Factors associated with anxiety disorder comorbidity

Molly R Davies, Kiran Glen, Jessica Mundy, Abigail R Ter Kuile, Brett N Adey, Chérie Armour, Elham Assary, Jonathan R I Coleman, Kimberley A Goldsmith, Colette R Hirsch, Matthew Hotopf, Christopher Hübel, Ian R Jones, Gursharan Kalsi, Georgina Krebs, Andrew M McIntosh, Geneviève Morneau-Vaillancourt, Alicia J Peel, Kirstin L Purves, Sang Hyuck LeeMegan Skelton, Daniel J Smith, David Veale, James T R Walters, Katherine S Young, Johan Zvrskovec, Gerome Breen, Thalia C Eley

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Anxiety and depressive disorders often co-occur and the order of their emergence may be associated with different clinical outcomes. However, minimal research has been conducted on anxiety-anxiety comorbidity. This study examined factors associated with anxiety comorbidity and anxiety-MDD temporal sequence.

METHODS: Online, self-report data were collected from the UK-based GLAD and COPING NBR cohorts (N = 38,775). Logistic regression analyses compared differences in sociodemographic, trauma, and clinical factors between single anxiety, anxiety-anxiety comorbidity, anxiety-MDD (major depressive disorder) comorbidity, and MDD-only. Additionally, anxiety-first and MDD-first anxiety-MDD were compared. Differences in familial risk were assessed in those participants with self-reported family history or genotype data.

RESULTS: Anxiety-anxiety and anxiety-MDD had higher rates of self-reported anxiety or depressive disorder diagnoses, younger age of onset, and higher recurrence than single anxiety. Anxiety-MDD displayed greater clinical severity/complexity than MDD only. Anxiety-anxiety had more severe current anxiety symptoms, less severe current depressive symptoms, and reduced likelihood of self-reporting an anxiety/depressive disorder diagnosis than anxiety-MDD. Anxiety-first anxiety-MDD had a younger age of onset, more severe anxiety symptoms, and less likelihood of self-reporting a diagnosis than MDD-first. Minimal differences in familial risk were found.

LIMITATIONS: Self-report, retrospective measures may introduce recall bias. The familial risk analyses were likely underpowered.

CONCLUSIONS: Anxiety-anxiety comorbidity displayed a similarly severe and complex profile of symptoms as anxiety-MDD but distinct features. For anxiety-MDD, first-onset anxiety had an earlier age of onset and greater severity than MDD-first. Anxiety disorders and comorbidity warrant further investigation and attention in research and practice.

Original languageEnglish
JournalJournal of Affective Disorders (JAD)
Early online date26 Nov 2022
Publication statusE-pub ahead of print - 26 Nov 2022


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