Clinical significance and comorbidity of subthreshold depression and anxiety in the community

Abstract

Objective: This report examines: 1) the magnitude of co-occurrence of threshold and subthreshold-level depression and anxiety in the community, and 2) the relationship between comorbidity and the diagnostic level of depression and anxiety and their clinical correlates. Method: A community sample of 591 subjects was interviewed prospectively five times across 15 years from the ages of 20-35. The diagnostic interview allowed the assignment of diagnoses according to DSM-III criteria and operational definitions of subthreshold syndromes. Results: 1) Comorbidity between depression and anxiety was more frequent when one syndrome reached threshold level; 2) comorbidity at both the threshold and subthreshold diagnostic levels was associated with symptom severity, disability and treatment, whereas the diagnostic level was associated with disability and suicidal attempts. Conclusion: The systematic association between comorbidity across diagnostic threshold levels of anxiety and depression with clinical correlates suggests the importance of a more dimensional approach to their classification.