Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis.
Level 3 - non-randomized controlled study
Meta-analysis of observational cohort studies and individual cohort analysis.
PubMed 23180756 · doi:10.1093/schbul/sbs136
What was done
The authors assessed baseline DSM/SCID anxiety and depressive disorders in a cohort of 509 individuals with an At-Risk Mental State (ARMS) to evaluate their impact on psychopathology, global functioning, and transition to psychosis. They also performed a meta-analysis and meta-regression across 1,683 clinical high-risk individuals from the published literature.
What was found
In the primary cohort of 509 subjects, approximately 73% had an Axis I comorbidity, with 40% diagnosed with a depressive disorder and 8% with an anxiety disorder. The meta-analysis of 1,683 subjects found baseline prevalence rates of 41% for depressive disorders and 15% for anxiety disorders. Comorbid anxiety and depression were associated with higher suicidality or self-harm behaviors, disorganized/odd/stigmatizing behavior, avolition/apathy, and impaired global functioning. However, neither the primary cohort nor the meta-regression showed an effect of baseline anxiety or depressive comorbidity on transition to psychosis (exact effect estimates and confidence intervals were not reported in the abstract).
Why it matters
Depression and anxiety are common and clinically impairing in individuals at high risk for psychosis, but they appear to reflect concurrent affective dysregulation rather than drivers of transition to full psychosis.
Limits
The abstract reports no numerical effect sizes, odds ratios, confidence intervals, or follow-up durations. Findings are derived from observational cohort designs, and comorbidity was assessed only at baseline rather than longitudinally.
Cited by
- supports Schizophrenia is typically preceded by mood disorders like depression and anxiety.