Co-morbidity between mood and anxiety disorders: A systematic review and meta-analysis

Abstract

There is consistent evidence that mood disorders often co-occur with anxiety disorders, however, the strength of the association of these two broad groups of disorders has been challenging to summarize across different studies. The aim was to conduct a meta-analysis of publications reporting on the pairwise comorbidity between mood and anxiety disorders after sorting into comparable study types. We searched MEDLINE, Embase, CINAHL, Web of Science, and the grey literature for publications between 1980 and 2017 regardless of geographical locations and languages. We meta-analyzed estimates from original articles after sorting by: (a) broad or narrow diagnostic criteria, (b) study time-frame, and (c) estimates with or without covariate adjustments. Over 43 000 unique studies were identified through electronic searches, of which 391 were selected for full-text review. Finally, 171 studies were eligible for inclusion, including 53 articles from additional snowball searching. In general, regardless of variations in diagnosis type, study time-frame, temporal order, or use of adjustments, there was substantial comorbidity between mood and anxiety disorders. Based on the entire 90 separate meta-analyses, the median OR was 6.1 (range 1.5-18.7). Of these estimates, all 90 were above 1, and 87 were significantly greater than 1 (i.e., the 95% confidence intervals did not include 1). Fourteen of the 90 pooled estimates had ORs that were greater than 10. This systematic review found robust and consistent evidence of comorbidity between broadly defined mood and anxiety disorders. Clinicians should be vigilant for the prompt identification and treatment of this common type of comorbidity.

Keywords: agoraphobia; anxiety disorders; bipolar disorder; depression; epidemiology; mood disorder.

Figure 1

Flow diagram (selection strategy) of included studies

Figure 2

Forest plot of the random‐effects meta‐analysis of period prevalence comorbidity between broadly defined mood and generalized anxiety disorders (adjusted) (aOR 18.7; 95% CI 16.2, 21.6)

Figure 3

Forest plot of the random‐effects meta‐analysis of period prevalence comorbidity between broadly defined depressive disorder and generalized anxiety disorders (unadjusted) (aOR 13.8; 95% CI 9.9, 19.3)

Figure 4

Forest plot of the random‐effects meta‐analysis of period prevalence comorbidity between broadly defined depressive disorder and generalized anxiety disorders (adjusted) (aOR 11.7; 95% CI 5.2, 26.3)