MIDAS Project
Publication Abstracts
McDermut, W., Mattia, J.I. & Zimmerman, M. Comorbidity burden
and its impact on psychosocial morbidity in depressed outpatients.
Journal of Affective Disorders, 2001, 65, 289-295.
Background: Many studies have examined the co-occurrence of
depression and one or two non-depressive disorders; however, little
research has looked at broad-spectrum comorbidity (i.e., comorbidity
across several diagnostic categories) in depressed patients. Research on
diagnostic practices in routine clinical settings--in which unstructured
interviewing is the norm--suggests that comorbid conditions are often not
detected (Zimmerman & Mattia, 2005). In this study we examined the
independent impact of different comorbid diagnostic categories on
psychosocial morbidity in psychiatric outpatients with Major Depressive
Disorder (MDD). Methods: Participants were drawn from a pool
of 1,000 psychiatric outpatients interviewed with the Structured Clinical
Interview for DSM-IV diagnoses (SCID-IV; First et al., 1995). We compared
the demographics, clinical characteristics, and psychosocial functioning
of depressed outpatients with and without different axis I comorbidities,
then conducted multivariate analyses to determine the respective impact of
comorbid axis I disorders. Result: Three hundred and
seventy-three patients had a principal diagnosis of unipolar MDD. One
hundred twenty-nine (34.6%) were diagnosed with MDD only, and 244 (65.4%)
had MDD and at least one other axis I disorder. Comorbidity was associated
with longer duration of index episode, more psychiatric morbidity, and
more social and occupational impairment. There was also a significant
relationship between increasing number of comorbid axis I disorders and
greater psychiatric and psychosocial impairment. In regression analyses,
comorbidity burden (i.e., the number of comorbid axis I disorders) showed
the strongest relation to psychiatric and psychosocial impairment. Limitations:
This is not a random sample of depressed outpatients and, thus, may not be
generalizable to all outpatients with depression. Second, Axes II and III
comorbidity were not assessed. Conclusion: Comorbidity
burden showed the strongest relation to impairment over and above the
presence of any particular class of disorders.
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