MULTIFOCAL NEGATIVE AFFECT: THE PREVALENCE AND CLINICAL PROFILE OF PSYCHIATRIC OUTPATIENTS WHO ARE DEPRESSED, ANXIOUS AND IRRITABLE

Objective

In clinical practice, patients frequently report the concurrent presence of 3 negative affects—anxiety, depression and anger/irritability. We refer to this constellation as multifocal negative affect (MNA). No prior studies have examined the prevalence and correlates of MNA in a large cohort of rigorously evaluated psychiatric outpatients.

Methods

The sample was derived from the 3,800 psychiatric outpatients evaluated with semi-structured diagnostic interviews. We excluded 334 patients who were asymptomatic or minimally symptomatic at the time of their evaluation and 5 patients who were missing data on at least 1 of the 3 symptom ratings. This left a final sample of 3,461 patients. We compared the demographic and clinical characteristics of patients with 1 or 2 negative affects to those with MNA.

Results

Depressed mood, anxiety, and anger/irritability were each present in at least twothirds of the patients, they were significantly intercorrelated, however < half of the patients met the criteria for MNA. Patients with MNA were more likely to have a history of suicide attempts, to report suicidal ideation during the week preceding the evaluation, to have greater social and occupational impairment and were diagnosed with a greater number of current psychiatric disorders.

Conclusions

The co-occurrence of 3 negative emotional states—depression, anxiety and anger—is associated with an increased likelihood psychosocial morbidity including suicidal behavior and of being diagnosed with multiple psychiatric disorders. The assessment of these affects is not time consuming and may identify patients needing a more thorough diagnostic evaluation than is typically conducted.