DSM-5 Anxious Distress Specifier Valid for Major Depressive Disorder

Hands picking at fingers, anxious
Hands picking at fingers, anxious
The validity of the anxiety specifier diagnosed with a semistructured interview was examined.

More than 78% of patients with major depressive disorder meet the DSM-5 criteria for anxious distress, according to a study published in Depression and Anxiety.

The DSM-5 anxious distress specifier was introduced to recognize the clinical significance of anxiety for patients with depression, but recent studies supporting the specifier’s validity used scales from an existing database rather than measures designed to assess the DSM-5 criteria for anxious distress.

As part of the Rhode Island Methods to Improve Diagnostic Assessment and Services project (MIDAS), the current investigators examined the specifier’s validity via a semistructured interview of 260 participants (70.0% women, 26.5% men, and 3.5% transgender patients; mean age=38.0, SD=14.3) diagnosed with major depressive disorder from August 2015 to January 2018. Participants completed self-report measures and their levels of anxiety, depression, and irritability were rated using clinician rating scales.

Results showed that 78.1% (n=203) of the 260 participants met the DSM-5 criteria for anxious distress. Anxiety disorders were more prevalent among these participants, in particular, generalized anxiety disorder, agoraphobia, and panic disorder. They also scored higher on measures of anger, anxiety, and depression and reported higher rates of substance use disorders, poorer coping abilities, and poorer functioning in the week prior to evaluations compared with participants who did not meet the criteria for anxious distress.

After controlling for the presence of anxiety disorders, anxious distress was still associated with poorer coping and functioning scores on the Remission from Depression Questionnaire (β =0.16, =.023 and β =0.22, =.003, respectively), but not with past week functioning or drug use disorder per the Schedule for Affective Disorders and Schizophrenia (SADS) interview (β =0.13, =.074 and β =0.14, =.061, respectively).

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There was no difference between the 2 groups in suicidal ideation, episode duration, or days missed from work, and they were also not more likely to have a history of suicide attempt (36.4% vs 26.3%, χ2 =2.03, n.s.) or psychiatric hospitalization (42.4% vs 31.6%, χ2 =2.16, n.s.)

Study investigators conclude that although the study was limited because the participants were primarily female and white with health insurance, the findings indicating “that the presence of an anxiety disorder was associated with poorer coping after controlling for the presence of anxious distress… suggests that anxious distress is not redundant with diagnosing an anxiety disorder as both capture unique variance with external variables.”


Zimmerman M, Martin J, McGonigal P, et al. Validity of the DSM-5 anxious distress specifier for major depressive disorder [published online October 12, 2018]. Depress Anxiety. doi: 10.1002/da.22837