TY - JOUR
T1 - The 9-year clinical course of depressive and anxiety disorders
T2 - New NESDA findings
AU - Solis, Ericka C.
AU - van Hemert, Albert M.
AU - Carlier, Ingrid V. E.
AU - Wardenaar, Klaas J.
AU - Schoevers, Robert A.
AU - Beekman, Aartjan T. F.
AU - Penninx, Brenda W. J. H.
AU - Giltay, Erik J.
N1 - Funding Information: The infrastructure for the NESDA study ( www.nesda.nl ) is funded through the Geestkracht program of the Netherlands organization for Health Research and Development (ZonMw, grant number 10–000–1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZ InGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Scientific Institute for Quality of Healthcare (IQ healthcare), Netherlands Institute for Health Services Research (NIVEL), and Netherlands Institute of Mental Health and Addiction (Trimbos)). All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: The NESDA study is funded through the Geestkracht program of the Netherlands organization for Health Research and Development (ZonMw, grant number 10–000–1002) and is supported by participating universities and mental health care organizations. The corresponding author is also supported by the ZonMw Doelmatigheidsonderzoek program (ZonMw, grant number 843–002–709, Projectleader: I.V.E. Carlier). These sponsors have not had any role in the conducted analyses, writing the manuscript and the decision to publish these results. Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: In longitudinal research, switching between diagnoses should be considered when examining patients with depression and anxiety. We investigated course trajectories of affective disorders over a nine-year period, comparing a categorical approach using diagnoses to a dimensional approach using symptom severity. Method: Patients with a current depressive and/or anxiety disorder at baseline (N = 1701) were selected from the Netherlands Study of Depression and Anxiety (NESDA). Using psychiatric diagnoses, we described ‘consistently recovered,’ ‘intermittently recovered,' ‘intermittently recurrent’, and ‘consistently chronic’ at two-, four-, six-, and nine-year follow-up. Additionally, latent class growth analysis (LCGA) using depressive, anxiety, fear, and worry symptom severity scores was used to identify distinct classes. Results: Considering the categorical approach, 8.5% were chronic, 32.9% were intermittently recurrent, 37.6% were intermittently recovered, and 21.0% remained consistently recovered from any affective disorder at nine-year follow-up. In the dimensional approach, 66.6% were chronic, 25.9% showed partial recovery, and 7.6% had recovered. Limitations: 30.6% of patients were lost to follow-up. Diagnoses were rated by the interviewer and questionnaires were completed by the participant. Conclusions: Using diagnoses alone as discrete categories to describe clinical course fails to fully capture the persistence of affective symptoms that were observed when using a dimensional approach. The enduring, fluctuating presence of subthreshold affective symptoms likely predisposes patients to frequent relapse. The commonness of subthreshold symptoms and their adverse impact on long-term prognoses deserve continuous clinical attention in mental health care as well further research.
AB - Background: In longitudinal research, switching between diagnoses should be considered when examining patients with depression and anxiety. We investigated course trajectories of affective disorders over a nine-year period, comparing a categorical approach using diagnoses to a dimensional approach using symptom severity. Method: Patients with a current depressive and/or anxiety disorder at baseline (N = 1701) were selected from the Netherlands Study of Depression and Anxiety (NESDA). Using psychiatric diagnoses, we described ‘consistently recovered,’ ‘intermittently recovered,' ‘intermittently recurrent’, and ‘consistently chronic’ at two-, four-, six-, and nine-year follow-up. Additionally, latent class growth analysis (LCGA) using depressive, anxiety, fear, and worry symptom severity scores was used to identify distinct classes. Results: Considering the categorical approach, 8.5% were chronic, 32.9% were intermittently recurrent, 37.6% were intermittently recovered, and 21.0% remained consistently recovered from any affective disorder at nine-year follow-up. In the dimensional approach, 66.6% were chronic, 25.9% showed partial recovery, and 7.6% had recovered. Limitations: 30.6% of patients were lost to follow-up. Diagnoses were rated by the interviewer and questionnaires were completed by the participant. Conclusions: Using diagnoses alone as discrete categories to describe clinical course fails to fully capture the persistence of affective symptoms that were observed when using a dimensional approach. The enduring, fluctuating presence of subthreshold affective symptoms likely predisposes patients to frequent relapse. The commonness of subthreshold symptoms and their adverse impact on long-term prognoses deserve continuous clinical attention in mental health care as well further research.
KW - Anxiety
KW - Chronicity
KW - Depression
KW - Diagnostic switching
KW - Nine-year course
KW - Prognosis
UR - http://www.scopus.com/inward/record.url?scp=85110316151&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jad.2021.08.108
DO - https://doi.org/10.1016/j.jad.2021.08.108
M3 - Article
C2 - 34706441
SN - 0165-0327
VL - 295
SP - 1269
EP - 1279
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -