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Macdonald-Gagnon G, Stefanovics EA, Potenza MN, Pietrzak RH. Generalized anxiety and mild anxiety symptoms in U.S. military veterans: Prevalence, characteristics, and functioning. J Psychiatr Res 2024; 171:263-270. [PMID: 38325107 DOI: 10.1016/j.jpsychires.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
Generalized anxiety disorder (GAD) is a mental disorder characterized by excessive anxiety and worries that impair daily functioning. While prior work has documented the prevalence and correlates of GAD and subthreshold GAD (SGAD) in clinical samples, contemporary data on the epidemiology of anxiety symptoms are lacking, particularly in higher-risk populations such as military veterans. To address this gap, we analyzed data from a large, nationally representative sample of U.S. veterans to examine the: prevalence of probable GAD and mild anxiety symptoms measured using a brief screener; sociodemographic and military characteristics associated with anxiety symptoms; and psychiatric and functional correlates of anxiety symptoms. Results revealed that a total of 7.9% (95% confidence interval [CI] = 6.7-9.3%) and 22.1% (95%CI = 20.5-23.9%) of veterans screened positive for probable GAD and mild anxiety symptoms, respectively. Relative to veterans without anxiety symptoms, those with probable GAD and mild anxiety symptoms were younger, more likely to be female and racial/ethnic minorities, and more likely to have served 2+ deployments. Further, a "dose-response" association was observed between anxiety symptom severity and clinical correlates, with robust associations observed between probable GAD and poorer mental health, suicidal thoughts and behaviors, and functional impairment. Mild anxiety symptoms showed intermediate magnitude associations with these outcomes. Results of this study suggest that 3-of-10 U.S. veterans report anxiety symptoms. While the use of a brief screener to assess mild anxiety symptoms and probable GAD is limited, findings underscore the importance of a dimensional approach to assessing anxiety symptoms and associated clinical and functional characteristics in veterans.
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Affiliation(s)
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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2
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Volz HP, Saliger J, Kasper S, Möller HJ, Seifritz E. Subsyndromal generalised anxiety disorder: operationalisation and epidemiology - a systematic literature survey. Int J Psychiatry Clin Pract 2022; 26:277-286. [PMID: 34314295 DOI: 10.1080/13651501.2021.1941120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The diagnosis of anxiety disorders, like other psychiatric disorders also, is operationalised since the introduction of diagnostic manuals. The diagnostic criteria of Generalised Anxiety Disorder (GAD) have been tightened in the last decades. This leads to the exclusion of patients with a high level of anxiety, but not fulfilling certain of the GAD-criteria, from effective treatment. Such so-called subsyndromal, subthreshold or subclinical GAD-states, however, often exhibit a comparable burden of disease like the full syndromal disorder and often tend to develop into the full syndromal disorder. The purpose of this review is - beside systematically reporting the papers found in respective data bases from 2013 onwards - to summarise the relevant data regarding definitions, epidemiology and consequences of subsyndromal anxiety states in order to give a comprehensive review.
