Previous disorders and depression outcomes in individuals with 12-month major depressive disorder in the World Mental Health surveys

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Abstract

Background:
Major depressive disorder (MDD) is a common mental disorder characterized by a recurrent course and high mental disorder comorbidity rates. A lifespan perspective focusing on mental disorders preceding MDD may provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded current (past 12-month) MDD and the impact of these disorders on depression outcomes.
Methods:
Data came from 29 community epidemiological surveys of adults administered in 27 countries (n=145,990). The WHO Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent’s age at interview. These disorders were grouped in depressive distress disorders (MDD and dysthymia), non-depressive distress disorders (generalized anxiety disorder [GAD], post-traumatic distress disorder [PTSD]), fear disorders (agoraphobia, panic disorder, social anxiety disorder, specific phobia, and separation anxiety disorder), and externalizing disorders (intermittent explosive disorder, attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, and substance abuse and dependence). Depression outcomes included 12-month suicidality, days out of role, and impairment in role functioning.
Results
94.9% (SE=0.4) of respondents with 12-month MDD had at least one prior disorder. History of non-depressive distress, fear and externalizing disorders, but not depressive distress disorders, predicted higher impairment and suicidality among respondents with 12-month MDD after adjustment for sociodemographic variables. Further adjustment for MDD characteristics (age of onset, lifetime chronicity and current MDD severity) weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalizing disorders predicted suicidal ideation among respondents with 12-month MDD.
Conclusion
The great majority of people with 12-month MDD have a history of common mental disorders. Comorbid mental disorders, especially if not remitted, are associated with poor outcomes in MDD. These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalizing disorders in individuals with MDD.
Original languageEnglish
JournalDepression and Anxiety
Publication statusAccepted/In press - 28 Jun 2020

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