 depression, (3) GAD on incident cardiovascular events and deaths after 4 years.
  
  
  
  LCA minor and major anxious depression was present in 21.9 and 7.8% of participants, respectively, DSM-IV/5 minor and major depression in 6.2 and 6.1%, respectively, and GAD in 4.8%. There were 110 deaths, 31 cardiovascular deaths, and 199 participants had incident cardiovascular events. In adjusted models, minor anxious depression (Hazard ratio (95% confidence intervals): 1.70 (1.15-2.50)) and major anxious depression (1.90 (1.11-3.25)) predicted incident cardiovascular events and major anxious depression also predicted cardiovascular mortality (4.32 (1.35-13.86)). By comparison, incident cardiovascular events were predicted by DSM-IV/5 major depression (2.10 (1.22-3.62)) only and cardiovascular mortality was predicted by both DSM-IV/5 major depression (3.56 (1.03-12.35)) and GAD (5.92 (1.84-19.08)).
  
  
  
  LCA-defined anxious depression is more common than DSM-IV/5 categories and is a strong predictor of cardiovascular outcomes in type 2 diabetes. These data suggest that this diagnostic scheme has predictive validity and clinical relevance.
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia. david.bruce@uwa.edu.au.
authors.forename: David G
authors.initials: DG
authors.lastname: Bruce
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Davis
authors.affiliation: School of Psychiatry & Clinical Neuroscience, University of Western Australia, Crawley, Western Australia, Australia.|Clinical Research Centre, North Metropolitan Health Service Mental Health, Perth, Australia.
authors.forename: Milan
authors.initials: M
authors.lastname: Dragovic
authors.affiliation: School of Medicine & Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Timothy M E
authors.initials: TM
authors.lastname: Davis
authors.affiliation: School of Psychiatry & Clinical Neuroscience, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Sergio E
authors.initials: SE
authors.lastname: Starkstein
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology*; D002423:Cause of Death; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
keywords: anxiety; cardiovascular disease; depression; longitudinal study; type 2 diabetes mellitus