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Affiliation(s)
- Hans-Peter Volz
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | - Julia Saliger
- Hospital for Psychiatry, Psychotherapy and Psychosomatic Medicine Schloss Werneck, Werneck, Germany
| | | | - Hans-Jürgen Möller
- Clinic and Policlinic for Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
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Danhauer SC, Miller ME, Divers J, Anderson A, Hargis G, Brenes GA. A Randomized Preference Trial Comparing Cognitive-Behavioral Therapy and Yoga for the Treatment of Late-Life Worry: Examination of Impact on Depression, Generalized Anxiety, Fatigue, Pain, Social Participation, and Physical Function. Glob Adv Health Med 2022; 11:2164957X221100405. [PMID: 35601466 PMCID: PMC9118438 DOI: 10.1177/2164957x221100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Depression, generalized anxiety, fatigue, diminished physical function, reduced social participation, and pain are common for many older adults and negatively impact quality of life. The purpose of the overall trial was to compare the effects of cognitive-behavioral therapy (CBT) and yoga on late-life worry, anxiety, and sleep; and examine preference and selection effects on these outcomes. Objective The present analyses compared effects of the 2 interventions on additional outcomes (depressive symptoms, generalized anxiety symptoms, fatigue, pain interference/intensity, physical function, social participation); and examined whether there are preference and selection effects for these treatments. Methods A randomized preference trial of CBT and yoga was conducted in adults ≥60 years who scored ≥26 on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), recruited from outpatient medical clinics, mailings, and advertisements. Cognitive-behavioral therapy consisted of 10 weekly telephone sessions. Yoga consisted of 20 bi-weekly group yoga classes. Participants were randomized to(1): a randomized controlled trial (RCT) of CBT or yoga (n = 250); or (2) a preference trial in which they selected their treatment (CBT or yoga; n = 250). Outcomes were measured at baseline and post-intervention. Results Within the RCT, there were significant between-group differences for both pain interference and intensity. The pain interference score improved more for the CBT group compared with the yoga group [intervention effect of (mean (95% CI) = 2.5 (.5, 4.6), P = .02]. For the pain intensity score, the intervention effect also favored CBT over yoga [.7 (.2, 1.3), P < .01]. Depressive symptoms, generalized anxiety, and fatigue showed clinically meaningful within-group changes in both groups. There were no changes in or difference between physical function or social participation for either group. No preference or selection effects were found. Conclusion Both CBT and yoga may be useful for older adults for improving psychological symptoms and fatigue. Cognitive-behavioral therapy may offer even greater benefit than yoga for decreasing pain.
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Affiliation(s)
- Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael E Miller
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jasmin Divers
- Division of Health Services Research, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Andrea Anderson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gena Hargis
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Alonso-Fernández M, Gillanders D, López-López A, Matías B, Losada A, González JL. An Exploration of the Psychometric Properties of the PASS-20 in Older Adults with Chronic Pain: Preliminary Development and Validity. Clin Gerontol 2022; 45:575-590. [PMID: 34047674 DOI: 10.1080/07317115.2021.1929628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Pain Anxiety Symptoms Scale (PASS-20) is well validated in adults and younger populations, but not in older adults. This study aimed to analyze the psychometric properties of the PASS-20 in Spanish older adults who experience chronic pain. METHODS Participants were 111 older adults with chronic pain living in nursing homes (mean age = 83.36; SD = 6.53; 78.6% female). Face-to-face interviews were conducted which included assessment of pain anxiety (PASS-20), chronic pain acceptance (CPAQ), depression symptoms (GDS), catastrophizing beliefs (PCS), pain severity, and sociodemographic information. An Exploratory Structural Equation Modeling (ESEM) approach was used to refine the scale. RESULTS The final scale was composed of seven items, measuring two factors that could be labeled "Internal experiences" and "Escape/Avoidance behaviors". The two factors explained 60.98% of the total variance. PASS-7 version fit properly: χ2/df = 14.57/13, CMIN/df = 1.121, CFI = 0.99, RMSEA = 0.033, TLI = 0.98, GFI = 0.96, AGFI = 0.92. Good validity indices were found and acceptable reliability results in the scale and its subscales (Chronbach´s α; Internal Experiences = 0.70; Escape/Avoidance Behaviors= 0.73; Total Scale = 0.77). CONCLUSIONS The short version of the PASS-7 has good psychometric properties. CLINICAL IMPLICATIONS The brevity of the PASS-7 increases the feasibility of this instrument which could potentially be utilized in a variety of clinical settings and research studies with older people with chronic pain samples, specially institutionalized older adults.
