The association between anxiety and active behaviour in patients with major depressive Disorder: An ecological momentary assessment study

Introduction: There is limited knowledge regarding the effect of anxiety symptoms on behavioural avoidance in patients diagnosed with a depressive disorder. The aim of this study is to improve insight into the association between levels of anxiety symptoms, daily life activity levels, social interactions, and physical activity in depressed individuals.

Methods: Participants were 54 patients diagnosed with major depressive disorder experiencing mild to severe levels of depressive symptoms. The current study is a secondary analysis of the Transitions in Depression Recovery study (TRANS-ID Recovery). Symptoms of anxiety were assessed at baseline using the Symptom Check List-90 anxiety subscale. Daily life active behaviours were assessed using Ecological Momentary Assessment (EMA, five times a day for one week). We tested the between-subject associations between anxiety symptom levels and four operationalizations of active behaviours: number of activities, perceived physical activity, perceived social interaction, and social activity using linear mixed models. Additionally, we explored the association between anxiety levels and specific activities.

Results: Levels of anxiety were not associated with any of the four operationalizations of active behaviour. However, in a post-hoc analysis, a positive association was found between levels of anxiety and the specific activity category ‘household, groceries, administration’.

Conclusions: Higher levels of symptoms of anxiety in depressed individuals are not associated with active behaviours in daily life but are associated with more household activities. In clinical practice, it therefore may be more beneficial to assess specific behaviours rather than broad categories of behaviour.