Incidence and Risk Patterns of Anxiety and Depressive Disorders and Categorization of Generalized Anxiety Disorder

Beesdo, Katja PhD
Pine, Daniel S. MD
Lieb, Roselind PhD
Wittchen, Hans-Ulrich PhD

Author Affiliations: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany (Drs Beesdo and Wittchen); Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland (Dr Pine); Max Planck Institute of Psychiatry, Munich, Germany (Drs Lieb and Wittchen); and Institute of Psychology, Epidemiology, and Health Psychology, University of Basel, Switzerland (Dr Lieb).

Correspondence: Katja Beesdo, PhD, Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer St 46, 01187 Dresden, Germany ([email protected]).

Submitted for Publication: November 18, 2008; final revision received February 26, 2009; accepted April 21, 2009.

Financial Disclosure: Dr Beesdo has received speaking honoraria from Pfizer and Eli Lilly. Dr Lieb has received speaking honoraria from Wyeth. Dr Wittchen has received research support from Eli Lilly and speaking honoraria from Novartis and Pfizer; he also has been a consultant for Eli Lilly, GlaxoSmithKline Pharmaceuticals, Novartis, and Pfizer.

Funding/Support: This work is part of the EDSP study, which is funded by grants 01EB9405/6, 01EB 9901/6, EB01016200, 01EB0140, and 01EB0440 from the German Federal Ministry of Education and Research. The field work and analyses were also supported in part by grants LA1148/1-1, WI2246/1-1, WI 709/7-1, and WI 709/8-1 from the Deutsche Forschungsgemeinschaft.

Additional Contributions: Hans-Ulrich Wittchen, PhD, and Roselind Lieb, PhD, are principal investigators of the EDSP study. Kirsten von Sydow, PhD; Gabriele Lachner, PhD; Axel Perkonigg, PhD; Peter Schuster, PhD; Michael Höfler, PhD; Holger Sonntag, DiplPsych; Tanja Brückl, PhD; Elzbieta Garczynski, DiplPsych; Barbara Isensee, PhD; Agnes Nocon, DiplPsych; Chris Nelson, PhD; Hildegard Pfister, DiplInf; Victoria Reed, PhD; Barbara Spiegel, DiplSoz; Andrea Schreier, PhD; Ursula Wunderlich, PhD; Petra Zimmermann, PhD; Katja Beesdo, PhD; Antje Bittner, PhD; Silke Behrendt, PhD; and Susanne Knappe, DiplPsych, are current or past core staff members of the EDSP group and managed field and data work. Jules Angst, MD (Zurich, Switzerland); Jürgen Margraf, PhD (Basel, Switzerland); Günther Esser, PhD (Potsdam, Germany); Kathleen Merikangas, PhD (National Institute of Mental Health, Bethesda, Maryland); Ronald C. Kessler, PhD (Harvard University, Boston, Massachusetts), and Jim van Os, PhD (Maastricht, the Netherlands), provided scientific advice on the design of the EDSP study.

Archives of General Psychiatry 67(1):p 47-57, January 2010.

Context

Controversy surrounds the diagnostic categorization of generalized anxiety disorder (GAD).

Objectives

To examine the incidence, comorbidity, and risk patterns for anxiety and depressive disorders and to test whether developmental features of GAD more strongly support a view of this condition as a depressive as opposed to an anxiety disorder.

Design

Face-to-face, 10-year prospective longitudinal and family study with as many as 4 assessment waves. The DSM-IV Munich Composite International Diagnostic Interview was administered by clinically trained interviewers.

Setting

Munich, Germany.

Participants

A community sample of 3021 individuals aged 14 to 24 years at baseline and 21 to 34 years at last follow-up.

Main Outcome Measures

Cumulative incidence of GAD, other anxiety disorders (specific phobias, social phobia, agoraphobia, and panic disorder), and depressive disorders (major depressive disorder, and dysthymia).

Results

Longitudinal associations between GAD and depressive disorders are not stronger than those between GAD and anxiety disorders or between other anxiety and depressive disorders. Survival analyses reveal that the factors associated with GAD overlap more strongly with those specific to anxiety disorders than those specific to depressive disorders. In addition, GAD differs from anxiety and depressive disorders with regard to family climate and personality profiles.

Conclusions

Anxiety and depressive disorders appear to differ with regard to risk constellations and temporal longitudinal patterns, and GAD is a heterogeneous disorder that is, overall, more closely related to other anxiety disorders than to depressive disorders. More work is needed to elucidate the potentially unique aspects of pathways and mechanisms involved in the etiopathogenesis of GAD. Grouping GAD with depressive disorders, as suggested by cross-sectional features and diagnostic comorbidity patterns, minimizes the importance of longitudinal data on risk factors and symptom trajectories.