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Affiliation(s)
- Miriam Alonso-Fernández
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Almudena López-López
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Borja Matías
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Andres Losada
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - José Luis González
- Department of Psychology, School of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Landreville P, Gosselin P, Grenier S, Carmichael PH. Self-help guided by trained lay providers for generalized anxiety disorder in older adults: study protocol for a randomized controlled trial. BMC Geriatr 2021; 21:324. [PMID: 34022795 PMCID: PMC8140311 DOI: 10.1186/s12877-021-02221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Only a small proportion of older patients with generalized anxiety disorder (GAD) seek professional help. Difficulties in accessing treatment may contribute to this problem. Guided self-help based on the principles of cognitive-behavioral therapy (GSH-CBT) is one way of promoting access to psychological treatment. Moreover, because the therapist’s role in GSH-CBT is limited to supporting the patient, this role could be assumed by trained and supervised lay providers (LPs) instead of licensed providers. The main goal of this study is to evaluate the efficacy of GSH-CBT guided by LPs for primary threshold or subthreshold GAD in older adults. Methods We will conduct a multisite randomized controlled trial comparing an experimental group receiving GSH-CBT guided by LPs (n = 45) to a wait-list control group (n = 45). Treatment will last 15 weeks and will be based on a participant’s manual. Weekly telephone sessions with LPs (30 min maximum) will be limited to providing support. Data will be obtained through clinician evaluations and self-assessment questionnaires. Primary outcomes will be the tendency to worry and severity of GAD symptoms. Secondary outcomes will be anxiety symptoms, sleep difficulties, functional deficit, diagnosis of GAD, and cognitive difficulties. For the experimental group, measurements will take place at pre- and post-treatment and at 6 and 12 months post-treatment. For the control group, three evaluations are planned: two pre-treatment evaluations (before and after the waiting period) and after receiving treatment (post-treatment). The efficacy of GSH-CBT will be established by comparing the change in the two groups on the primary outcomes. Discussion This project will provide evidence on the efficacy of a novel approach to treat GAD in older adults. If effective, it could be implemented on a larger scale and provide many older adults with much needed mental health treatment through an expanded workforce. Trial registration The trial was registered at ClinicalTrials.gov, number NCT03768544, on December 7, 2018.
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Affiliation(s)
- Philippe Landreville
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec City, Quebec, G1V 0A6, Canada. .,Centre d'Excellence sur le Vieillissement de Québec, Quebec City, Canada. .,VITAM - Centre de Recherche en Santé Durable, Quebec City, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Quebec City, Canada.
| | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Canada.,Institut Universitaire de Première Ligne en Santé et Services Sociaux (IUPLSSS), Sherbrooke, Canada
| | - Sébastien Grenier
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montreal, Canada
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Brenes GA, Divers J, Miller ME, Anderson A, Hargis G, Danhauer SC. Comparison of cognitive-behavioral therapy and yoga for the treatment of late-life worry: A randomized preference trial. Depress Anxiety 2020; 37:1194-1207. [PMID: 33107666 DOI: 10.1002/da.23107] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the effects of cognitive-behavioral therapy (CBT) and yoga on late-life worry, anxiety, and sleep; and examine preference and selection effects on these outcomes. METHODS A randomized preference trial of CBT and yoga was conducted in community-dwelling adults 60 years or older, who scored 26 or above on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A). CBT consisted of 10 weekly telephone sessions. Yoga consisted of 20 biweekly group yoga classes. The primary outcome was worry (PSWQ-A); the secondary outcomes were anxiety (PROMIS-Anxiety) and sleep (Insomnia Severity Index [ISI]). We examined both preference effects (average effect for those who received their preferred intervention [regardless of whether it was CBT or yoga] minus the average for those who did not receive their preferred intervention [regardless of the intervention]) and selection effect (which addresses the question of whether there is a benefit to getting to select one intervention over the other, and measures the effect on outcomes of self-selection to a specific intervention). RESULTS Five hundred older adults were randomized to the randomized trial (125 each in CBT and yoga) or the preference trial (120 chose CBT; 130 chose yoga). In the randomized trial, the intervention effect of yoga compared with CBT adjusted for baseline psychotropic medication use, gender, and race was 1.6 (-0.2, 3.3), p = .08 for the PSWQ-A. Similar results were observed with PROMIS-Anxiety (adjusted intervention effect: 0.3 [-1.5, 2.2], p = .71). Participants randomized to CBT experienced a greater reduction in the ISI compared with yoga (adjusted intervention effect: 2.4 [1.2, 3.7], p < .01]). Estimated in the combined data set (N = 500), the preference and selection effects were not significant for the PSWQ-A, PROMIS-Anxiety, and ISI. Of the 52 adverse events, only two were possibly related to the intervention. None of the 26 serious adverse events were related to the study interventions. CONCLUSIONS CBT and yoga were both effective at reducing late-life worry and anxiety. However, a greater impact was seen for CBT compared with yoga for improving sleep. Neither preference nor selection effects was found.
