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Longitudinal Trajectories of Depression and Anxiety in a Prospective Community Study
The Zurich Cohort Study
Kathleen Ries Merikangas, PhD;
Heping Zhang, PhD;
Shelli Avenevoli, PhD;
Suddhasatta Acharyya, PhD;
Martin Neuenschwander, PhD;
Jules Angst, MD
Arch Gen Psychiatry. 2003;60:993-1000.
Background The dearth of long-term follow-up studies of community-based samples and differences in methodology in existing studies highlight the need for research designed to examine the stability, comorbidity, and diagnostic thresholds of depression and anxiety in the community.
Methods Prospective study of a community-based cohort aged 19 and 20 years from the canton of Zurich, Switzerland. Semistructured diagnostic interviews were administered by clinically experienced interviewers at 5 assessment points during a 15-year period. The format of the interview permitted assessment of major mental disorders at both the diagnostic and subthreshold levels.
Results Comorbid anxiety and depression tended to be far more persistent than either syndrome alone. Individuals with anxiety states alone tended to develop either depression alone or comorbid anxiety and depression as they progressed through adulthood. In contrast, depression alone and depression comorbid with anxiety tended to be more stable than anxiety alone over time. The patterns of stability were similar for subthreshold- and threshold-level disorders.
Conclusions These findings have important implications for classification and treatment of affective disorders. The greater stability of comorbid anxiety and depression than either disorder alone illustrates the importance of further investigation of comorbid states compared with noncomorbid states in etiologic and treatment research. The persistence of subthreshold-level depression and anxiety from early to mid adulthood also suggests the importance of characterizing the continuum of expression of depression and anxiety rather than adhering to strict diagnostic thresholds.
From the Section on Developmental Genetic Epidemiology, Mood and Anxiety Disorders Program, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Drs Merikangas and Avenevoli); Department of Epidemiology and Public Health, New Haven, Conn (Dr Zhang); Department of Community Health, Brown University, Providence, RI (Dr Acharyya); and Department of Psychiatry, University of Zurich, Zurich, Switzerland (Drs Neuenschwander and Angst).
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