Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-15T17:11:41.177Z Has data issue: false hasContentIssue false
  • English
  • Français

An examination of generalized anxiety disorder and dysthymic disorder by latent class analysis

Published online by Cambridge University Press:  11 September 2013

D. Rhebergen ,
I. M. van der Steenstraten ,
M. Sunderland ,
R. de Graaf ,
M. ten Have ,
F. Lamers ,
B. W. J. H. Penninx  and
G. Andrews
D. Rhebergen*
Affiliation:
Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, The Netherlands GGZ inGeest, Amsterdam, The Netherlands
I. M. van der Steenstraten
Affiliation:
Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, The Netherlands
M. Sunderland
Affiliation:
Clinical Research Unit for Anxiety and Depression (CRUfAD), University of New South Wales, Sydney, NSW, Australia
R. de Graaf
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
M. ten Have
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
F. Lamers
Affiliation:
Genetic Epidemiological Research Branch, National Institute of Mental Health, Bethesda, MD, USA
B. W. J. H. Penninx
Affiliation:
Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, The Netherlands GGZ inGeest, Amsterdam, The Netherlands
G. Andrews
Affiliation:
Clinical Research Unit for Anxiety and Depression (CRUfAD), University of New South Wales, Sydney, NSW, Australia
*
* Address for correspondence: D. Rhebergen, M.D., Ph.D., VU University Medical Center Amsterdam, Amsterdam, The Netherlands. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The nosological status of generalized anxiety disorder (GAD) versus dysthymic disorder (DD) has been questioned. The aim of this study was to examine qualitative differences within (co-morbid) GAD and DD symptomatology.

Method

Latent class analysis was applied to anxious and depressive symptomatology of respondents from three population-based studies (2007 Australian National Survey of Mental Health and Wellbeing; National Comorbidity Survey Replication; and Netherlands Mental Health Survey and Incidence Study-2; together known as the Triple study) and respondents from a multi-site naturalistic cohort [Netherlands Study of Depression and Anxiety (NESDA)]. Sociodemographics and clinical characteristics of each class were examined.

Results

A three-class (Triple study) and two-class (NESDA) model best fitted the data, reflecting mainly different levels of severity of symptoms. In the Triple study, no division into a predominantly GAD or DD co-morbidity subtype emerged. Likewise, in spite of the presence of pure GAD and DD cases in the NESDA sample, latent class analysis did not identify specific anxiety or depressive profiles in the NESDA study. Next, sociodemographics and clinical characteristics of each class were examined. Classes only differed in levels of severity.

Conclusions

The absence of qualitative differences in anxious or depressive symptomatology in empirically derived classes questions the differentiation between GAD and DD.

