Brief reportMixed anxiety–depression in a 1 year follow-up study: shift to other diagnoses or remission?
Introduction
A substantial number of patients suffer from depressive and anxiety symptoms without meeting official criteria of either ICD-10 or DSM-IV depressive and/or anxiety disorders (Zinbarg et al., 1994, Stein et al., 1995; see Katon and Roy-Byrne, 1991, Wittchen and Essau, 1993, Boulenger et al., 1997 for reviews). These patients are frequent in primary care (Barrett et al., 1988, Wittchen and Essau, 1993, Barlow and Campbell, 2000). To provide a clinical definition for those patients the ICD-10 (WHO, 1992) introduced the concept of mixed anxiety–depression disorder (MAD). The criteria for MAD are as follows:
- 1.
Presence of mild or moderate anxiety and depression, without prevailing of anxiety or depression,
- 2.
at least temporary occurrence of vegetative symptoms,
- 3.
the symptoms do not fulfil the criteria of an anxiety disorder or a depressive episode.
The status of the ICD-10-MAD diagnosis — in relation to depressive and anxiety disorders — needs further research. There is a need for follow-up studies — explicitly applying the specified diagnostic criteria of the ICD-10 — to determine the temporal stability of a given ICD-10-MAD diagnosis and the possible shift to depressive and/or anxiety disorders (see also Katon and Roy-Byrne, 1991, Wittchen and Essau, 1993, Stein et al., 1995). This study examines the outcome of a given ICD-10-MAD diagnosis as compared to depression and anxiety after one year in a primary care sample in terms of the diagnostic status. Data were collected within the scope of the World Health Organization (WHO) Collaborative Study on ‘Psychological Problems in General Health Care’, which is a cross-sectional and prospective-longitudinal international study (Sartorius et al., 1993, Üstün and Sartorius, 1995).
Section snippets
Methods
From the sample of the WHO Collaborative Study1 patients meeting ICD-10 criteria for a depressive episode, dysthymia, agoraphobia, panic disorder, generalised anxiety disorder (GAD), comorbid depressive and anxiety disorder, and MAD at the baseline assessment were identified and reassessed after 12 months. Additional ICD-10 psychiatric diagnoses were
Sample characteristics
A total of 1856 patients were identified to meet ICD-10 criteria for a depressive episode, dysthymia, agoraphobia, panic disorder, GAD, comorbid anxiety and depressive disorder, and MAD at the baseline diagnostic assessment. 1183 subjects (63.7%) could be re-examined at the follow-up. A total of 673 (36.3%) did not participate in the follow-up examination because they had moved and were not found anymore, because of refusal or because of death. Exact proportions were not recorded. There was no
Discussion
The data presented herein did not show temporal stability of MAD as compared to depressive and anxiety disorders. Our results are in contrast to the findings of Usall and Marquez (1999) who concluded that MAD is a stable diagnosis. These authors applied DSM-IV research criteria so that their results cannot be directly compared with our findings.
References (19)
- et al.
Mixed anxiety–depression and its implications for models of mood and anxiety disorders
Compr. Psychiatry
(2000) - et al.
Long-term follow-up of generalized anxiety disorder
Compr. Psychiatry
(1993) Generalized anxiety disorder. Longitudinal course and pharmacologic treatment
Psychiatr. Clin. North Am.
(1995)- et al.
Mixed anxiety–depression in a primary-care clinic
J. Affect. Disord.
(1995) Diagnostic and Statistical Manual of Mental Disorders
(1994)- et al.
The prevalence of psychiatric disorders in a primary care praxis
Arch. Gen. Psychiatry
(1988) - et al.
Mixed anxiety and depression: from theory to practice
J. Clin. Psychiatry
(1997) - et al.
Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications
J. Abnorm. Psychol.
(1991) CIDI-Core. Composite International Diagnostic Interview, Core Version 1.0-November 1990
(1990)
Cited by (34)
Polysomnographic identification of anxiety and depression using deep learning
2022, Journal of Psychiatric ResearchCitation Excerpt :Although the diagnostic criteria of these conditions are well established in the DSM-5, a significant degree of interchangeability and ambiguity has been noted among clinical practitioners, particularly non-psychiatrist clinicians. This is further complicated by high rates of co-morbidity and the transdiagnostic efficacy of many treatment modalities, which may inadvertently reinforce diagnostic inaccuracies(Barkow et al., 2004; Biederman et al., 2004; Cook et al., 2004; Hinden et al., 1997; Szaflarski et al., 2017; Weiss and Catron, 1994). Notably, psychiatric researchers have struggled to develop a classification system for these conditions based on surrogate biological and psychophysiological markers.
Efficacy of Silexan in mixed anxiety-depression - A randomized, placebo-controlled trial
2016, European NeuropsychopharmacologyCitation Excerpt :In a study published by Stein et al., (1995) 12.8% of primary care clinic attendees without known psychiatric illness had a combination of subsyndromal anxiety and depressive features that fulfilled the criteria for MADD. Although there is some variation in the estimated prevalence rates, probably due to differences between clinical definitions (Spijker et al., 2010), researchers widely agree that MADD is a very common disorder, particularly in primary care (Barkow et al., 2004; Das-Munshi et al., 2008). Patients suffering from subsyndromal psychiatric conditions, including MADD, have been shown to suffer from similarly pronounced distress, co-morbidity, and impairment of daily living skills as those with fully syndromal disorders (e.g. Das-Munshi et al., 2008; Lewinsohn et al., 2004).
The German Version of the Hopkins Symptoms Checklist-25 (HSCL-25) - Factorial structure, psychometric properties, and population-based norms
2014, Comprehensive PsychiatryCitation Excerpt :In ICD-10 and DSM-IV a mixed anxiety–depression disorder (MADD) which is characterised by sub-threshold depressive and anxiety symptoms was introduced. Several studies showed that MADD is associated with negative outcomes like impairment of quality of life, days out of work [31], but on the other hand the stability of MADD across one year was not very high [32]. All in all symptoms of depression and anxiety are highly comorbid.
Who is MADD? Mixed anxiety depressive disorder in the general population
2010, Journal of Affective DisordersMixed anxiety depression: Taxometric exploration of the validity of a diagnostic category in youth
2007, Journal of Affective DisordersIdentification and validation of mixed anxiety-depression
2015, Psychological Medicine