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Original Research

Comorbidity Patterns of Anxiety and Depressive Disorders in a Large Cohort Study: the Netherlands Study of Depression and Anxiety (NESDA)

Femke Lamers, PhD; Patricia van Oppen, PhD; Hannie C. Comijs, PhD; Johannes H. Smit, PhD; Philip Spinhoven, PhD; Anton J. L. M. van Balkom, MD, PhD; Willem A. Nolen, MD, PhD; Frans G. Zitman, MD, PhD; Aartjan T. F. Beekman, MD, PhD; and Brenda W. J. H. Penninx, PhD

Published: January 25, 2011

Article Abstract

Background: Comorbidity of depressive and anxiety disorders is common and has been shown to be a consistent predictor of chronicity. Comorbidity patterns among specific depressive and anxiety disorders have not been extensively reported. This study examines comorbidity patterns and temporal sequencing of separate depressive and anxiety disorders using data from a large psychiatric cohort.

Method: Baseline data (N = 1,783) of the Netherlands Study of Depression and Anxiety, collected between September 2004 and February 2007, were used. Current and lifetime comorbidity rates for depressive and anxiety disorders (DSM-IV-TR criteria) were calculated. Associations of comorbidity with sociodemographic, vulnerability, and clinical characteristics, and temporal sequencing of disorders were examined.

Results: Of those with a depressive disorder, 67% had a current and 75% had a lifetime comorbid anxiety disorder. Of persons with a current anxiety disorder, 63% had a current and 81% had a lifetime depressive disorder. Comorbidity of depressive and anxiety disorders was associated with more childhood trauma (OR = 1.19; 95% CI, 1.06-1.33), higher neuroticism (OR = 1.05; 95% CI, 1.02-1.08), earlier age at onset of first disorder (OR = 1.59; 95% CI, 1.22-2.07), longer duration of depressive and/or anxiety symptoms (OR = 1.01; 95% CI, 1.01-1.01), and higher symptom severity (ORs ranging from 1.01 to 1.03; all P values < .05). In 57% of comorbid cases, anxiety preceded depression, and in 18%, depression preceded anxiety. Comorbidity with preceding depression compared to preceding anxiety was associated with a shorter duration of symptoms of depressive and/or anxiety symptoms (OR = 0.99; 95% CI, 0.98-0.99), earlier age at first onset (OR = 0.46; 95% CI, 0.31-0.68), and fewer fear symptoms (OR = 0.98; 95% CI, 0.97-0.99).

Conclusions: Comorbidity rates in anxiety and depressive disorders were very high, indicating that it is advisable to assess both disorders routinely regardless of the primary reason for consultation. This is especially important since comorbid patients showed a specific vulnerability pattern, with more childhood trauma, neuroticism, and higher severity and duration of symptoms.

J Clin Psychiatry 2011;72(3):341-348′ ‹’ ‹

Submitted: April 14, 2010; accepted August 30, 2010.

Online ahead of print: January 25, 2011 (doi:10.4088/JCP.10m06176blu).

Corresponding author: Femke Lamers, PhD, Department of Psychiatry, VU University Medical Center, AJ Ernststraat 1887, 1081 HL Amsterdam, The Netherlands (

© Copyright 2011 Physicians Postgraduate Press, Inc.’ ‹

Volume: 72

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