Overlap Between Mood And Anxiety Disorders

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Although this review considered the magnitude and risk factors for anxiety and depression independently, there is compelling evidence from prospective longitudinal studies, family studies, twin studies, and treatment studies that anxiety and depression have a common diathesis. There are now several reviews of comorbidity of anxiety and depression in youth that provide a comprehensive summary of the evidence for comorbidity as well as of the possible sources of comorbidity (Caron and Rutter, 1991; Angold et al., 1999). Their evaluation of methodologic issues, criterial overlap, common criteria, shared versus independent genetic and familial influences, and stability of course concluded that there is a common underlying genetic diathesis between anxiety and depression in general, but that there are also specific genetic and environmental factors that mold susceptibility to fear and anxiety.

Table 4 presents the risk factors for anxiety and depression divided by their unique associations with anxiety or depression as well as common risk factors that

TABLE 4. Vulnerability Factors for Anxiety Disorders and Depression

Both

Depression

Anxiety

Gender

Exposure to stress

Temperature:

Age

Pre-existing psychiatric

Behavioral inhibition

Genetic/family history

disorders

Anxiety sensitivity

Temperament

Premorbid medical disorders:

Autonomic reactivity

Pre-existing medical

e.g., migraine, diabetes

Respiratory function

disorders

Premorbid medical disorders

Stress reactivity

e.g., asthma, allergies

Neuroendocrine factors

Life events

Parenting behaviors

Family environment

may influence either syndrome. This table illustrates the importance of considering each disorder alone, but also the importance of integration of research across anxiety and depression. There are numerous common risk factors for anxiety and depression, as well as several unique risk factors that affect one of the two syndromes specifically.

This chapter has reviewed the findings of community-based studies regarding the magnitude, risk factors, and consequences of anxiety and depression. Their magnitude renders these two syndromes as the most common mental disorders in the population. The persistence and serious social, personal, and economic consequences of the mood and anxiety disorders is alarming and highlights the need for intervention with these disorders on a community-wide basis. Although they are not as severe as schizophrenia and other major mental disorders, their high prevalence and associated impairment suggests that they should be a major target for early identification, prevention, and treatment.

The emerging neuroscience of mood and anxiety disorders and progress in classification and risk factor research should lead to major advances in our understanding of the mechanisms through which vulnerability to depression and anxiety subsequently translates into prevention and/or treatment. From a public health perspective, the devotion of substantial effort to enhance our understanding of the etiology of mood and anxiety disorders and to identify the most effective interventions would have major public health impact because of their high frequency and individual and community cost.

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