The British Journal of Psychiatry (2011) 198: 206-212. doi: 10.1192/bjp.bp.110.080572
© 2011 The Royal College of Psychiatrists
This Article



Julie Karsten, MSc and Catharina A. Hartman, PhD
University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands

Johannes H. Smit, PhD

VU University Medical Center, Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, Amsterdam, The Netherlands

Frans G. Zitman, MD

Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands

Aartjan T. F. Beekman, MD

VU University Medical Center, Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, Amsterdam, The Netherlands

Pim Cuijpers, PhD

VU University, Department of Clinical Psychology, Amsterdam, The Netherlands

A. J. Willem van der Does, PhD

Leiden University, Institute of Psychology, Leiden, The Netherlands

Johan Ormel, PhD and Willem A. Nolen, MD

University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands

Brenda W. J. H. Penninx, PhD

VU University Medical Center, Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, Amsterdam, and University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, and Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands

Correspondence: Julie Karsten, University Medical Center Groningen, Department of Psychiatry, PO box 660, 9700 AR, Groningen, The Netherlands. E-mail: J.Karsten@accare.nl

Declaration of interest

W.A.N. has received speaking fees from Astra Zeneca, Eli Lilly, Pfizer, Servier, Wyeth; unrestricted research funding from Astra Zeneca, Eli Lilly, GlaxoSmithKline, Wyeth; and served on advisory boards for Astra Zeneca, Cyberonics, Eli Lilly, GlaxoSmithKline, Pfizer, Servier.

Background

Past episodes of depressive or anxiety disorders and subthreshold symptoms have both been reported to predict the occurrence of depressive or anxiety disorders. It is unclear to what extent the two factors interact or predict these disorders independently.

Aims

To examine the extent to which history, subthreshold symptoms and their combination predict the occurrence of depressive (major depressive disorder, dysthymia) or anxiety disorders (social phobia, panic disorder, agoraphobia, generalised anxiety disorder) over a 2-year period.

Method

This was a prospective cohort study with 1167 participants: the Netherlands Study of Depression and Anxiety. Anxiety and depressive disorders were determined with the Composite International Diagnostic Interview, subthreshold symptoms were determined with the Inventory of Depressive Symptomatology–Self Report and the Beck Anxiety Inventory.

Results

Occurrence of depressive disorder was best predicted by a combination of a history of depression and subthreshold symptoms, followed by either one alone. Occurrence of anxiety disorder was best predicted by both a combination of a history of anxiety disorder and subthreshold symptoms and a combination of a history of depression and subthreshold symptoms, followed by any subthreshold symptoms or a history of any disorder alone.

Conclusions

A history and subthreshold symptoms independently predicted the subsequent occurrence of depressive or anxiety disorder. Together these two characteristics provide reasonable discriminative value. Whereas anxiety predicted the occurrence of an anxiety disorder only, depression predicted the occurrence of both depressive and anxiety disorders.