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Affiliation(s)
- Gretchen A Brenes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jasmin Divers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael E Miller
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrea Anderson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gena Hargis
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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7
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Chong TWH, Lautenschlager NT, Anstey KJ, Bryant C. Anxiety disorders in late life-Why are we not more worried? Int J Geriatr Psychiatry 2020; 35:955-961. [PMID: 32250488 DOI: 10.1002/gps.5300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/14/2020] [Accepted: 03/29/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Terence W H Chong
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,St Vincent's Hospital Melbourne, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Mental Health, Epworth Healthcare, Melbourne, Victoria, Australia.,North Western Mental Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,North Western Mental Health, Melbourne Health, Melbourne, Victoria, Australia.,Division of Psychiatry and WA Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | - Kaarin J Anstey
- School of Psychology and UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia.,Lifecourse Ageing Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Convergence of psychiatric symptoms and restless legs syndrome: A cross-sectional study in an elderly French population. J Psychosom Res 2020; 128:109884. [PMID: 31794908 DOI: 10.1016/j.jpsychores.2019.109884] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/14/2019] [Accepted: 11/24/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective was to evaluate the association between restless legs syndrome (RLS) with generalized anxiety disorder (GAD), major depression disorder (MDD), dysthymia, and GAD-depression comorbidity. Secondary aims were to examine the association between RLS with the cognitive-affective and somatic-vegetative disturbances experienced as part of depression and GAD. METHODS This was a cross-sectional study of 1493 elderly participants (median age 80.6 years, 64% women) from Dijon, France. Probable RLS was assessed using the minimal diagnostic criteria of the International Restless Legs Study Group and RLS symptom frequency and treatment. Participants underwent structured interviews for MDD, dysthymia, and GAD. Participants also completed the Center for Epidemiological Studies-Depression scale (CES-D). The association between RLS and psychiatric disorders, their criterion symptoms, or symptom factors was examined using logistic regression. RESULTS The point prevalence of probable RLS in this sample was 8.2%. Probable RLS was associated with isolated GAD (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.01-4.68) and comorbid GAD-any depression disorder (OR 3.26, 95% CI 1.14-9.29), but not MDD or dysthymia. Probable RLS was also associated with the GAD criterion worry most days and feeling tense, and the CES-D factors representing depressed affect, somatic symptoms, and positive affect. CONCLUSIONS Probable RLS was associated with GAD-depression comorbidity as well as isolated GAD. The findings challenge previous reports linking RLS solely with MDD, suggesting the association is partly driven by GAD-depression comorbidity.
