Key Takeaways
Extended Takeaways
- Diagnostic complexity was substantial: among 1,783 patients with a current depressive or anxiety disorder, 40% had only 1 disorder, 30% had 2 depressive or anxiety disorders, and another 30% had ≥ 3 depressive or anxiety disorders.
- Comorbidity varied by subtype, with dysthymia showing higher anxiety comorbidity than major depressive disorder, while generalized anxiety disorder had the highest depressive comorbidity and agoraphobia alone the lowest; clinicians should be especially alert for mixed presentations in dysthymia and generalized anxiety disorder.
- Educational differences did not remain independently associated with comorbidity once clinical variables were added, suggesting that symptom burden and illness course may explain sociodemographic disparities better than education alone.
- Among comorbid cases, simultaneous onset was not rare, occurring in 25% overall, and generalized anxiety disorder most often began at the same time as depression at 41%, which argues against assuming a fixed anxiety-first sequence in every patient.
- Social phobia had the earliest mean age at onset and preceded depressive disorders in 67% of cases, supporting early identification of social anxiety symptoms as a potential opportunity to detect patients at risk for later depressive illness.
- When depression preceded anxiety, the clinical profile was somewhat less severe than when anxiety came first, with shorter duration of depressive and/or anxiety symptoms, fewer fear symptoms, and later age at onset of the first disorder.
