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Investigating differential symptom profiles in major depressive episode with and without generalized anxiety disorder: true co-morbidity or symptom similarity?

Published online by Cambridge University Press:  06 November 2009

M. Sunderland ,
L. Mewton ,
T. Slade  and
A. J. Baillie
M. Sunderland*
Affiliation:
Clinical Research Unit for Anxiety and Depression (CRUfAD), University of New South Wales, Sydney, Australia
L. Mewton
Affiliation:
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
T. Slade
Affiliation:
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
A. J. Baillie
Affiliation:
Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
*
*Address for correspondence: M. Sunderland, Clinical Research Unit for Anxiety and Depression, 299 Forbes Street, Darlinghurst, NSW2010, Australia. (Email: [email protected])
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Abstract

Background

Large community-based epidemiological surveys have consistently identified high co-morbidity between major depressive episode (MDE) and generalized anxiety disorder (GAD). Some have suggested that this co-morbidity may be artificial and the product of the current diagnostic system. Because of the added direct and indirect costs associated with co-morbidity, it is important to investigate whether methods of diagnostic classification are artificially increasing the level of observed co-morbidity.

Method

The item response theory (IRT) log-likelihood ratio procedure was used to test for differential item functioning (DIF) of MDE symptoms between respondents with and without a diagnosis of GAD in the 2001–2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC).

Results

The presence of GAD significantly increased the chances of reporting any symptom of MDE, with odds ratios ranging from 2.54 to 5.36. However, there was no indication of significant DIF of MDE symptoms in respondents with and without GAD.

Conclusions

The lack of any significant DIF indicates that cases with GAD do not present with a distinct MDE symptom profile, one that is consistent with the endorsement of symptoms that are conceptually similar in nature between the two disorders, compared to cases without GAD. This does not support the hypothesis that co-morbidity between MDE and GAD is artificially inflated because of the similar symptom criteria required by the current diagnostic system. Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur because of a shared underlying trait.

Keywords

Co-morbiditydifferential item functioninggeneralized anxiety disorderitem response theorymajor depressive episode
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 7 , July 2010 , pp. 1113 - 1123
Copyright
Copyright © Cambridge University Press 2009

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