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Nilsson J, Sigström R, Östling S, Waern M, Skoog I. Changes in the expression of worries, anxiety, and generalized anxiety disorder with increasing age: A population study of 70 to 85-year-olds. Int J Geriatr Psychiatry 2019; 34:249-257. [PMID: 30353567 DOI: 10.1002/gps.5012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/05/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The prevalence of generalized anxiety disorder (GAD) is supposed to decrease with age. Reasons suggested include that emotional control increases and that anxiety and worry are expressed differently in older adults. The aim of this study was to examine how the expression of anxiety and worry changes with age and how this influences diagnoses in current classification systems. METHOD Semistructured psychiatric examinations were performed in population-based samples of 70- (n = 562), 75- (n = 770), 79/80- (n = 603), and 85-year-olds (n = 433). Individuals with dementia were excluded. GAD was diagnosed according to DSM-5 (DSM5 GAD) and ICD-10 (ICD10 GAD) criteria. Individual symptoms were assessed according to severity and frequency. Functioning was measured with Global Assessment of Functioning (GAF). RESULTS The prevalence of clinical anxiety, autonomic arousal, muscle tension, and irritability decreased with age, while that of worry and fatigue increased. Concentration difficulties and sleep disturbances remained stable. The prevalence of ICD10 GAD tended to decrease, while that of DSM5 GAD did not change with age. Core symptoms and diagnoses of GAD were related to lower GAF scores. However, in those with autonomic arousal and ICD10 GAD, GAF scores increased with age. CONCLUSIONS The prevalence of ICD10 GAD tended to decrease with increasing age while the prevalence of DSM5 GAD remained stable. This difference was partly due to a decreased frequency of severe anxiety and autonomic arousal symptoms, and that worries increased, suggesting changes in the expression of GAD with increasing age.
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Affiliation(s)
- Johan Nilsson
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Robert Sigström
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Svante Östling
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Carvalho AF, Stubbs B, Maes M, Solmi M, Vancampfort D, Kurdyak PA, Brunoni AR, Husain MI, Koyanagi A. Different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms among older adults in Ireland: A prospective community-based study. J Affect Disord 2018; 238:651-658. [PMID: 29957483 DOI: 10.1016/j.jad.2018.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The associations of different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms in older age remain unclear. METHODS Data on 6095 adults aged ≥ 50 years old from the Irish Longitudinal Study on Aging (TILDA) was analyzed. Participants completed the CAGE instrument to screen for problematic alcohol use at baseline between October 2009 and February 2011. Outcomes were incident (assessed by the CES-D scale) and anxiety (assessed by the Hospital Anxiety and Depressive scale) symptoms after a two-year follow-up as well as persistence of probable depression and anxiety among those with a positive screen for those disorders at baseline. Associations were adjusted for potential confounders through multivariable models. RESULTS In the overall sample, problem drinking did not predict incident and persistent depression and anxiety in this sample. Among females, problem drinking increased the risk for incident depression (OR = 2.11; 95%CI = 1.12-4.00) and anxiety (OR = 2.22; 95%CI = 1.01-4.86). In addition, problem drinking increased the risk of persistent depressive symptoms (OR = 2.43; 95%CI = 1.05-5.06) among females. CONCLUSION Problem drinking may increase the risk of incident probable depression and anxiety among older females. Furthermore, problem drinking led to a higher likelihood of persistent depressive symptoms in older female participants. Interventions targeting problem drinking among older females may prevent the onset and persistence of depression in this population, while also decreasing the incidence of anxiety symptoms.
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Affiliation(s)
- Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Center, KU Leuven, Leuven, Kortenberg, Belgium
| | - Paul A Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Andre R Brunoni
- Center for Clinical and Epidemiological Research & Interdisciplinary Center for Applied Neuromodulation, University Hospital, University of São Paulo, São Paulo, Brazil; Laboratory of Neuroscience and National Institute of Biomarkers in Psychiatry, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Muhammad I Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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11
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Payette MC, Bélanger C, Benyebdri F, Filiatrault J, Bherer L, Bertrand JA, Nadeau A, Bruneau MA, Clerc D, Saint-Martin M, Cruz-Santiago D, Ménard C, Nguyen P, Vu TTM, Comte F, Bobeuf F, Grenier S. The Association between Generalized Anxiety Disorder, Subthreshold Anxiety Symptoms and Fear of Falling among Older Adults: Preliminary Results from a Pilot Study. Clin Gerontol 2017; 40:197-206. [PMID: 28452660 DOI: 10.1080/07317115.2017.1296523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE A relationship between generalized anxiety disorder (GAD) and fear of falling (FOF) has long been proposed but never specifically studied. This study aimed at analyzing the relationship between FOF and GAD or anxiety symptoms, while controlling for major depressive episodes (MDE), depressive symptoms, fall risk, and sociodemographic variables. METHODS Twenty-five older adults participated in this pilot study. Assessments included the following: Anxiety Disorder Interview Schedule, Geriatric Anxiety Inventory, Geriatric Depression Scale, Falls-Efficacy Scale-International. A multidisciplinary team evaluated fall risk. RESULTS FOF was significantly correlated with GAD, MDE, anxiety and depressive symptoms, and fall risk, but not with sociodemographic variables. Multiple regression analyses indicated that GAD and anxiety symptoms were significantly and independently associated with FOF. CONCLUSION Although the results of this pilot study should be replicated with larger samples, they suggest that FOF is associated with GAD and anxiety symptoms even when considering physical factors that increase the risk of falling. CLINICAL IMPLICATIONS Treatment of FOF in patients with GAD may present a particular challenge because of the central role of intolerance of uncertainty, which may prevent patients from regaining confidence despite the reduction of fall risk. Clinicians should screen for GAD and anxiety symptoms in patients with FOF to improve detection and treatment.
