DSM-5 anxious distress specifier in patients with bipolar depression

BACKGROUND: DSM-5 introduced the anxious distress specifier in recognition of the significance of anxiety in patients who are depressed. Studies have supported the validity of the specifier in patients with major depressive disorder (MDD). In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the validity of the specifier in patients with bipolar depression.

METHODS: Forty-nine patients with a principal diagnosis of bipolar depression and 369 with MDD were evaluated with semi-structured diagnostic interviews, including the DSM-5 Anxious Distress Specifier Interview (DADSI). The patients were rated on measures of depression, anxiety, and irritability, and completed self-report measures.

RESULTS: The majority of patients with bipolar depression met the DSM-5 anxious distress specifier, no different than the frequency in patients with MDD. The DADSI was significantly correlated with other measures of anxiety, and more highly correlated with other measures of anxiety than with measures of depression and irritability. Patients with panic and generalized anxiety disorder scored higher on the DADSI than patients without an anxiety disorder.

CONCLUSIONS: The results of our study indicate that anxious distress is common in patients with bipolar depression and support the validity of the DSM-5 anxious distress specifier.

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