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Social Psychiatry and Psychiatric Epidemiology

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01-03-2008 | ORIGINAL PAPER

A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population

The HUNT study

Authors: Ottar Bjerkeset, MD, PhD, Hans M. Nordahl, PhD, Sara Larsson, MA, Alv A. Dahl, MD, PhD, Olav Linaker, MD, PhD

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 3/2008

Abstract

Background

Our aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level status after 4 years in a general population sample.

Methods

Prospective cohort study. Based on the total score on the Hospital Anxiety and Depression rating scale (HADS-T) in HUNT 2 (1995–1997), three groups were identified: Level 3 (n = 654, score ≥ 25 points), Level 2 (n = 654, score 19–24 points), and Level 1 (n = 1,308, score < 19 points). The groups were followed up with a mailed questionnaire after 4 years.

Results

Among the 1,326 (53% response rate) who participated in the follow-up, 816 (62%) had not changed symptom level. The number of participants that had crossed the HADS-T caseness level (19 points) was the same in both directions. In non-cases at baseline (Level 1), lack of friends (OR 2.34, 95% CI 1.28–4.27, P = 0.006) and previous episodes of depression (OR 2.90, 95% CI 1.76–4.78, P < 0.001) predicted HADS-T caseness at follow-up, while higher educational level (OR 0.66, 95% CI 0.46–0.96, P = 0.028) protected from developing caseness level of anxiety and depression. In HADS-T cases (Levels 2 and 3) at baseline, previous episode(s) of depression (OR 0.36, 95% CI 0.19–0.68, P = 0.002) and being unemployed (OR 0.58, 95% CI 0.34–1.00, P = 0.050) predicted HADS-T caseness at follow-up, whereas a higher educational level (OR 1.83, 95% CI 1.24–2.70, P = 0.002) was associated with remission from HADS-T caseness after 4 years.

Conclusions

Though symptom fluctuation was considerable, conventional HADS-T caseness (≥19 points) was a reliable and valid predictor for high long-term symptom stability of anxiety and depression in our general population sample.

Agrawal A, Jacobson KC, Gardner CO, et al (2004) A population based twin study of sex differences in depressive symptoms. Twin Res 7:176–181PubMedCrossRef

Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, et al (2007) Diagnostic stability of psychiatric disorders in clinical practice. Br J Psychiatry 190:210–216PubMedCrossRef

Beard JR, Heathcote K, Brooks R, et al (2007) Predictors of mental disorders and their outcome in a community based cohort. Soc Psychiatry Psychiatr Epidemiol 42:623–630PubMedCrossRef

Bebbington PE, Dunn G, Jenkins R, et al (1998) The influence of age and sex on the prevalence of depressive conditions: report from the National Survey of Psychiatric Morbidity. Psychol Med 28:9–19PubMedCrossRef

Bjelland I, Dahl AA, Haug TT, et al (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77PubMedCrossRef

Bjerkeset O, Dahl AA, Stordal E, et al (2006) Feasibility of mental health screening and intervention in the HUNT population study. Soc Psychiatry Psychiatr Epidemiol 41:191–198PubMedCrossRef

Bjerkeset O, Mykletun A, Dahl AA, et al (2007) Mortality in relation to self-reported mixed anxiety and depression symptoms—the HUNT study. Nord J Psychiatry 61:6–11PubMedCrossRef

Bland JM, Altman DG (1994) Some examples of regression towards the mean. BMJ 309:780PubMed

Blazer DG, Kessler RC, McGonagle KA, et al (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry JID-0370512 151:979–986

10.

Bogner HR, Gallo JJ (2004) Are higher rates of depression in women accounted for by differential symptom reporting? Soc Psychiatry Psychiatr Epidemiol 39:126–132PubMedCrossRef

11.

Bracke P (1998) Sex differences in the course of depression: evidence from a longitudinal study of a representative sample of the Belgian population. Soc Psychiatry Psychiatr Epidemiol 33:420–429PubMedCrossRef

12.

Brugha TS, Weich S, Singleton N, et al (2005) Primary group size, social support, gender and future mental health status in a prospective study of people living in private households throughout Great Britain. Psychol Med 35:705–714PubMedCrossRef

13.

Chen LS, Eaton WW, Gallo JJ, et al (2000) Understanding the heterogeneity of depression through the triad of symptoms, course and risk factors: a longitudinal, population-based study. J Affect Disord 59:1–11PubMedCrossRef

14.