Keywords

Dysthymiageneralized anxiety disorderlatent class analysisnosology
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 8 , June 2014 , pp. 1701 - 1712
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrews, G (1996). Comorbidity and the general neurotic syndrome. British Journal of Psychiatry 168 (Suppl. 30), 76–84.CrossRefGoogle Scholar
Andrews, G, Peters, L (1998). The psychometric properties of the Composite International Diagnostic Interview. Social Psychiatry and Psychiatric Epidemiology 33, 80–88.CrossRefGoogle ScholarPubMed
Andrews, G, Slade, T, Issakidis, C (2002). Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being. British Journal of Psychiatry 181, 306–314.CrossRefGoogle ScholarPubMed
APA (2001). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Publishing: Washington, DC.Google Scholar
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893–897.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA (1990). Manual for the Beck Anxiety Inventory. Psychological Corp.: San Antonio.Google Scholar
Beesdo, K, Pine, DS, Lieb, R, Wittchen, HU (2010). Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Archives of General Psychiatry 67, 47–57.CrossRefGoogle ScholarPubMed
Chelminski, I, Zimmerman, M (2003). Pathological worry in depressed and anxious patients. Journal of Anxiety Disorders 17, 533–546.CrossRefGoogle ScholarPubMed
Chwastiak, LA, Von Korff, M (2003). Disability in depression and back pain: evaluation of the World Health Organization Disability Assessment Schedule (WHO DAS II) in a primary care setting. Journal of Clinical Epidemiology 56, 507–514.CrossRefGoogle Scholar
Clark, DA, Beck, AT, Beck, JS (1994). Symptom differences in major depression, dysthymia, panic disorder, and generalized anxiety disorder. American Journal of Psychiatry 151, 205–209.Google ScholarPubMed
Costa, PT, McCrae, RR (1995). Domains and facets: hierarchical personality assessment using the revised NEO personality inventory. Journal of Personality Assessment 64, 21–50.CrossRefGoogle ScholarPubMed
Cox, BJ, Cohen, E, Direnfeld, DM, Swinson, RP (1996). Does the Beck Anxiety Inventory measure anything beyond panic attack symptoms? Behaviour Research and Therapy 34, 949–954.CrossRefGoogle ScholarPubMed
de Graaf, R, ten Have, M, van Dorsselaer, S (2010). The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. International Journal of Methods in Psychiatric Research 19, 125–141.CrossRefGoogle ScholarPubMed
Fyer, AJ, Weissman, MM (1999). Genetic linkage study of panic: clinical methodology and description of pedigrees. American Journal of Medical Genetics 88, 173–181.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, De Girolamo, G, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA, Kessler, RC (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research 15, 167–180.CrossRefGoogle ScholarPubMed
Hidalgo, RB, Sheehan, DV (2012). Generalized anxiety disorder. In Handbook of Clinical Neurology, vol. 106 (ed. Aminoff, M. J., Boller, F. and Swaab, D. F.), pp. 343–362. Elsevier: Amsterdam.Google Scholar
Hipp, JR, Bauer, DJ (2006). Local solutions in the estimation of growth mixture models. Psychological Methods 11, 36–53.CrossRefGoogle ScholarPubMed
Hunt, C, Issakidis, C, Andrews, G (2002). DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine 32, 649–659.CrossRefGoogle ScholarPubMed
Judd, LL, Kessler, RC, Paulus, MP, Zeller, PV, Wittchen, HU, Kunovac, JL (1998). Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study. Acta Psychiatrica Scandinavica 98, 6–11.CrossRefGoogle Scholar
Kendler, KS (1996). Major depression and generalized anxiety disorder. Same genes, (partly) different environments – revisited. British Journal of Psychiatry 168 (Suppl. 30), 68–75.CrossRefGoogle Scholar
Kessler, RC (2000). The epidemiology of pure and comorbid generalized anxiety disorder: a review and evaluation of recent research. Acta Psychiatrica Scandinavica Supplementum 406, 7–13.CrossRefGoogle Scholar
Kessler, RC, Berglund, P, Chiu, WT, Demler, O, Heeringa, S, Hiripi, E, Jin, R, Pennell, BE, Walters, EE, Zaslavsky, A, Zheng, H (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 69–92.CrossRefGoogle ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustün, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921–926.CrossRefGoogle ScholarPubMed
