Social anxiety in older adults: phenomenology, prevalence, and measurement

The impact of audience dynamics on public speaking anxiety in virtual scenarios: An online survey

BACKGROUND

Public speaking is one of the most commonly feared situations reported in both community and university samples. Despite extensive theoretical models and empirical studies aimed at delineating the underlying factors of Public Speaking Anxiety (PSA), the specific variables contributing to its onset remain incompletely characterised.

METHODS

The research involved 297 participants from an AmazonTurk survey, engaging with virtual public speaking scenarios differentiated by audience size, engagement levels, and room spatial dimensions. Participants' anticipated anxiety levels were quantitatively assessed across these scenarios, enabling a comprehensive exploration of the interaction between situational variables and PSA, thereby providing a framework to explore the influence of audience size, engagement, and spatial dimensions on PSA.

RESULTS

The mixed-effect model revealed a significant interaction among audience size, audience engagement, and room spatial dimensions. Further analyses using principal axis factoring and multiple regression identified three main factors: F1 (Engagement in a Large Audience), F2 (Confinement or Evaluation Anxiety), and F3 (Audience Disengagement). These factors significantly predict PSA scores.

CONCLUSIONS

This study reveals that PSA is influenced by a complex interplay of audience size, room dimensions, and audience engagement. The finding underscores the viable way to incorporate these situational variables in both empirical investigations and therapeutic interventions. Specifically, it introduces a novel framework for standardising audience size relative to room capacity.

Examining Differences in Behavioural Avoidance Between Younger and Older Adults

OBJECTIVES

Studies have found older adults report fewer anxiety symptoms than younger adults. As behavioral avoidance is theoretically associated with maintaining anxiety, this study sought to examine age-related differences in avoidance and anxiety in a cross-cultural sample of older (n = 60, 60-92 years) and younger adults (n = 70; 17-24 years).

METHODS

Community dwelling participants from Australia and the United States of America completed self-report measures of anxiety, worry, and depression. Participants also self-rated levels of avoidance to 133 common fearful situations using a card sort task.

RESULTS

Older adults reported significantly less avoidance of age-adjusted social and medical scenarios, more avoidance of aggressive scenarios, with no significant difference for animal or agoraphobic scenarios when compared to younger adults. Age-related effects were no longer significant in full models, in which the main effect of anxiety explained variance in avoidance for social, medical, animal, agoraphobic, but not aggression scenarios.

CONCLUSIONS

Age differences in avoidance behavior were accounted for by differences in anxiety symptoms, except for avoidance of aggressive scenarios, which was not associated with anxiety. CLINICAL IMPLICATIONS: Age differences in levels of avoidance of common fearful situations were found, and may be associated with differences in anxiety symptom severity.

Validation of the Older Adult Social Evaluative Scale (OASES) as a measure of social anxiety

ABSTRACTBackground:Social anxiety disorder (SAD) (formerly called social phobia) is among the most common mental health diagnoses among older adults; however, the research on late-life social anxiety is scarce. A limited number of studies have examined the assessment and diagnosis of social anxiety disorder in this population, and there are few social anxiety measures that are validated for use with older adults. One such measure, the Older Adult Social Evaluative Scale (OASES), was designed for use with this population, but until now has lacked validation against a gold-standard diagnostic interview.

METHODS

Using a sample of 47 community-dwelling older adults (aged 60 years and over) with anxiety, the present study compared OASES performance to that of the Structured Clinical Interview for DSM-5 Disorders (SCID-5), as well as other measures of anxiety and depression.

RESULTS

The OASES demonstrated convergent validity with other measures of anxiety, and demonstrated discriminant validity on other measures (e.g. depression, somatic symptoms). Receiver operating characteristic (ROC) analysis revealed that a cut-point of ≥76 optimized sensitivity and specificity compared to SCID-5 derived diagnoses of social anxiety disorder.

CONCLUSIONS

This study is the first study to provide psychometric validation for the OASES and one of the first to administer the SCID-5 to an older adult sample. In addition to establishing a clinically significant cut-off, this study also describes the clinical utility of the OASES, which can be used to identify distressing situations, track anxiety severity, and monitor behavioral avoidance across a variety of social situations.

Differences in anxiety and depression symptoms: comparison between older and younger clinical samples

BACKGROUND

Anxiety and depression symptoms change over the lifespan and older adults use different terms to describe their mental health, contributing to under identification of anxiety and depression in older adults. To date, research has not examined these differences in younger and older samples with comorbid anxiety and depression.

METHODS

One hundred and seven treatment-seeking participants (47 older, 60% female, and 60 younger, 50% female) with anxiety and mood disorders completed the Anxiety Disorders Interview Schedule and a symptom checklist to examine differences in symptom severity, symptom profiles and terms used to describe anxiety and mood.

RESULTS

The findings indicated several key differences between the presentation and description of anxiety and depression in younger and older adults. Older adults with Social Phobia reported fearing a narrower range of social situations and less distress and interference. Older adults with Generalized Anxiety Disorder (GAD) reported less worry about interpersonal relationships and work/school than younger adults, however, there were no differences between age groups for behavioral symptoms endorsed. Further older adults reported phobia of lifts/small spaces more frequently than younger adults. Depressed older depressed adults also reported more anhedonia compared to younger adults, but no differences in terms of reported sadness were found. Finally, older and younger adults differed in their descriptions of symptoms with older adults describing anxiety as feeling stressed and tense, while younger adults described anxiety as feeling anxious, worried or nervous.