Clark LA, Watson D (1991) Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol 100:316–336PubMedCrossRef

15.

Cohen J (1992) Statistical power analysis. Curr Dir Psychol Sci 1:98–101CrossRef

16.

De Graaf R, Bijl RV, Smit F, et al (2002) Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. Am J Psychiatry 159:620–629PubMedCrossRef

17.

Dunbar M, Ford G, Hunt K, et al (2000) A confirmatory factor analysis of the Hospital Anxiety and Depression scale: comparing empirically and theoretically derived structures. Br J Clin Psychol 39(Pt 1):79–94PubMedCrossRef

18.

Endicott J (1998) Gender similarities and differences in the course of depression. J Gend Specif Med 1:40–43PubMed

19.

Frank E, Rucci P, Katon W, et al (2002) Correlates of remission in primary care patients treated for minor depression. Gen Hosp Psychiatry 24:12–19PubMedCrossRef

20.

Hansen V, Jacobsen BK, Arnesen E (2001) Prevalence of serious psychiatric morbidity in attenders and nonattenders to a health survey of a general population: the Tromso Health Study. Am J Epidemiol 154:891–894PubMedCrossRef

21.

Herrmann C (1997) International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results. J Psychosom Res JID-0376333 42:17–41CrossRef

22.

Hettema JM, Prescott CA, Myers JM, et al (2005) The structure of genetic and environmental risk factors for anxiety disorders in men and women. Arch Gen Psychiatry 62:182–189PubMedCrossRef

23.

Holmen J, Midthjell K, Kruger Ø, et al (2003) The Nord-Trøndelag Health Study 1995–97 (HUNT 2): Objectives, content, methods and participation. Nor Epidemiol 13:19–32

24.

Jorm AF (2000) Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychol Med 30:11–22PubMedCrossRef

25.

Judd LL, Akiskal HS, Maser JD, et al (1998) A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 55:694–700PubMedCrossRef

26.

Judd LL, Kessler RC, Paulus MP, et al (1998) Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatr Scand Suppl 393:6–11PubMedCrossRef

27.

Kendler KS (1996) Major depression and generalised anxiety disorder. Same genes, (partly)different environments—revisited. Br J Psychiatry Suppl 68–75

28.

Kendler KS, Thornton LM, Gardner CO (2001) Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. Am J Psychiatry 158:582–586PubMedCrossRef

29.

Kennedy N, Abbott R, Paykel ES (2003) Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychol Med 33:827–838PubMedCrossRef

30.

Kennedy N, Abbott R, Paykel ES (2004) Longitudinal syndromal and sub-syndromal symptoms after severe depression: 10-year follow-up study. Br J Psychiatry 184:330–336PubMedCrossRef

31.

Kessing LV (2004) Severity of depressive episodes according to ICD-10: prediction of risk of relapse and suicide. Br J Psychiatry 184:153–156PubMedCrossRef

32.

Kessing LV (2005) Diagnostic stability in depressive disorder as according to ICD-10 in clinical practice. Psychopathology 38:32–37PubMedCrossRef

33.

Kessler D, Lloyd K, Lewis G, et al (1999) Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. BMJ 318:436–439PubMed

34.

Kornstein SG, Schatzberg AF, Thase ME, et al (2000) Gender differences in chronic major and double depression. J Affect Disord 60:1–11PubMedCrossRef

35.

Krishnan KR (2005) Psychiatric disease in the genomic era: rational approach. Mol Psychiatry 10:978–984PubMedCrossRef

36.

Lepine JP (2001) Epidemiology, burden, and disability in depression and anxiety. J Clin Psychiatry 62(suppl 13):4–10PubMed

37.

Lesperance F, Frasure-Smith N, Talajic M (1996) Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med JID-0376505 58:99–110

38.

Lesperance F, Frasure-Smith N, Talajic M, et al (2002) Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation JID-0147763 105:1049–1053

39.

Lundberg I, Damstrom TK, Hallstrom T, et al (2005) Determinants of non-participation, and the effects of non-participation on potential cause-effect relationships, in the PART study on mental disorders. Soc Psychiatry Psychiatr Epidemiol 40:475–483PubMedCrossRef

40.

Martin CR, Thompson DR, Chan DS (2004) An examination of the psychometric properties of the Hospital Anxiety and Depression Scale in Chinese patients with acute coronary syndrome. Psychiatry Res 129:279–288PubMedCrossRef

41.

