Operating characteristics of depression and anxiety disorder phenotype dimensions and trait neuroticism: A theoretical examination of the fear and distress disorders from the Netherlands study of depression and anxiety

Background: The receiver operating characteristics (ROC) of anhedonic depression and anxious arousal to detect the distress- (major depression, dysthymia, generalized anxiety disorder) and fear-disorder clusters (i.e. panic disorder, agoraphobia, social phobia) have not been reported in a large sample.

Methods: A sample of 2981 persons underwent structured psychiatric interview; n= 652 were without lifetime depression and anxiety disorder history. Participants also completed a neuroticism scale (Revised NEO Five Factor Inventory [NEO-FFI]), and the 30-item short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ-D30) measuring anhedonic depression, anxious arousal and general distress. Maximal sensitivity and specificity was determined by the Youden Index and the area-under-the-curve (AUC) in ROC analysis.

Results: A total of 2624 completed all measures (age M= 42.4 years 713.1, 1760 females [67.1%]), including 1060 (40.4%) persons who met criteria for a distress-disorder, and 973 (37.1%) who met criteria for a fear-disorder. The general distress dimension provided the highest ROC values in the detection of the distress-disorders (AUC=.814, sensitivity =71.95%, specificity= 76.34%, positive predictive value=67.33, negative predictive value= 80.07). None of the measures provided suitable operating characteristics in the detection of the fear-disorders with specificity values <75%.

Limitations: Over sampling of depression and anxiety disorders may lead to inflated positive- and negative predictive values.

Conclusions: The MASQ-D30 general distress dimension showed clinically suitable operating characteristics in the detection of distress-disorders. Neither neuroticism nor the MASQ-D30 dimensions provided suitable operating characteristics in the detection of the fear-disorders.