Research reportRecurrence of anxiety disorders and its predictors
Section snippets
Background
Recurrence of anxiety disorders contributes to an unfavourable long-term course of anxiety disorders. Minimizing recurrence rates is of importance, not only for the individual patient, but also for society, given the fact that anxiety disorders are prevalent (Alonso et al., 2004b), have a profound impact on functioning and well-being (Alonso et al., 2004a, Mendlowicz and Stein, 2000) and are associated with high economic costs (Rice and Miller, 1998, Smit et al., 2006). Only few studies
Sample
Data were derived from the Netherlands Study of Depression and Anxiety (NESDA), an ongoing cohort study aimed at examining the long-term course of depressive and anxiety disorders in the adult (18–65 years) population. A total of 2981 persons were included for baseline assessment, consisting of healthy controls (22%) and persons with a past or current depressive and/or anxiety disorder (78%). To represent various settings and stages of psychopathology, persons were recruited from the community
Measures
Remitted anxiety disorders and recurrence of anxiety disorders were assessed using the DSM-IV (American Psychiatric Association, 2001) based Composite International Diagnostic Interview (CIDI, version 2.1). A remitted anxiety disorder was defined at study baseline as having one or more anxiety diagnoses (panic disorder with or without agoraphobia, agoraphobia, social phobia or generalized anxiety disorder) in the past, but no anxiety diagnoses 6 months prior to baseline. Recurrence was defined
Statistical analyses
We calculated overall recurrence rates, recurrence rates of the separate pure anxiety disorders (panic disorder without agoraphobia, panic disorder with agoraphobia, agoraphobia alone, social phobia and generalized anxiety disorder), and multiple anxiety disorders (>1 remitted anxiety disorder). These recurrence rates were compared using Chi-square statistics. Given that no significant differences were found between the pure and multiple anxiety disorders, further analyses would be conducted
Baseline characteristics
Sociodemographics, illness-related variables and psychosocial vulnerabilities at baseline are presented in Table 1. Of notice, 24.4% of the participants had a current depressive disorder at baseline of this study.
Recurrence
Of the 429 participants with a remitted anxiety disorder at baseline, 23.5% (n=101) had a recurrence of an anxiety disorder. This could be a recurrence of the remitted anxiety disorder or the incidence of a new anxiety disorder. In Table 2 recurrence rates are specified for each
Discussion
In this study, high relapse rates were found over a 2-year period, and diagnostic conversions to different anxiety frequently occurred. We identified independent predictors of recurrence from a broad range of putative predictors. In our study population, 23.5% (N=101) of those with remitted anxiety disorders had a recurrence within the 2-year follow-up period. Recurrence rates were comparable for the separate pure anxiety disorders (panic disorder, panic disorder with agoraphobia, agoraphobia
Role of funding source
The infrastructure for the Netherlands Study of Depression and Anxiety (www.nesda.nl) is funded through the Geestkracht program of the Netherlands Organisation for Health and Research and Development (Zon-Mw, grant number 10-000-1002) and is supported by participating universities and mental health care organizations. These sponsors have not had any role in the conducted analyses, writing the manuscript and the decision to publish the results.
Conflict of interest
Scholten, Batelaan, Van Balkom, Penninx, Smit and Van Oppen have no personal affiliations or financial relationship with any commercial interest to disclosure relative to this article.
Acknowledgements
The infrastructure for the Netherlands Study of Depression and Anxiety (www.nesda.nl) is funded through the Geestkracht program of the Netherlands Organisation for Health and Research and Development (Zon-Mw, grant number 10-000-1002) and is supported by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Arkin, Leiden University Medical Center, GGZ Rivierduinen, University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe,
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