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Limited Functioning After Remission of an Anxiety Disorder as a Trait Effect Versus a Scar Effect: Results of a Longitudinal General Population Study

J Clin Psychiatry 2018;79(3):16m11256

Objective: After remission of an anxiety disorder, subjects often experience persistent functional impairments. We examined whether impairments in mental and physical functioning following remission are a continuation of premorbid lower functioning (trait effect), due to impairments that develop during the anxiety disorder and persist beyond recovery (scar effect), or both.

Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a prospective psychiatric epidemiologic study among the general population with a 3-wave design (6-year follow-up, with the study starting in 2007 and ending in 2015). DSM-IV anxiety disorders were measured with the Composite International Diagnostic Interview. Functioning was assessed with the Medical Outcomes Study 36-Item Short Form Health Survey. We evaluated trait effects using between-subjects comparison and scar effects using within-subjects comparisons.

Results: Compared to healthy controls, individuals with anxiety disorders had showed significant impairment in mental functioning (β = 11.6 [SE = 0.78]; P < .001) and physical functioning (β = 12.1 [SE = 1.14]; P < .001) prior to the onset of the anxiety disorder (n = 199), indicating a trait effect. In those who developed an anxiety disorder that remitted within the 6-year follow-up (n = 92), functioning after remission (at second follow-up) was similar to functioning before onset (at baseline), indicating that a scar effect was absent. A trend toward mental scarring was visible in the subgroup with recurrent anxiety disorders (P = .03).

Conclusions: Persistent functional limitations following remission largely reflect a preexisting trait effect. Since lower levels of functioning are associated with relapse, investments in functional improvement seem worthwhile. Relapse prevention might help to prevent mental scarring.