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Dimensions of anxiety in Major depressive disorder and their use in predicting antidepressant treatment outcome: an iSPOT-D report

Published online by Cambridge University Press:  26 April 2019

Taylor A. Braund Open the ORCID record for Taylor A. Braund [Opens in a new window] ,
Donna M. Palmer ,
Leanne M. Williams  and
Anthony W. F. Harris
Taylor A. Braund*
Affiliation:
Brain Dynamics Centre, The Westmead Institute for Medical Research, Sydney, NSW, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia The Brain Resource Company, Sydney, NSW, Australia
Donna M. Palmer
Affiliation:
Brain Dynamics Centre, The Westmead Institute for Medical Research, Sydney, NSW, Australia The Brain Resource Company, Sydney, NSW, Australia
Leanne M. Williams
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
Anthony W. F. Harris
Affiliation:
Brain Dynamics Centre, The Westmead Institute for Medical Research, Sydney, NSW, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
*
Author for correspondence: Taylor A. Braund, E-mail: [email protected]
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Abstract

Background

Major depressive disorder (MDD) commonly co-occurs with clinically significant levels of anxiety. However, anxiety symptoms are varied and have been inconsistently associated with clinical, functional, and antidepressant treatment outcomes. We aimed to identify and characterise dimensions of anxiety in people with MDD and their use in predicting antidepressant treatment outcome.

Method

1008 adults with a current diagnosis of single-episode or recurrent, nonpsychotic, MDD were assessed at baseline on clinical features and cognitive/physiological functioning. Participants were then randomised to one of three commonly prescribed antidepressants and reassessed at 8 weeks regarding symptom change, as well as remission and response, on the 17-item Hamilton Rating Scale Depression (HRSD17) and the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR16). Exploratory factor analysis was used on items from scales assessing anxiety symptoms, and resulting factors were assessed against clinical features and cognitive/physiological functioning. Factors were also assessed on their ability to predict treatment outcome.

Results

Three factors emerged relating to stress, cognitive anxiety, and somatic anxiety. All factors showed high internal consistency, minimal cross-loadings, and unique clinical and functional profiles. Furthermore, only higher somatic anxiety was associated with poorer QIDS-SR16 remission, even after adjusting for covariates and multiple comparisons.

Conclusions

Anxiety symptoms in people with MDD can be separated onto distinct factors that differentially respond to treatment outcome. Furthermore, these factors do not align with subscales of established measures of anxiety. Future research should consider cognitive and somatic symptoms of anxiety separately when assessing anxiety in MDD and their use in predicting treatment outcome.

Keywords

AnxietyantidepressantDASSexploratory factor analysismajor depressive disorder
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 6 , April 2020 , pp. 1032 - 1042
Copyright
Copyright © Cambridge University Press 2019

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