Brief report Anxiety symptoms among remitted depressed outpatients: Prevalence and association with quality of life and psychosocial functioning Catherine D’Avanzato n , Jennifer Martinez, Naureen Attiullah, Michael Friedman, Cristina Toba, Daniela A. Boerescu, Mark Zimmerman a Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Rhode Island Hospital, Providence, RI, USA article info Article history: Received 25 January 2013 Received in revised form 8 March 2013 Accepted 19 June 2013 Available online 23 July 2013 Keywords: Major depression Anxiety Residual symptoms Remission Functioning Quality of life abstract Background: Prior studies of remission from depression have only examined the impact of residual depressive, but not anxiety, symptoms. Given that anxiety comorbidity in currently depressed patients is common and is associated with poorer outcomes, residual anxiety symptoms may play a significant role in remitted patients' well-being and vulnerability to relapse. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the frequency of residual anxiety symptoms among depressed outpatients in remission based on the HAM-D and associations among residual anxiety, psychosocial functioning and quality of life. Methods: We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder. Patients completed measures of depression and anxiety symptoms, psychosocial functioning, and quality of life. Results: Nearly three-quarters of remitted depressed patients endorsed at least one residual anxiety symptom, with a majority experiencing more than one symptom. Anxiety severity was associated with reduced functioning and quality of life across all life domains. Controlling for depression severity, anxiety symptoms were independently related to reduced functioning and quality of life in several domains. Limitations: We did not assess for specific pre-existing DSM-IV anxiety disorders nor particular treatments patients received, which may have influenced residual anxiety symptoms. Future studies should replicate the results using other measures of remission. Conclusions: Anxiety symptoms are common in depressed patients in remission, and independently related to reduced functioning and quality of life. Thus, it is important to consider anxiety symptoms in evaluating the completeness of treatment response of depressed patients. & 2013 Elsevier B.V. All rights reserved. 1. Introduction Anxiety disorders are frequent in depressed patients, occurring in nearly 50% of depressed individuals (e.g. Howland et al., 2009). A majority of those individuals are diagnosed with more than one anxiety disorder (Zimmerman et al., 2000), and an additional subgroup of depressed patients report clinically significant sub- threshold anxiety symptoms (Fava et al., 2006). The high prevalence of co-occurring anxiety among depressed patients has important implications for intervention, given that anxiety symptoms are associated with the clinical characteristics and course of depression, as well as treatment response. In particular, the presence of comorbid anxiety is associated with greater depression severity, higher recurrence rates, longer duration of depressive symptoms (Rush et al., 2000; Rhebergen et al., 2011), and increased suicidality (Sareen et al., 2005). Anxiety comorbidity among depressed patients is also associated with poorer psycho- social functioning and quality of life (Klein-Hofmeijer Sevink et al., 2012), as well as higher healthcare utilization (Kessler et al., 1994). Further, anxiety comorbidity is related to poorer response to antidepressants (Howland et al., 2009). Thus, detection of anxiety in depressed patients is critical because it is likely to require modifications to treatment (Petersen et al., 2009). In light of the high prevalence and clinical significance of anxiety comorbidity in depressed patients, it is surprising that little attention has been given to the impact of anxiety in patients who have remitted from depression following treatment. Merely a small number of residual depression symptoms is related to reduced functioning and quality of life (Zimmerman et al., 2007), as well as increased risk for relapse (Nierenberg et al., 2010), thus experts in depression treatment have emphasized the need to aim for complete or near complete symptomatic remission (Rush et al., 2006). However, no studies have examined the frequency and Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders 0165-0327/$ - see front matter & 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2013.06.040 n Correspondence to: 146 West River Street, Suite 11B, Providence, RI 02904, USA. Tel.: +1 401 444 2769; fax: +1 401 444 7107. E-mail address: cdavanzato@lifespan.org (C. D’Avanzato). Journal of Affective Disorders 151 (2013) 401–404