The influence of anxiety as a risk to early onset major depression

Objective: we seek to identify and quantify any risk provided by several ex pressions of "anxiety" to major depression overall, and to separate melanch olic and non-melancholic sub-types. Method: a sample of 269 patients with a current major depressive episode was assessed for rates of separate formal ised anxiety disorders, both for lifetime and prior to the initial depressi ve episode. We also sought for evidence of familial anxiety and, early chil dhood expression of anxiety forerunners, measured both state and trait anxi ety levels as well as anxiety at a "personality" level, and assessed use of anxiolytic medications. Depressive sub-typing was undertaken using DSM-IV criteria, while "early onset" (EO) depression was defined as an initial ons et at 25 years or less, and subsequently re-examined with a cut-off age of 20 years or less. Results. overall, 42% of our sample were assigned as havi ng EO depression, with there being a higher representation of non-melanchol ic than melancholic EO subjects (i.e., 51% vs. 29%), arguing for sub-type s tatus being respected in the analyses. For both melancholic and non-melanch olic subjects two hair anxiety items ("tense"; "keyed up/on edge") were ove r-represented, suggesting that such a tense anxiety style may provide an an tecedent risk to depression (of either sub-type) or be a consequence of dep ression. Specificity was most evident in the non-melancholic sub-sample, wh ere EO depression was associated with a family history of anxiety, early ch ildhood expressions of anxiety and with two lifetime anxiety disorders (soc ial phobia and obsessive-compulsive disorder). Broadly similar results were returned when "EO" definition was reduced to 20 years or less. Conclusions : our study is consistent with previous research in identifying anxiety in the form of social inhibition or social avoidance as being particularly lik ely to precede and perhaps be a conduit to early onset non-melancholic majo r depression. This conclusion both sharpens risk factor research and indica tes an important fulcrum that could be used to assist primary prevention of the depressive disorders. (C) 1999 Elsevier Science B.V. Ail rights reserv ed.