Get access

COURSE AND RISK FACTORS OF FUNCTIONAL IMPAIRMENT IN SUBTHRESHOLD DEPRESSION AND ANXIETY

Authors

  • Julie Karsten Ph.D.,

    Corresponding author
    • Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    Search for more papers by this author
  • Brenda W.J.H. Penninx Ph.D.,

    1. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    2. Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
    3. Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
    Search for more papers by this author
  • Charlotte E Verboom Ph.D.,

    1. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    Search for more papers by this author
  • Willem A. Nolen M.D., Ph.D.,

    1. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    Search for more papers by this author
  • Catharina A. Hartman

    1. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
    Search for more papers by this author

  • Disclosures: During the years 2007–2012, W.A. Nolen has received grants from the Netherlands Organisation for Health Research and Development, the European Union, the Stanley Medical Research Institute, Astra Zeneca, Eli Lilly, GlaxoSmithKline, and Wyeth; has received honoraria/speaker's fees from Astra Zeneca, Lundbeck, Pfizer, and Wyeth; and has served in advisory boards for Astra Zeneca. None of the other authors have any financial disclosures.

Correspondence to: Julie Karsten, Department of Psychiatry, University Medical Center Groningen, PO box 30 001, 9700 RB, Groningen, The Netherlands. E-mail: J.Karsten@umcg.nl.

Abstract

Background

Although persons with subthreshold depression or anxiety are known to be at risk for full-syndromal disorders, little is known about their functioning over time. In this study, we investigate the functional impairment of persons with subthreshold depression or anxiety over time, compared to that of controls. Furthermore, we evaluate which illness, personal, and environmental risk factors influence its course.

Methods

Data come from the Netherlands Study of Depression and Anxiety (N = 1,266, aged 18–65). Linear mixed models were used to identify predictors of functional impairment at baseline, 1-, and 2-year follow-up. Risk factors were evaluated in their overall effect on functioning and on change in functioning over time, and whether they differed for respondents with and without subthreshold depression or anxiety.

Results

Functional impairment in subthreshold respondents improved over time, but remained much higher than in controls. Prior anxiety disorder, high neuroticism, low conscientiousness, more somatic conditions, and more childhood trauma all predicted greater functional impairment. Older age predicted lower functioning only in subthreshold respondents, while the effect of neuroticism was stronger in subthreshold respondents relative to controls.

Conclusions

Functional impairment in subthreshold respondents improved over time, but remained elevated compared to that of controls. Given continuously elevated levels of impairment, preventive interventions should be focused on persons with subthreshold symptoms; in particular those with prior anxiety disorder, high neuroticism, low conscientiousness, somatic conditions, or childhood trauma.

Ancillary