Lamers, F, van Oppen, P, Comijs, HC, Smit, JH, Spinhoven, P, van Balkom, AJ, Nolen, WA, Zitman, FG, Beekman, AT, Penninx, BW (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). Journal of Clinical Psychiatry 72, 341–348.CrossRefGoogle Scholar
Meyer, TJ, Miller, ML, Metzger, RL, Borkovec, TD (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 28, 487–495.CrossRefGoogle ScholarPubMed
Muntingh, ADT, Van der Feltz-Cornelis, CM, Van Marwijk, HWJ, Spinhoven, P, Penninx, BWJH, Van Balkom, AJLM (2011). Is the Beck Anxiety Inventory a good tool to assess the severity of anxiety? A primary care study in The Netherlands Study of Depression and Anxiety (NESDA). BMC Family Practice 12, 66.CrossRefGoogle ScholarPubMed
Muthén, LK, Muthén, BO (2007). Mplus User's Guide, fifth edn. Muthén and Muthén: Los Angeles.Google Scholar
Nylund, KL, Asparouhov, T, Muthén, BO (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling 14, 535–569.CrossRefGoogle Scholar
Olino, TM, Klein, DN, Farmer, RF, Seeley, JR, Lewinsohn, PM (2012). Examination of the structure of psychopathology using latent class analysis. Comprehensive Psychiatry 53, 323–332.CrossRefGoogle ScholarPubMed
Osman, A, Kopper, BA, Barrios, FX, Osman, JR, Wade, T (1997). The Beck Anxiety Inventory: reexamination of factor structure and psychometric properties. Journal of Clinical Psychology 53, 7–14.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Penninx, BW, Beekman, AT, Smit, JH, Zitman, FG, Nolen, WA, Spinhoven, P, Cuijpers, P, De Jong, PJ, Van Marwijk, HW, Assendelft, WJ, Van Der Meer, K, Verhaak, P, Wensing, M, De Graaf, R, Hoogendijk, WJ, Ormel, J, Van Dyck, R; NESDA Research Consortium (2008). The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods. International Journal of Methods in Psychiatric Research 17, 121–140.CrossRefGoogle ScholarPubMed
Rush, AJ, Giles, DE, Schlesser, MA, Fulton, CL, Weissenburger, J, Burns, C (1986). The Inventory for Depressive Symptomatology (IDS): preliminary findings. Psychiatry Research 18, 65–87.CrossRefGoogle ScholarPubMed
Rush, AJ, Gullion, CM, Basco, MR, Jarrett, RB, Trivedi, MH (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine 26, 477–486.CrossRefGoogle ScholarPubMed
Simon, NM (2009). Generalised anxiety disorder and psychiatric comorbidities such as depression, bipolar disorder, and substance abuse. Journal of Clinical Psychiatry 70 (Suppl. 2), 10–14.CrossRefGoogle ScholarPubMed
Slade, T, Johnston, A, Oakley Browne, MA, Andrews, G, Whiteford, H (2009). 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Australian and New Zealand Journal of Psychiatry 43, 594–605.CrossRefGoogle ScholarPubMed
Sunderland, M, Mewton, L, Slade, T, Baillie, AJ (2010). Investigating differential symptom profiles in major depressive episode with and without generalized anxiety disorder: true co-morbidity or symptom similarity? Psychological Medicine 40, 1113–1123.CrossRefGoogle ScholarPubMed
Titov, N, Dear, BF, Schwencke, G, Andrews, G, Johnston, L, Craske, MG, McEvoy, P (2011). Transdiagnostic Internet treatment for anxiety and depression: a randomised controlled trial. Behaviour Research and Therapy 49, 441–452.CrossRefGoogle ScholarPubMed
Tyrer, P, Seivewright, H, Johnson, T (2003). The core elements of neurosis: mixed anxiety–depression (cothymia) and personality disorders. Journal of Personality Disorder 17, 129–138.CrossRefGoogle Scholar
Tyrer, P, Seivewright, H, Johnson, T (2004). The Nottingham Study of Neurotic Disorder: predictors of 12-year outcome of dysthymic, panic and generalized anxiety disorder. Psychological Medicine 34, 1385–1394.CrossRefGoogle ScholarPubMed
Vaidyanathan, U, Patrick, CJ, Iacono, WG (2011). Patterns of comorbidity among mental disorders: a person-centered approach. Comprehensive Psychiatry 52, 527–535.CrossRefGoogle ScholarPubMed
Vollebergh, WAM, Iedema, J, Bijl, RV, De Graaf, R, Smit, F, Ormel, J (2001). The structure and stability of common mental disorders: the NEMESIS Study. Archives of General Psychiatry 58, 597–603.CrossRefGoogle ScholarPubMed
Wittchen, HU (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 57–84.CrossRefGoogle ScholarPubMed
Wittchen, HU, Höfler, M, Merikangas, K (1999). Toward the identification of core psychopathological processes? Archives of General Psychiatry 56, 929–931.CrossRefGoogle ScholarPubMed
Wittchen, HU, Zhao, S, Kessler, RC, Eaton, W (1994). DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Archives of General Psychiatry 51, 355–364.CrossRefGoogle ScholarPubMed