Depresion

D

The Influence of Depression and Anxiety on Risk of Adult
Maheruh Khandker, M.H.S.,1 Sonya S. Brady, Ph.D.,1 Allison F. Vitonis, Sc.M.,2 Richard F. MacLehose, Ph.D.,1,,3 Elizabeth G. Stewart, M.D.,2 and Bernard L. Harlow, Ph.D.1
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Abstract
Background
Studies have shown that women with vulvodynia are more psychologicallydistressed than women without vulvodynia. These studies, however, have not effectively established temporal associations between diagnosed psychiatric disorders and vulvodynia.
Methods
The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered to 240 case-control pairs of women with and without vulvodynia. Interviews established age at first onset of diagnosed mood andanxiety disorder. Age information was used to determine whether the first episode of mood and/or anxiety was antecedent or subsequent to the first onset of vulvodynia symptoms. Conditional logistic regressions tested whether antecedent depression or anxiety was more likely among women with or without vulvodynia. Cox proportional hazards modeling was then used to estimate risk of subsequent new orrecurrent onset of mood or anxiety disorder.
Results
After adjusting for education, race, age at menarche, age at first tampon use, and age at first sexual intercourse, odds of vulvodynia were four-times more likely among women with antecedent mood or anxiety compared to women without (95% confidence interval [CI] 2.1-7.5). Vulvodynia was associated with new or recurrent onset of mood or anxietydisorder after adjustment (hazard ratio [HR] 1.7, 95% CI 1.1-2.6) and did not significantly change after including history of mood or anxiety disorder before the onset of vulvodynia or reference age of controls in the models.
Conclusions
This is the first community-based epidemiologic study demonstrating that DSM-IV-diagnosed antecedent depression and anxiety disorders influence the risk ofvulvodynia and that vulvodynia increases the risk of both new and recurrent onset of psychopathology.
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Introduction
Although vulvodynia, or chronic vulvar pain, has long been documented, the medical and psychologic underpinnings remain elusive.1 With unexplained vulvar pain now known to be common (lifetime risk and prevalence of 16% and 7%, respectively),2 the continued lack of informationavailable about antecedent risk factors and treatment has become a source of frustration for many women and their healthcare providers.3 Diagnosable psychologic disorders, such as depression and anxiety, have not been thoroughly examined in the pathogenesis of vulvodynia, as they have for many medical conditions (e.g., urinary tract or yeast infections).1,7 One reason for this disparity lies in thecomplexity of determining if psychologic disorders precede the onset of vulvodynia or occur primarily as a consequence of chronic vulvar pain.
It is well documented that women with vulvodynia are more psychologically distressed than women without vulvodynia.5–10 However, there is less certainty about the influence of psychiatric morbidity as an antecedent risk factor. This is largely due to severallimitations in earlier studies that relied on self-reported diagnoses, lacked the capacity to establish age at first onset of depression or anxiety, and as a result, were unable to establish the temporal relationship between psychiatric disorders and vulvar pain onset.4–9 Moreover, the lack of structured clinical interviews in these prior studies meant documenting only symptoms of depression andanxiety in women; these measures preclude establishing a psychiatric diagnosis.4–9 Lastly, the selection of only women actively seeking treatment for vulvar pain in these earlier studies excludes the nearly 40% of women choosing not to seek treatment for their unexplained vulvar pain.2,5–7,9,10 Thus, the lack of studies that use a community-based population source has limited the generalizability...