Predictors of remission from generalized anxiety disorder and major depressive disorder

Abstract

Background: The predictors of onset of major depressive disorder (MDD) and generalized anxiety disorder (GAD) are well-characterized. However the factors that predict remission from these conditions are less clear, and the study of this area is further complicated by differing definitions of remission.

Methods: Data come from the National Comorbidity Survey - Replication, and analysis was limited to respondents with a lifetime history of GAD (n=621) or MDD (n=1299) assessed by the Composite International Diagnostic Interview. Predictors of remission included demographic factors, adverse childhood events, family history, and clinical characteristics. Multiple definitions of remission were explored to account for residual symptoms.

Results: Half (54.4%) of respondents with MDD and 41.1% of respondents with GAD experienced full remission. Older age and higher socioeconomic status were positively related to remission in a dose-response manner for both disorders. Adverse childhood experiences and family history of anxious/depressive symptoms were negatively associated with remission from MDD. Comorbid GAD was inversely associated with remission from MDD (Odds ratio (OR): 0.62, 95% Confidence interval (CI): 0.44-0.88), but comorbid MDD did not impact remission from GAD (OR: 0.93, 95% CI: 0.64-1.35). With the exception of the influence of comorbidity, these associations were robust across definitions of remission.

Limitations: Cross-sectional analysis and retrospective recall of onset of MDD/GAD.

Conclusions: Many individuals with MDD or GAD will experience full remission. Some predictors appear to have a general association with remission from both disorders, while others are uniquely associated with remission from MDD.

Figure 1

Proportional Venn diagram of comorbidity and full remission

Figure 2. Predictors of full remission from MDD

Total N=1299, Remitted N=707. Values are odds ratio and 95% confidence intervals. Note: Each main exposure was fit in a separate model, all controlling for age, gender, and income-to-poverty ratio.

Figure 3. Predictors of full remission from GAD

Total N=621, Remitted N=255. Values are odds ratios and 95% confidence intervals. Each main exposure was fit in a separate model, all controlling for age, gender, and income-to-poverty ratio.