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Affiliation(s)
- Marie-Christine Payette
- a Université du Québec à Montréal , Quebec , Canada.,b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada
| | - Claude Bélanger
- a Université du Québec à Montréal , Quebec , Canada.,c McGill University , Montreal , Quebec , Canada
| | - Fethia Benyebdri
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada
| | - Johanne Filiatrault
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada
| | - Louis Bherer
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,e PERFORM Centre , Concordia University , Montreal , Quebec , Canada.,f Concordia University , Montreal , Quebec , Canada
| | - Josie-Anne Bertrand
- g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada.,h Rotman Research Institute , Baycrest Center , Toronto , Ontario , Canada
| | - Alexandra Nadeau
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada
| | - Marie-Andrée Bruneau
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Doris Clerc
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Monique Saint-Martin
- i Centre hospitalier de l'Université de Montréal (CHUM) , Montreal , Quebec , Canada
| | - Diana Cruz-Santiago
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Caroline Ménard
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Philippe Nguyen
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - T T Minh Vu
- d Université de Montréal , Montreal , Quebec , Canada.,g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada.,i Centre hospitalier de l'Université de Montréal (CHUM) , Montreal , Quebec , Canada
| | - Francis Comte
- g Institut universitaire de gériatrie de Montréal (IUGM) , Montreal , Quebec , Canada
| | - Florian Bobeuf
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,f Concordia University , Montreal , Quebec , Canada
| | - Sébastien Grenier
- b Centre de recherche de l'Institut universitaire de gériatrie de Montréal , Quebec , Canada.,d Université de Montréal , Montreal , Quebec , Canada
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12
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Pink A, Przybelski SA, Krell-Roesch J, Stokin GB, Roberts RO, Mielke MM, Spangehl KA, Knopman DS, Jack CR, Petersen RC, Geda YE. Cortical Thickness and Anxiety Symptoms Among Cognitively Normal Elderly Persons: The Mayo Clinic Study of Aging. J Neuropsychiatry Clin Neurosci 2017; 29:60-66. [PMID: 27578447 PMCID: PMC5473777 DOI: 10.1176/appi.neuropsych.15100378] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors conducted a cross-sectional study to investigate the association between anxiety symptoms and cortical thickness, as well as amygdalar volume. A total of 1,505 cognitively normal participants, aged ≥70 years, were recruited from the Mayo Clinic Study of Aging in Olmsted County, Minnesota, on whom Beck Anxiety Inventory and 3T brain MRI data were available. Even though the effect sizes were small in this community-dwelling group of participants, anxiety symptoms were associated with reduced global cortical thickness and reduced thickness within the frontal and temporal cortex. However, after additionally adjusting for comorbid depressive symptoms, only the association between anxiety symptoms and reduced insular thickness remained significant.
