Association Between Depression and Anxiety: Longitudinal Course and Family History

1
Association Between Depression and Anxiety
Longitudinal Course and Family History

• Thomas M. Olino1,2, Daniel N. Klein1,2,
• Peter M. Lewinsohn2
• Stony Brook University1, Oregon Research
  Institute2

2
Abstract

• Depression and anxiety are highly comorbid
  disorders. Data from a number of previous
  studies utilizing different methodologies offer
  multiple potential models of how depressive and
  anxiety disorders influence each other or are
  caused by overlapping processes. The current
  study reports on 841 participants from the Oregon
  Adolescent Depression Project who participated in
  up to four diagnostic assessments over the course
  of approximately 15 years. Five structural
  equation models examined competing explanations
  for the overlap between the depressive and
  anxiety disorders. The best fitting model
  specified that depressive and anxiety disorders
  were caused by separate, but highly correlated
  latent factors. We also examined the influence
  of parental depression and anxiety on offspring
  depression and anxiety. In the most parsimonious
  model, maternal and paternal depressive disorder
  was associated with offspring depressive disorder
  and paternal depressive disorder and maternal and
  paternal anxiety disorder were associated with
  offspring anxiety disorder.

3
Comorbidity Between Depressive and Anxiety
Disorders

• Depressive and anxiety disorders are highly
  comorbid (Clark, 1989 Kessler, Nelson,
  McGonagle, 1996).
• Comorbidity has theoretical implications for
  defining disorders and interventions (Mineka et
  al., 1998).
• Reasons for comorbidity are not well understood.

4
Potential Models of Comorbidity

• The presence of an anxiety disorder increases the
  likelihood of the development of a depressive
  disorder (Alloy et al., 1990 Avenevoli et al.,
  2001 Kessler et al., 1997 Orvaschel, Lewinsohn,
  Seeley, 1995 Warner et al., 1999 ).
• The presence of a depressive disorder increases
  the likelihood of the development of an anxiety
  disorder (Markowitz, 1993 Markowitz et al.,
  1992).

5
Potential Models of Comorbidity (contd)

• Depressive and anxiety disorders are related due
  to a common factor giving rise to both disorders.
  
• e.g., Krueger (Krueger Finger, 2001) Tyrer
  (2001) Andrews (1996).
• Depressive and anxiety disorders have both shared
  and unique influences.
• e.g., Clark Watsons Tripartite model (Clark
  Watson, 1991).

6
Goals of the Present Study

• Compare multiple competing models of the
  comorbidity between depressive and anxiety
  disorders.
• Examine the influence of parental history of
  depressive and anxiety disorder on offspring
  depressive and anxiety disorders in the best
  fitting model.

7
Methods

• Participants were selected from the Oregon
  Adolescent Depression Project (OADP Lewinsohn et
  al., 1993) and were assessed on up to four
  occasions over the course of approximately 15
  years.
• At the time of each assessment, participants
  completed structured diagnostic interviews.
• All participants who completed the T3 assessment
  and did not experience a lifetime bipolar or
  psychotic disorder were included. Thus, the
  sample included 891 participants.

8
Methods (contd)

• A total of 770 participants were assessed at all
  four time points 119 at three time points and 2
  at two time points.
• At the time of the T3 assessment, diagnostic
  interviews were conducted with all first degree
  family relatives. If diagnostic interviews could
  not be completed, family history interviews were
  conducted. Data were available for 756 mothers
  and 741 fathers.

9
Analytic Approach

• Caucasian OADP participants with no history of
  psychopathology through T2 were undersampled in
  the T3 follow-up hence in all statistical
  analyses offspring were weighted as a function of
  their probability of being selected at T3.
• Structural equation modeling was performed using
  Mplus, version 3.12 (Muthén Muthén, 1998-2004).
• Due to the categorical nature of the data,
  chi-square values were computed using the WLSMV
  estimator and theta parameterization. All
  available data was included by using the full
  information maximum likelihood method.

10
Baseline Model
p RMSEA .06.
11
Contemporaneous Effects Model
p RMSEA .06.
12
Cross-Lagged Effects Model
p RMSEA .05 ?2baseline model (6) 25.65, p .001 Not shown in the model are covariance paths
between the error terms at T2 (r -.13, p
n.s.), T3 (r .09, p n.s.), and T4 (r .22, p
13
One-Factor Model
p CFI .99 RMSEA .01. Not shown in the model
are covariance paths between the error terms at
T1 (r .26, p T3 (r .12, p n.s.), and T4 (r .19, p .01).
14
Two-Factor Model
p CFI 1.00 RMSEA model are covariance paths between the error
terms at T1 (r .26, p n.s.), T3 (r .17, p 15
Results

• The two-factor model fit the data best.
• The two-factor model fit the data significantly
  better than the one factor model.
• The fit indices for the two-factor model were
  also best when compared to the baseline,
  contemporaneous, and cross-lagged effects models.
  
• Thus, the two-factor model serves as the basis
  for the examination of family history.

16
Latent Depressive and Anxiety Disorder Factors
Regressed on Family History of Psychopathology
p CFI .99 RMSEA .005. Not shown in the model
are covariance paths between the error terms at
T1 (r .25, p (r .16, p 17
Discussion

• Of the models estimated, the best fitting model
  was the two-factor model.
• Rather than reflecting autoregressive,
  cross-disorder influence over time, or a single
  factor influencing each disorder, the best
  fitting model suggests that depressive and
  anxiety disorders at various time points are
  expressions of separate, but highly correlated,
  vulnerabilities.
• This model is consistent with, but not a direct
  estimation of, the tripartite model (Clark
  Watson, 1991).

18
Discussion (contd)

• Evidence for independent transmission and
  co-aggregation of depressive and anxiety
  disorders was mixed.
• Maternal depressive disorder was specifically
  associated with offspring depressive disorder.
• Maternal and paternal anxiety disorder was
  specifically associated with offspring anxiety
  disorder.
• Paternal depressive disorder was associated with
  both offspring depressive disorder and anxiety
  disorder.

19
Future Directions

• Future studies should examine if the latent
  depressive disorder and latent anxiety disorder
  factors are associated with their theoretically
  relevant symptom and personality features from
  the tripartite model.
• Future studies could also examine the processes
  by which maternal depressive disorder is
  associated with offspring depressive disorder,
  however, paternal depressive disorder is
  associated with both offspring depressive and
  anxiety disorder.

20
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