Differences in psychiatric comorbidity patterns in patients diagnosed with chronic stress-induced exhaustion disorder and depression 2024 Wallensten+

Full title: Differences in psychiatric comorbidity patterns in patients diagnosed with chronic stress-induced exhaustion disorder and depression – A cohort study in the total population of Region Stockholm

Highlights

• Chronic stress-induced exhaustion disorder (SED) and depression were compared in a population study.
  
  
• SED and depression exhibited distinct psychiatric comorbidity patterns.
  
  
• SED had higher odds ratios (OR) for acute and severe stress reactions, and postviral fatigue than depression.
  
  
• Both depression and SED had high ORs for ADHD, autistic disorder, and PTSD (OR<3.5).
  
  
• Depression had higher ORs for ADHD, autistic disorder, and PTSD than SED.

Abstract

The high prevalence of stress-related disorders and depression underscores the urgent need to unravel their impact on individual well-being. This study aim to investigate common psychiatric and stress-related diagnoses, along with postviral fatigue, in individuals with prior stress-induced exhaustion disorder (SED) and prior depression compared to those without prior SED or depression, and to study whether the psychiatric comorbidity patterns differ.

The study includes individuals in Region Stockholm who, in 2011, did not have a diagnosis of SED or depression. ICD-10 diagnosis of SED, depression, or both, recorded in 2012–2013, were compared to individuals without prior SED or depression in a cohort (n = 1,362,886), aged 18 to 65. Odds ratios (OR) with 99 % confidence intervals, adjusted for age and neighborhood socioeconomic status, were calculated for psychiatric disorders and post-viral fatigue in 2014–2022.

Patients with prior SED showed associations primarily with stress related diagnoses, including acute stress reaction, reaction to severe stress, as well as post-COVID-19 and post-viral fatigue syndrome. These ORs were all larger for SED than depression. Depression was primarily associated with post-traumatic stress disorder (PTSD), alcohol related and substance use disorders, schizophrenia, schizotypal disorders, delusional disorders, manic episode, bipolar affective disorder, persistent mood disorder, neurotic disorder, borderline personality disorder, autistic disorder, Asperger's syndrome, attention -deficit hyperactivity disorder, attention-deficit disorders ADHD/ADD), and suicide attempt. These ORs were all higher for depression, although autistic disorders, ADHD/ADD and PTSD were also highly associated with prior SED (OR > 3.5).

The divergent psychiatric comorbidity patterns suggest different underlying mechanisms and clinical prognosis.

Open access, https://www.sciencedirect.com/science/article/pii/S0165032724002970

 

"The SED diagnostic criteria partially overlap with the diagnostic criteria for depression, and around one-third of individuals with SED also experience depressive symptoms (Glise et al., 2012). Similarities are also found with chronic fatigue (Billones et al., 2021; Lindsäter et al., 2023) as well as with burnout (van Dam, 2021). In line with the debate whether burnout is a unique phenomenon or a variant of depression (Bianchi et al., 2015), SED may also constitutes a diagnostic category separate from depression, or be a variant of depression. Regardless of this discussion, the SED diagnosis can be considered a marker for individual experience of chronic stress."

"The hypothesis is that individuals who experience chronic stress may have higher risk for certain comorbidities such as other stress related disorders and neuropsychiatric disorders, and patients with depression may have greater risk for substance abuse, personality disorders and suicide attempts. Stress is also a suggested trigger for ME/CFS (Chu et al., 2019), so we also hypothesized that patients with SED might be more likely to develop also post-viral fatigue. Findings of divergent psychiatric comorbidity patterns would indicate that patients exposed to chronic stress as identified by the SED diagnosis, require a different management approach to those with depression only, and that chronic stress may effect the underlying mechanisms of symptom development."

 

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