Background Anxious depression is a common subtype of major depressive disorder (MDD) associated with adverse outcomes and severely impaired social function. The aim of this study was to explore the relationships between child maltreatment, family functioning, social support, interpersonal problems, dysfunctional attitudes, and anxious depression.
Methods Data were collected from 809 MDD patients. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), Family Assessment Device (FAD), Childhood Trauma Questionnaire (CTQ), Social Support Rating Scale (SSRS), Interpersonal Relationship Integrative Diagnostic Scale (IRIDS), and Dysfunctional Attitudes Scale (DAS) were administered and recorded. Anxious depression was defined as an anxiety/somatization factor score ≥ 7 on the HAMD-17. Chi-squared tests, Mann-Whitney U tests, distance correlations, and structural equation models were used for data analysis.
Results Two-fifths of MDD patients had comorbid anxiety, and there were significant differences in child maltreatment, family functioning, social support, interpersonal problems, and dysfunctional attitudes between groups. Of these factors, interpersonal relationships were most related to anxiety in MDD patients, and dysfunctional attitudes mediated the relationship between interpersonal relationships and anxiety in MDD patients.
Limitations This study used cross-sectional data with no further follow-up to assess patient outcomes. This study did not include information about pharmacological treatments. A larger sample size is needed to validate the results.
Conclusions Psychosocial factors were significantly associated with anxious depression. Interpersonal relationships and dysfunctional attitudes have a direct effect on anxious depression, and interpersonal relationships also mediate the effects of anxious depression via dysfunctional attitudes.
Major depressive disorder (MDD) is highly prevalent and incurs a major burden on both the individual and society (Charlson et al., 2019; Kessler et al., 2009; Levav and Rutz, 2002). Anxious depression, a common subtype of MDD (prevalence 45.7 %–75.0 %) (Andrade et al., 2003; Fava et al., 2008; Kessler et al., 2005; Kessler et al., 2015; Lamers et al., 2011), is defined as MDD with a high level of anxiety. Anxiety and depression may have a common underlying pathophysiology, which is supported by epidemiological data (Fava et al., 2004; Sandi and RichterLevin, 2009; Wiethoff et al., 2010). Patients with anxious depression have more severe and persistent depressive symptoms (Fichter et al., 2010; McLaughlin et al., 2006; Murphy et al., 1986). A study of college students showed that elevated anxiety or depression might each be associated with increases in the frequency of suicidal thoughts, while elevations on both together convey additional risk (Norton et al., 2008). Furthermore, patients with co-existent anxiety and depression consistently have reduced responses to antidepressants (Fava et al., 2008), poor compliance with medication (Stein et al., 2006), and severely impaired social function (Sherbourne et al., 1996). These studies suggest that there may be differences between MDD patients with and without anxiety and that targeting and personalizing treatment to specific patient subgroups may be beneficial.
We show that MDD patients with and without anxiety have significant differences in dysfunctional attitudes, childhood abuse, interpersonal relationships, social support, and family functioning. Interpersonal relationships mediated the effects of anxiety in MDD patients via dysfunctional attitudes.