Merikangas KR, Zhang H, Avenevoli S, et al (2003) Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study. Arch Gen Psychiatry 60:993–1000PubMedCrossRef

42.

Mueller TI, Leon AC, Keller MB, et al (1999) Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry 156:1000–1006PubMed

43.

Mykletun A, Bjerkeset O, Dewey M, et al (2007) Anxiety, depression, and cause-specific mortality: the HUNT study. Psychosom Med 69:323–331PubMedCrossRef

44.

Mykletun A, Overland S, Dahl AA, et al (2006) A population-based cohort study of the effect of common mental disorders on disability pension awards. Am J Psychiatry 163:1412–1418PubMedCrossRef

45.

Mykletun A, Stordal E, Dahl AA (2001) Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry JID-0342367 179:540–544CrossRef

46.

Nease DE Jr, Aikens JE (2003) DSM depression and anxiety criteria and severity of symptoms in primary care: cross sectional study. BMJ 327:1030–1031PubMedCrossRef

47.

Nease DE, Klinkman MS, Volk RJ (2002) Improved detection of depression in primary care through severity evaluation. J Fam Pract 51:1065–1070PubMed

48.

Nease DE Jr, Volk RJ, Cass AR (1999) Does the severity of mood and anxiety symptoms predict health care utilization? J Fam Pract 48:769–777PubMed

49.

O’Sullivan C (2004) The psychosocial determinants of depression: a lifespan perspective. J Nerv Ment Dis 192:585–594PubMedCrossRef

50.

Paykel ES (1994) Historical overview of outcome of depression. Br J Psychiatry Suppl 6–8

51.

Paykel ES (1998) Remission and residual symptomatology in major depression. Psychopathology 31:5–14PubMedCrossRef

52.

Paykel ES, Hayhurst H, Abbott R, et al (2001) Stability and change in milder psychiatric disorder over 7 years in a birth cohort. Psychol Med 31:1373–1384PubMed

53.

Simpson HB, Nee JC, Endicott J (1997) First-episode major depression. Few sex differences in course. Arch Gen Psychiatry 54:633–639PubMed

54.

Snaith RP, Zigmond AS (1986) The hospital anxiety and depression scale. Br Med J (Clin Res Ed) 292:344CrossRef

55.

Spijker J, Bijl RV, De Graaf R, et al (2001) Determinants of poor 1-year outcome of DSM-III-R major depression in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Acta Psychiatr Scand 103:122–130PubMedCrossRef

56.

Spijker J, De Graaf R, Bijl RV, et al (2002) Duration of major depressive episodes in the general population: results from The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Br J Psychiatry 181:208–213PubMedCrossRef

57.

Spinhoven P, Ormel J, Sloekers PP, et al (1997) A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 27:363–370PubMedCrossRef

58.

Stordal E, Bjartveit KM, Dahl NH, et al (2001) Depression in relation to age and gender in the general population: the Nord-Trondelag Health Study (HUNT). Acta Psychiatr Scand JID-0370364 104:210–216CrossRef

59.

Stordal E, Mykletun A, Dahl AA (2003) The association between age and depression in the general population: a multivariate examination. Acta Psychiatr Scand 107:132–141PubMedCrossRef

60.

Thompson MG, Heller K, Rody CA (1994) Recruitment challenges in studying late-life depression: do community samples adequately represent depressed older adults? Psychol Aging 9:121–125PubMedCrossRef

61.

Tyrer P, Seivewright H, Simmonds S, et al (2001) Prospective studies of cothymia (mixed anxiety-depression): how do they inform clinical practice? Eur Arch Psychiatry Clin Neurosci 251(suppl 2):II53–II56PubMed

62.

White D, Leach C, Sims R, et al (1999) Validation of the Hospital Anxiety and Depression Scale for use with adolescents. Br J Psychiatry 175:452–454PubMed

63.

Wilhelm K, Roy K, Mitchell P, et al (2002) Gender differences in depression risk and coping factors in a clinical sample. Acta Psychiatr Scand 106:45–53PubMedCrossRef

Title: A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population
The HUNT study
Authors: Ottar Bjerkeset, MD, PhD
Hans M. Nordahl, PhD
Sara Larsson, MA
Alv A. Dahl, MD, PhD
Olav Linaker, MD, PhD
Publication date: 01-03-2008
Publisher: D. Steinkopff-Verlag
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 3/2008
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-007-0289-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population

The HUNT study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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