Abstract
Background: In longitudinal research, switching between diagnoses should be considered when examining patients with depression and anxiety. We investigated course trajectories of affective disorders over a nine-year period, comparing a categorical approach using diagnoses to a dimensional approach using symptom severity.
Method: Patients with a current depressive and/or anxiety disorder at baseline (N = 1701) were selected from the Netherlands Study of Depression and Anxiety (NESDA). Using psychiatric diagnoses, we described 'consistently recovered,' 'intermittently recovered,' 'intermittently recurrent', and 'consistently chronic' at two-, four-, six-, and nine-year follow-up. Additionally, latent class growth analysis (LCGA) using depressive, anxiety, fear, and worry symptom severity scores was used to identify distinct classes.
Results: Considering the categorical approach, 8.5% were chronic, 32.9% were intermittently recurrent, 37.6% were intermittently recovered, and 21.0% remained consistently recovered from any affective disorder at nine-year follow-up. In the dimensional approach, 66.6% were chronic, 25.9% showed partial recovery, and 7.6% had recovered.
Limitations: 30.6% of patients were lost to follow-up. Diagnoses were rated by the interviewer and questionnaires were completed by the participant.
Conclusions: Using diagnoses alone as discrete categories to describe clinical course fails to fully capture the persistence of affective symptoms that were observed when using a dimensional approach. The enduring, fluctuating presence of sub-threshold affective symptoms likely predisposes patients to frequent relapse. The commonness of subthreshold symptoms and their adverse impact on long-term prognoses deserve continuous clinical attention in mental health care as well further research.
Original language | English |
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Pages (from-to) | 1269-1279 |
Number of pages | 11 |
Journal | Journal of Affective Disorders |
Volume | 295 |
DOIs | |
Publication status | Published - 1-Dec-2021 |
Keywords
- Depression
- Anxiety
- Nine-year course
- Prognosis
- Chronicity
- Diagnostic switching
- STATE WORRY QUESTIONNAIRE
- EVENT HISTORY CALENDARS
- CLASS GROWTH ANALYSIS
- COURSE TRAJECTORIES
- MAJOR DEPRESSION
- FOLLOW-UP
- DYSTHYMIC DISORDER
- SOCIAL PHOBIA
- 2-YEAR COURSE
- PRIMARY-CARE