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Co-morbidity between major depressive disorder and anxiety disorders: shared etiology or direct causation?

Published online by Cambridge University Press:  25 March 2011

A. R. Mathew ,
J. W. Pettit ,
P. M. Lewinsohn ,
J. R. Seeley  and
R. E. Roberts
A. R. Mathew
Affiliation:
University of Houston, Houston, TX, USA
J. W. Pettit*
Affiliation:
Florida International University, Miami, FL, USA
P. M. Lewinsohn
Affiliation:
Oregon Research Institute, Eugene, OR, USA
J. R. Seeley
Affiliation:
Oregon Research Institute, Eugene, OR, USA
R. E. Roberts
Affiliation:
University of Texas Health Science Center, Houston, TX, USA
*
*Address for correspondence: Dr J. W. Pettit, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL 33199, USA. (Email: [email protected])
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Abstract

Background

Major depressive disorder (MDD) and anxiety disorders (ANX) are debilitating and prevalent conditions that often co-occur in adolescence and young adulthood. The leading theoretical models of their co-morbidity include the direct causation model and the shared etiology model. The present study compared these etiological models of MDD–ANX co-morbidity in a large, prospective, non-clinical sample of adolescents tracked through age 30.

Method

Logistic regression was used to examine cross-sectional associations between ANX and MDD at Time 1 (T1). In prospective analyses, Cox proportional hazards models were used to examine T1 predictors of subsequent disorder onset, including risk factors specific to each disorder or common to both disorders. Prospective predictive effect of a lifetime history of one disorder (e.g. MDD) on the subsequent onset of the second disorder (e.g. ANX) was then examined. This step was repeated while controlling for common risk factors.

Results

The findings supported relatively distinct profiles of risk between MDD and ANX depending on order of development. Whereas the shared etiology model best explained co-morbid cases in which MDD preceded ANX, direct causation was supported for co-morbid cases in which ANX preceded MDD.

Conclusions

Consistent with previous research, significant cross-sectional and prospective associations were found between MDD and ANX. The results of the present study suggest that different etiological models may characterize the co-morbidity between MDD and ANX based upon the temporal order of onset. Implications for classification and prevention efforts are discussed.

Keywords

Anxietyco-morbiditydepressionetiology
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 10 , October 2011 , pp. 2023 - 2034
Copyright
Copyright © Cambridge University Press 2011

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