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13
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Hall J, Kellett S, Berrios R, Bains MK, Scott S. Efficacy of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Older Adults: Systematic Review, Meta-Analysis, and Meta-Regression. Am J Geriatr Psychiatry 2016; 24:1063-1073. [PMID: 27687212 DOI: 10.1016/j.jagp.2016.06.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) is a common disorder in older adults producing functional impairment, and psychotherapy is the preferred treatment option. Meta-analytic methods sought to determine the efficacy of outpatient cognitive behavioral therapy (CBT) with respect to the hallmark feature of GAD-uncontrolled and excessive worry. In order to optimize clinical applicability, variables associated with GAD treatment outcomes were also examined. METHODS Systematic search of relevant databases and iterative searches of references from articles retrieved. All studies were required to have been a randomized control trial (RCT), to have used the Penn State Worry Questionnaire (PSWQ) or its abbreviated version (PSWQ-A) as an outcome measure, and to have conducted CBT with outpatient older adults. Fourteen RCTs (N = 985) were suitable and random-effects meta-analyses and univariate meta-regressions were conducted. RESULTS At the end of treatment, and at 6-month follow-up, significant treatment effects favoring CBT were found in comparison to a waitlist or treatment-as-usual. When CBT was compared with active controls, a small nonsignificant treatment advantage was found for CBT at the end of treatment, with equivalence of outcomes at follow-up. Treatment effect size of CBT for GAD was significantly associated with attrition rates and depression outcomes. CONCLUSIONS CBT is more helpful than having no treatment for GAD in later life. Nevertheless, whether CBT shows long-term durability, or is superior to other commonly available treatments (such as supportive psychotherapy), remains to be tested. The relationship between treatment effects for GAD and depression following CBT warrants further research.
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Affiliation(s)
- Jo Hall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
| | - Stephen Kellett
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK; Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Raul Berrios
- Departamento de Administracion, Facultad de Administracion y Economia, Universidad de Santiago de Chile, Chile
| | | | - Shonagh Scott
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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14
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Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Näätänen P, Koivisto M, Melartin T, Oksanen J, Suominen K, Heikkinen M, Paunio T, Isometsä E. Anxiety symptoms in a major mood and schizophrenia spectrum disorders. Eur Psychiatry 2016; 37:1-7. [PMID: 27447101 DOI: 10.1016/j.eurpsy.2016.04.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Comorbid anxiety symptoms and disorders are present in many psychiatric disorders, but methodological variations render comparisons of their frequency and intensity difficult. Furthermore, whether risk factors for comorbid anxiety symptoms are similar in patients with mood disorders and schizophrenia spectrum disorders remains unclear. METHODS The Overall Anxiety Severity and Impairment Scale (OASIS) was used to measure anxiety symptoms in psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), or depressive disorder (DD, n=188) in the Helsinki University Psychiatric Consortium Study. Bivariate correlations and multivariate linear regression models were used to examine associations of depressive symptoms, neuroticism, early psychological trauma and distress, self-efficacy, symptoms of borderline personality disorder, and attachment style with anxiety symptoms in the three diagnostic groups. RESULTS Frequent or constant anxiety was reported by 40.2% of SSA, 51.5% of BD, and 55.6% of DD patients; it was described as severe or extreme by 43.8%, 41.4%, and 41.2% of these patients, respectively. SSA patients were significantly less anxious (P=0.010) and less often avoided anxiety-provoking situations (P=0.009) than the other patients. In regression analyses, OASIS was associated with high neuroticism, symptoms of depression and borderline personality disorder and low self-efficacy in all patients, and with early trauma in patients with mood disorders. CONCLUSIONS Comorbid anxiety symptoms are ubiquitous among psychiatric patients with mood or schizophrenia spectrum disorders, and in almost half of them, reportedly severe. Anxiety symptoms appear to be strongly related to both concurrent depressive symptoms and personality characteristics, regardless of principal diagnosis.
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Affiliation(s)
- B Karpov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - G Joffe
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - K Aaltonen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - J Suvisaari
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - I Baryshnikov
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - P Näätänen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - M Koivisto
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Melartin
- Department of Psychiatry, Helsinki University Central Hospital, PO Box 590, 00029 Helsinki, Finland
| | - J Oksanen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - K Suominen
- Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland; Department of Social Services and Health Care, Helsinki, Finland
| | - M Heikkinen
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland
| | - T Paunio
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland
| | - E Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki University Hospital, PO Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland; Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland.
