Relationships among psychosocial functioning, diagnostic comorbidity, and the recurrence of generalized anxiety disorder, panic disorder, and major depression

Rodriguez, Benjamin F.; Bruce, Steven E.; Pagano, Maria E.; Keller, Martin B.

doi:10.1016/j.janxdis.2004.10.002

Cited by 67 publications

(55 citation statements)

References 27 publications

(25 reference statements)

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“…These results support previous data comparing psychosocial functioning in pure anxiety or depressive disorders 17, 41 and their comorbidity 42. With regard to specific anxiety disorders, we found that GAD and especially SP are more strongly associated with social dysfunction or higher impairment compared to PD and AP, which is in agreement with findings of several other studies 9, 34, 43.…”

Section: Discussionsupporting

confidence: 93%

“…Evidence suggests that residual psychosocial impairment increases the recurrence of depressive and anxious symptomatology 41, 45, and the affective components are suggested to drive this effect. Several studies have for instance shown that loneliness is predictive of both depressive symptomatology within geriatric populations 8, 46, 47 and social phobia 48.…”

Section: Discussionmentioning

confidence: 99%

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Social functioning in patients with depressive and anxiety disorders

Saris

Aghajani

Werff

et al. 2017

Acta Psychiatr Scand

138

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ObjectiveAdaptive social functioning is severely impeded in depressive and anxiety disorders, even after remission. However, a comprehensive overview is still lacking.MethodUsing data from the Netherlands Study of Depression and Anxiety (NESDA), behavioural (network size, social activities, social support) and affective (loneliness, affiliation, perceived social disability) indicators of social functioning were analyzed in patients with anxiety (N = 540), depressive (N = 393), comorbid anxiety and depressive disorders (‘comorbid’, N = 748), remitted participants (N = 621), and healthy control subjects (N = 650).ResultsAnalyses revealed an increasing trend of social dysfunction among patient groups, in patients with comorbid anxiety and depressive disorders, showing the most severe impairments, followed by depressed and anxious patients (P's < 0.001 for all social functioning indicators). Affective indicators showed the largest effect sizes (Cohen's d range from 0.13 to 1.76). We also found impairments in social functioning among remitted patients. Furthermore, perceived social disability among patients was predictive of still having a depressive and/or anxiety diagnosis 2 years later (P < 0.01).ConclusionsBehavioural but especially affective indicators of social functioning are impaired in patients with anxiety or depressive disorders and most in patients with comorbid disorders. After remission of affective psychopathology, residual impairments tend to remain, while social dysfunction in patients seems predictive of future psychopathology.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Social functioning in patients with depressive and anxiety disorders

Saris

Aghajani

Werff

et al. 2017

Acta Psychiatr Scand

138

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“…Whilst disability has been postulated as a better predictor of treatment outcome than a diagnosis and that high levels of disability may affect treatment efficacy, the influence on treatment outcome among traumatized refugees has yet to be examined. Previous studies have examined the relationship between psychiatric disorders and disability in a unidirectional fashion by conceptualizing disability as the result of symptoms (Rodriguez, Bruce, Pagano & Keller, 2005). It has been suggested that psychiatric disorders and disability influence and reinforce one another.…”

Section: Disabilitymentioning

confidence: 99%

“…Ormel et al (1994) hypothesized that psychiatric distress could lead to poor psychosocial functioning, which subsequently leads to poorer prognosis or new disease onset. Prospective studies have offered support for a distress-disability cycle hypothesis, by demonstrating that poor psychosocial functioning during remission of anxiety and depression predicted later recurrences (Rodriguez et al, 2005;Solomon et al, 2004). That said, it has not been fully tested if disability can predict treatment outcome in a refugee sample, as tests have only extended to the first link in the distress-disability cycle.…”

Section: Disabilitymentioning

confidence: 99%

Can disability predict treatment outcome among traumatized refugees?

