Pathways to anxiety-depression comorbidity: A longitudinal examination of childhood anxiety disorders

Depress Anxiety. 2016 Oct;33(10):978-986. doi: 10.1002/da.22544. Epub 2016 Jul 19.

Abstract

Background: Anxiety disorders are prevalent in youth and associated with later depressive disorders. A recent model posits three distinct anxiety-depression pathways. Pathway 1 represents youth with a diathesis to anxiety that increases risk for depressive disorders; Pathway 2 describes youth with a shared anxiety-depression diathesis; and Pathway 3 consists of youth with a diathesis for depression who develop anxiety as a consequence of depression impairment. This is the first partial test of this model following cognitive-behavioral treatment (CBT) for child anxiety.

Method: The present study included individuals (N = 66; M age = 27.23 years, SD = 3.54) treated with CBT for childhood anxiety disorders 7-19 years (M = 16.24; SD = 3.56) earlier. Information regarding anxiety (i.e., social phobia (SoP), separation anxiety disorder (SAD), generalized anxiety disorder (GAD)) and mood disorders (i.e., major depressive disorder (MDD) and dysthymic disorders) was obtained at pretreatment, posttreatment, and one or more follow-up intervals via interviews and self-reports.

Results: Evidence of pathways from SoP, SAD, and GAD to later depressive disorders was not observed. Treatment responders evidenced reduced GAD and SoP over time, although SoP was observed to have a more chronic and enduring pattern.

Conclusions: Evidence for typically observed pathways from childhood anxiety disorders was not observed. Future research should prospectively examine if CBT treatment response disrupts commonly observed pathways.

Keywords: anxiety; cognitive-behavioral therapy; comorbidity; depression; evidence-based treatment.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Anxiety Disorders / diagnosis*
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology*
  • Anxiety Disorders / therapy
  • Child
  • Cognitive Behavioral Therapy
  • Comorbidity
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / psychology*
  • Depressive Disorder, Major / therapy
  • Disease Progression
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Recurrence
  • Risk
  • Treatment Outcome
  • Young Adult