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15
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Abstract
BACKGROUND There are age-related differences in the manifestation of generalized anxiety disorder (GAD) symptoms and their associated impact on psychosocial and functional status. However, it remains unclear whether specific symptoms (or symptom patterns) are of comparable clinical significance across different functional domains. METHODS A sample of 865 self-reported worriers (aged 60 years and older) who endorsed GAD screening questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. RESULTS Being easily fatigued was significantly associated with occupational disability and a functional disability variable (restricting usual activity in any way). Irritability was significantly associated with social friction (arguments with friends, family, or colleagues) and a functional disability variable (found was unable to do something wanted to do), and poor self-perceived health was also associated with the same functional disability variable. Excessive worry, despite being among the least reported symptoms, was significantly associated with distress. CONCLUSIONS These findings suggest that individual GAD symptoms are differentially associated with aspects of clinical significance relevant to daily life, such as social, occupational, and functional ability. The differential impact of individual symptoms on functional status may be diluted when using symptom sum scores. A nuanced approach to assessing the clinical significance of individual GAD symptoms in older adults may be fruitful for efforts aimed at early detection and treatment.
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Affiliation(s)
- Beyon Miloyan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nancy A. Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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16
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Lortie CL, Thibeault M, Guitton MJ, Tremblay P. Effects of age on the amplitude, frequency and perceived quality of voice. AGE (DORDRECHT, NETHERLANDS) 2015; 37:117. [PMID: 26578457 PMCID: PMC5005868 DOI: 10.1007/s11357-015-9854-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/03/2015] [Indexed: 05/21/2023]
Abstract
The manner and extent to which voice amplitude and frequency control mechanisms change with age is not well understood. The related question of whether the assessment of one's own voice evolves with age, concomitant with the acoustical changes that the voice undergoes, also remains unanswered. In the present study, we characterized the aging of voice production mechanisms (amplitude, frequency), compared the aging voice in different experimental contexts (vowel utterance, connected speech) and examined the relationship between voice self-assessment and age-related voice acoustical changes. Eighty healthy adults (20 to 75 years old) participated in the study, which involved computation of several acoustical measures of voice (including measures of fundamental frequency, voice amplitude, and stability) as well as self-assessments of voice. Because depression is frequent in older adults, depression and anxiety scores were also measured. As was expected, analyses revealed age effects on most acoustical measures. However, there was no interaction between age and the ability to produce high/low voice amplitude/frequency, suggesting that voice amplitude and frequency control mechanisms are preserved in aging. Multiple mediation analyses demonstrated that the relationship between age and voice self-assessment was moderated by depression and anxiety scores. Taken together, these results reveal that while voice production undergoes important changes throughout aging, the ability to increase/decrease the amplitude and frequency of voice are preserved, at least within the age range studied, and that depression and anxiety scores have a stronger impact on perceived voice quality than acoustical changes themselves.
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Affiliation(s)
- Catherine L Lortie
- Département de Réadaptation, Université Laval, Quebec City, Quebec, Canada
- Département d'ophtalmologie et ORL - chirurgie cervico-faciale, Université Laval, Quebec City, Quebec, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec (CRIUSMQ), 2601 chemin de la Canardière, Quebec City, Quebec, G1J 2G3, Canada
| | | | - Matthieu J Guitton
- Département d'ophtalmologie et ORL - chirurgie cervico-faciale, Université Laval, Quebec City, Quebec, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec (CRIUSMQ), 2601 chemin de la Canardière, Quebec City, Quebec, G1J 2G3, Canada
| | - Pascale Tremblay
- Département de Réadaptation, Université Laval, Quebec City, Quebec, Canada.
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec (CRIUSMQ), 2601 chemin de la Canardière, Quebec City, Quebec, G1J 2G3, Canada.
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