Jørgensen¹,

Auning-Hansen²,

Elklit

2017

Torture

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The aim of the present study was to examine the influence of disability on changes in symptoms of PTSD, anxiety, and depression among treatment-seeking traumatized refugees. Eighty-one refugees participated in different rehabilitation programs. PTSD symptomatology was assessed by the HTQ-IV and symptoms of depression and anxiety were assessed by the HSCL-25. Disability was assessed by the WHODAS 2.0 before treatment. Following treatment, no statistically significant changes in PTSD, depression, and anxiety symptom scores were observed. Disability in the domain 'getting along' was a significant predictor of PTSD scores following treatment, when controlling for baseline scores. Neither total disability nor individual disability domains predicted any other symptom changes. Living with one's partner did, however, seem to be a consistent and significant predictor of treatment outcome. The results are discussed in terms of clinical implications and future research needs.

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“…Little systematic information exists about long-term course of mental illness other than among patients with chronic psychosis, as so much treatment is shortterm and based on acute episodic symptom relief. Most of our systematic knowledge about course of more common mental disorders comes from a small number of landmark long-term prospective clinical epidemiological studies, most notably the NIMH Collaborative Depression Study (Coryell et al, 2003;Mueller et al, 1999) and the Harvard/Brown Anxiety Disorders Research Program Rodriguez et al, 2005). Serious questions can be raised, though, about the extent to which information about illness course from these studies can be generalized due the fact that the patients in these studies were recruited from tertiary care facilities.…”

Section: B Clinical Epidemiological Studies Of Long-term Course and mentioning

confidence: 99%

Psychiatric epidemiology: Challenges and opportunities

Kessler

2007

International Review of Psychiatry

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This paper discusses challenges and prospects for increasing the clinical relevance of psychiatric epidemiological research. The discussion begins with a review of the structural determinants of the fact that current psychiatric epidemiological research has less clinical relevance that epidemiological research in other areas of medicine. The discussion then turns to ways in which the focus of psychiatric epidemiological research might be changed to increase its clinical relevance. A review is then presented of recent innovations in community psychiatric epidemiological research that were designed to increase clinical relevance. An argument is then made that the full clinical value of psychiatric epidemiology will only be realized when community epidemiology becomes better integrated with clinical epidemiology and the latter takes on a more prominent role than it currently has in psychiatric research. Existing initiatives to realize an integration of community psychiatric epidemiology with clinical epidemiology are then reviewed. Finally, an agenda is proposed for an expansion of clinical psychiatric epidemiology to include a focus on both naturalistic and quasiexperimental studies of illness course and treatment response in diverse clinical samples. KeywordsMental illness; Psychiatric epidemiology; epidemiology; clinical epidemiology; World Mental Health (WMH) Survey Initiative I was asked to prepare a paper on the challenges of using epidemiology to inform clinical practice in psychiatry because of my involvement in recently published exchanges about the clinical value (or lack thereof) of the WHO World Mental Health (WMH) Survey Initiative (Jorm, 2006;Kessler, 2006; Kessler et al., in press-b;Weich and Araya, 2004). The WMH Survey Initiative (henceforth WMH) is a project of the Assessment, Classification, and Evaluation (ACE) Group at the WHO that involves the implementation, coordination, and centralized analysis of data from a series of psychiatric epidemiological surveys in more than two dozen countries around the world. (www.hcp.med.harvard.edu/wmh.) I am one of the WMH co-directors.Psychiatric epidemiologists have done quite a bit over the past two decades to increase the clinical relevance of their research. The vast majority of this work has been carried out in general population samples. The potential for clinical relevance is much greater, though, for epidemiological research carried out in clinical samples. In this paper I review recent developments in community psychiatric epidemiology related to clinical relevance. I also sketch out a research agenda for clinical psychiatric epidemiology aimed at increasing clinical relevance. Before turning to these topics, though, it is important to define some basic terms and to discuss the overarching practical challenges faced by psychiatric epidemiologists as they attempt to increase the clinical relevance of their research.

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Relationships among psychosocial functioning, diagnostic comorbidity, and the recurrence of generalized anxiety disorder, panic disorder, and major depression

Cited by 67 publications

References 27 publications

Social functioning in patients with depressive and anxiety disorders

Social functioning in patients with depressive and anxiety disorders

Can disability predict treatment outcome among traumatized refugees?

Psychiatric epidemiology: Challenges and opportunities

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