Validity of the DSM-5 anxious distress specifier for major depressive disorder

Zimmerman, Mark; Martín, Juan Antonio González; McGonigal, Patrick; Harris, Lauren M.; Kerr, Sophie; Balling, Caroline; Kiefer, Reina; Stanton, Kasey; Dalrymple, Kristy

doi:10.1002/da.22837

Cited by 33 publications

(22 citation statements)

References 43 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with anxious depression are characterized by higher levels of suicidal ideation, poorer functioning, poorer health-related quality of life, and greater chronicity 68 . Co-occurring anxiety has been reported to be a predictor of a poor response to antidepressant treatment in general 33 or to specific antidepressants 69 , but these findings do not necessarily apply to anxious depression as defined in the DSM-5 and ICD-11, because alternative definitions of this depression subtype show only modest levels of concordance 70 .…”

Section: Clinical Subtypesmentioning

confidence: 99%

The clinical characterization of the adult patient with depression aimed at personalization of management

et al. 2020

Self Cite

View full text Add to dashboard Cite

Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial‐and‐error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta‐analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self‐report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above‐mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.

show abstract

Section: Clinical Subtypesmentioning

confidence: 99%

The clinical characterization of the adult patient with depression aimed at personalization of management

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Hamilton Depression Rating Scale or the Beck Depression Inventory) either in patients who suffered from major depression or in mentally healthy individuals. Despite the high diagnostic validity of modern diagnostic criteria for major depression [23], the presence of subclinical or very mild depressive symptoms, not justifying the diagnosis of a clinical depressive or anxiety disorder, cannot be precluded. Recently, high proneness of medical students with high levels of trait anxiety to clinical depression and particularly to persistence of depressive symptoms was reported [48].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, 70% of individuals with mood disorders fulfil criteria for an anxiety disorder during their lifetime and up to 90% of patients with anxiety disorders fulfill criteria for concurrent mood disorder [ 21 ]. Anxiety and stress are common symptoms of a depressive episode [ 22 , 23 ], while many antidepressant drugs have both antidepressant and anxiolytic effects) [ 24 ]. Approximately 30 years ago, a dimensional approach to depression and anxiety, the tripartite model, was proposed [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Associations between (sub) clinical stress- and anxiety symptoms in mentally healthy individuals and in major depression: a cross-sectional clinical study

et al. 2020

View full text Add to dashboard Cite

Background: Responses to stressful circumstances have psychological and physiological dimensions, and are related to anxiety symptoms and mental disorders such as depression. Nonetheless, the relationship between subclinical stress and anxiety symptoms is still elusive. Methods: To explore possible associations between stress and anxiety symptoms, patients with major depression (N = 77) and mentally healthy individuals of different age clusters and occupations (N = 412) were enrolled into the study. Stress was assessed with the new subclinical stress symptom questionnaire (SSQ-25). Anxiety was studied with the Beck Anxiety Inventory (BAI), mainly focusing on clinical anxiety, whilst anxiety as a personality trait was assessed with the trait aspect of the State Τrait Αnxiety Ιnventory Y (STAI Y). Statistical analyses included ANOVA, Scheffe test, linear regression models and a two-step cluster analysis using Log-Likelihood Distance measure and fixed number of two clusters. Results: Age, stress symptoms and BAI scores differed significantly between among groups (P < 0.001), whilst STAI Y scores did not. Stress levels were found to be related to clinical anxiety (P < 0.001), while neither group identity nor age exerted any influence on anxiety levels (P > 0.05). The two Step Cluster analysis classified 76 out of 77 participants with milder stress (subclinical) symptoms into the cluster with moderate anxiety, as indicated by BAI scores, and all individuals with more severe stress into the severe anxiety cluster. Conclusions: The observed associations between stress and anxiety shed light on the interrelations between even very mild (subclinical) stress and anxiety symptoms and may point to the potential of mild stress to serve as a target for early interventions aiming to prevent anxiety morbidity.

show abstract

“…Anxiety is common in patients with depression. 4,5,17,18 Depressed patients with anxiety tend to have poorer psychosocial functioning and poorer outcome than depressed patients without anxiety. [19][20][21][22] Does this mean that measures of the severity of depression should include items assessing anxiety?…”

Section: Discussionmentioning

confidence: 99%

“…3 It is well known that patients with depression have elevated symptom levels of anxiety, irritability, and somatization. [4][5][6][7][8][9] Moreover, item analyses of depression scales, which include these nondepressive constructs, have found that these items correlate significantly with total scale scores, 3,10 thereby suggesting that these features can be considered valid indicators of depression severity. However, a significant correlation between an associated feature of depression severity does not mean that such a variable should be included on a measure of depression severity.…”

Section: Introductionmentioning

confidence: 99%

Understanding the severity of depression: do nondepressive symptoms influence global ratings of depression severity?

et al. 2019

Self Cite

View full text Add to dashboard Cite

Objective. Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. It is therefore not surprising that measures differ in both how items are rated and item content. The question that we address in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is whether a measure of depression severity should include symptoms that are frequent in depressed patients but are defining features of other disorders (eg, anxiety, irritability) Methods. Patients were evaluated with a semi-structured interview and severity ratings were made of each symptom of major depressive disorder (MDD) as well as anxiety, irritability, and somatization. Patients were also rated on the Clinical Global Index of severity (CGI). Results. Three of the 5 nondepressive symptoms (psychic anxiety, somatic anxiety, and subjective anger) were significantly correlated with the CGI. The correlation between the sum of all 5 nondepressive symptoms and the CGI was significantly lower than the correlation between the sum of the depressive symptom severity ratings (0.12 vs 0.52, z = 11.0, p < .001). The partial correlation between the CGI and the nondepressive symptom severity ratings (after controlling for the total depressive symptom ratings) was nonsignificant. Discussion. After accounting for the severity of depressive symptoms, the severity of the nondepressive symptoms was not associated with global ratings of depressive severity. These findings raise questions regarding the appropriateness of including ratings of anxiety, irritability, and somatization on a measure that purportedly assesses the severity of depression.

show abstract

Validity of the DSM-5 anxious distress specifier for major depressive disorder

Cited by 33 publications

References 43 publications

The clinical characterization of the adult patient with depression aimed at personalization of management

The clinical characterization of the adult patient with depression aimed at personalization of management

Associations between (sub) clinical stress- and anxiety symptoms in mentally healthy individuals and in major depression: a cross-sectional clinical study

Understanding the severity of depression: do nondepressive symptoms influence global ratings of depression severity?

Contact Info

Product

Resources

About