Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression?

We assessed whether a coexisting anxiety disorder predicts risk for persist ent depression in primary care patients with major depression at baseline. Patients with major depression were identified in a 12-month prospective co hort study at a University-based family practice clinic. Presence of an anx iety disorder and other potential prognostic factors were measured at basel ine. Persistent depressive illness (major depression, minor depression, or dysthymia) was determined at 12 months. Of 85 patients with major depressio n at baseline, 43 had coexisting anxiety disorder (38 with social phobia). The risk for persistent depression at 12 months was 44% greater [Risk Ratio (RR) = 1.44, 95% confidence interval (CI) 1.02-2.04] in those with coexist ing anxiety. This risk persisted in stratified analysis controlling for oth er prognostic factors. Patients with coexisting anxiety had greater mean de pressive severity [repeated measures analysis of variance (ANOVA), p < 0.04 ] and total disability days (54.9 vs 19.8, p < 0.02) over the 12-month stud y. Patients with social phobia had similar increased risk for persistent de pression (RR = 1.40, 95% CI 0.98-2.00). A coexisting anxiety disorder indic ates risk for persistent depression irt primary cave patients with major de pression. Social phobia may be important to recognize in these patients. Id entifying anxiety disorders can help primary care clinicians target patient s needing more aggressive treatment for depression. (C) 1999 Elsevier Scien ce Inc.