Anxious distress in people with major depressive episodes: a cross-sectional analysis of clinical correlates

Objective. Most people with major depressive episodes meet criteria for the anxiety distress (AD) specifier defined by DSM-5 as the presence of symptoms such as feeling of tension, restlessness, and difficulty concentrating, and fear that something awful may happen. This cross-sectional study was aimed at identifying clinical correlates of AD in people with unipolar or bipolar depression. Methods. Inpatients with a current major depressive episode were included. Data on sociodemographic and clinical variables were collected. The SCID-5 was used to diagnose depressive episodes and relevant specifiers. The Montgomery-Åsberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) were used to assess the severity of depression and symptoms of the opposite polarity (manic symptoms), respectively. Multiple logistic regression analyses were carried out to identify clinical correlates of AD. Results. We included 206 people (mean age: 48.4±18.6 yrs.; males: 38.8%) admitted for a major depressive episode (155 with major depressive disorder and 51 with bipolar disorder). Around two thirds of the sample (N=137; 66.5%) had AD. Multiple logistic regression models showed that AD was associated with mixed features, higher YMRS scores, psychotic features, and a diagnosis of major depressive disorder (p < 0.05). There were no other clinical variables associated with AD. Conclusion. Despite some limitations, including the cross-sectional design and the inpatient setting, our study shows that AD is likely to be associated with mixed and psychotic features, as well as with unipolar depression. The identification of these clinical domains may be helpful for clinicians to better contextualize AD in the context of major depressive episodes.