The prevalence and clinical characteristics associated with Diagnostic and Statistical Manual Version-5-defined anxious distress specifier in adults with major depressive disorder: results from the International Mood Disorders Collaborative Project

Abstract

Objectives:The aim of the study was to evaluate the prevalence of and illness characteristics in adults with major depressive disorder (MDD) with anxious distress specifier (ADS) enrolled in the International Mood Disorders Collaborative Project, which is a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto, Canada and the Cleveland Clinic, Cleveland, Ohio, USA. Methods: Data from participants who met criteria for a current major depressive episode as part of MDD (n = 830) were included in this post hoc analysis. Diagnostic and Statistical Manual Version-5-defined ADS was operationalized as the presence of at least two out of three proxy items instead of two out of five specifiers. Results: A total of 464 individuals (i.e. 56%) met criteria for ADS. There were no betweengroup differences in sociodemographic variables (e.g. gender, employment, marital status). Greater severity of illness was observed in adults with ADS as evidenced by a higher number of hospitalizations, higher rates of suicidal ideation, greater depressive symptom severity, greater workplace impairment, decreased quality of life, and greater self-reported cognitive impairment. Conclusions: Our findings underscore the importance of evaluating ADS in adults with MDD as its presence identifies a subpopulation with greater illness-associated burden and hazards.

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

“…In the present study, the patients with anxious distress were more frequently diagnosed with a drug use disorder and reported significantly poorer functioning and coping ability. This is consistent with other studies finding that depressed patients with comorbid anxiety disorders or high levels of anxiety have poorer functioning (Klein‐Hofmeijer Sevink et al., ; McIntyre et al., ) and an increased frequency of substance use disorders (Howland, Rush, Wisniewski, & Trivedi, ). Although the effect sizes for the differences in coping and functioning were small to medium, that these differences were found at all in a relatively severely ill patient group presenting to a partial hospital program is noteworthy.…”

“…Similar to other studies of the anxious distress specifier, symptom severity, in general, was greater in the patients who met the anxious distress specifier (Gaspersz et al., ; McIntyre et al., ). This is consistent with our previous study examining the anxious distress specifier as a cross‐sectional dimensional measure, which found that scores on the DADSI were significantly correlated with symptom severity measures of anxiety, depression, and anger (Zimmerman et al., ).…”

“…Both McIntyre et al. () and Gaspersz, Lamers, Kent, and Beekman () also found significantly elevated rates of panic disorder and generalized anxiety disorder in patients who met the anxious distress specifier.…”

“…A few recent studies have supported the validity of the specifier, however, they did not use measures that were designed to assess the criteria of the specifier, but instead these studies approximated the DSM‐5 criteria from scales that were part of an already existing data base (Gaspersz, Lamers, Kent, & Beekman, , ; McIntyre, Weiller, Zhang, & Weiss, ; McIntyre, Woldeyohannes, Soczynska, & Vinberg, ; Melca, Yucel, Mendlowicz, & de Oliveira‐Souza, ; Shim, Woo, & Bahk, ). In some of these studies, not all the criteria were assessed (McIntyre et al., ; McIntyre, Woldeyohannes, et al., ; Melca et al., ; Shim et al., ), and in other studies, the authors noted that some of the proxy items may not have been accurate representations of the DSM‐5 criterion (Gaspersz et al., , ). Moreover, in each of these studies, the proxy assessment of the DSM‐5 criteria was cross‐sectional based on symptom presence during the past week.…”

Expert Consensus on Screening and Assessment of Cognition in Psychiatry

“…8 Epidemiological and clinical studies provide results that are in accordance with the assertion that cognitive deficits (self-rated, objectively measured) account for more variability in interpersonal adjustments and/or workplace performance (i.e., absenteeism, presenteeism) than total depression symptom severity and/or other domains (i.e., factors) in persons with mood disorders. [9][10][11][12] It is additionally noted that cognitive deficits in MDD may predate the onset of "mood symptoms" in MDD and may progress in overall magnitude of deficits as a function of episode frequency/illness duration. 13,14 Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves PROs and/ or is cost effective.…”