CONCLUSIONS

Clinicians need to assess symptoms broadly to avoid missing the presence of anxiety and mood disorders especially in older adults.

Positive Affect and Social Anxiety Across the Lifespan: An Investigation of Age as a Moderator

Recent literature has supported a moderate, inverse relationship between social anxiety and positive affect. It has been proposed, but not clearly established, that the inverse relationship between the constructs may be stronger in younger adults than in adults who are older. We tested this hypothesis in two archival data sets of community participants. The expected age-related interaction was not found in Study 1, which used a measure capturing a conflation of valence and arousal known as activated positive affect. Conversely, the interaction was present in Study 2, in which the positive affect measure was primarily based on valence. We found only partial support for the hypothesis, and results highlight the need for a more comprehensive measure of positive affect.

Social Phobia symptoms across the adult lifespan

BACKGROUND

This study investigated symptom patterns that might distinguish between individuals with and without a diagnosis of Social Phobia (SP) across the adult lifespan.

METHODS

A sample of 5411 self-reported social worriers was derived from Wave 1 (2001 and 2002) of the U.S. National Epidemiological Survey of Alcohol and Related Conditions (NESARC). Participants were stratified into four age groups (18-29 years, 30-44 years, 45-64 years, 65-96 years), and further divided into two diagnostic groups (self-reported social worriers with and without a SP diagnosis).

RESULTS

Binary logistic regression analyses revealed that a core set of symptoms was associated with SP across the adult lifespan. There were also successive reductions in the number of symptoms associated with SP in each age group, such that older adults endorsed numerically fewer SP symptoms.

LIMITATIONS

Though our sample size is smaller than ideal for the nature of our analyses, the NESARC represents one of the largest existing clinical datasets we know of.

CONCLUSIONS

Despite age-related reductions in symptom frequency, a core set of SP symptoms consistently distinguished between diagnostic groups, irrespective of age.

Initial evaluation of the Older Adult Social-Evaluative Situations Questionnaire: a measure of social anxiety in older adults

BACKGROUND

The assessment of social anxiety in late life has been examined in few studies (e.g. Gretarsdottir et al., 2004; Ciliberti et al., 2011). The present study describes the creation and initial psychometric evaluation of a new, content valid measure of social anxiety for older adults, the Older Adult Social-Evaluative Situations Questionnaire (OASES).

METHODS

Psychometric properties of the OASES were evaluated in a community dwelling sample of older adults (N = 137; 70.8% female). Convergent validity was established by examining the relation between the OASES and the Liebowitz Social Anxiety Scale (LSAS), Social Phobia and Anxiety Inventory (SPAI), and Beck Anxiety Inventory (BAI). Discriminant validity was established by examining the relation between the OASES and measures of depression (Geriatric Depression Scale, GDS), perceived health status (Short Form Health Survey, SF-12), and demographic variables. The validity analyses of the OASES were based on a smaller sample with n values ranging from 98 to 137 depending on missing data on each questionnaire.

RESULTS

Internal consistency, measured by Cronbach's α, for the OASES total score was 0.96. All items on the OASES were endorsed by participants. Convergent validity was demonstrated by medium to large correlations with the SPAI, LSAS, and BAI. Support for discriminant validity was evidenced by small to medium correlations between the OASES and GDS, SF-12, and demographic variables.

CONCLUSIONS

Evidence in support of convergent and discriminant validity of the OASES is discussed. Although the results from the present study suggest that this measure may assess anxiety in and avoidance of social situations salient to older adults, future studies are needed to further examine the psychometric properties of the OASES and replicate these results in both clinical and more diverse samples of older adults.

A preliminary investigation of developmentally sensitive items for the assessment of social anxiety in late life

The current study aimed to examine the salience of anxiety-provoking social situations for older adults. A list of potentially anxiety-provoking situations was developed from a review of existing measures of social anxiety. In addition to items derived from existing measures, the investigators generated items thought to be particularly relevant for older adults. One hundred and four older adults were asked, "Please check all situations where you might feel uncomfortable, nervous, scared, worried, embarrassed, or anxious." Participants were also prompted to record any additional situations in which they experienced anxiety. Older adults endorsed items not included on typical measures of social anxiety at high rates. Exploratory analyses of the effects of gender on item endorsement were examined and significant differences were found for several items. The authors discuss these findings and their implications for the assessment of late-life social anxiety.

Anxiety disorders in older adults: a comprehensive review

This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults.

Prevalence of anxiety disorders among elderly people

OBJECTIVES

The objectives of this study are to determine current and lifetime prevalence of anxiety disorders and also to explore the relationship, if any, between possible risk factors and anxiety disorders, amongst elderly people living in the Sivas province of Turkey.

METHODS

The research sample consisted of 462 persons. A Socio-demographic Data Form was given to the participants and the Anxiety Module of SCID-I was applied. Chi-square and Fischer's exact tests were used to evaluate the data obtained.

RESULTS

The current prevalence for all types of anxiety disorder was found to be 17.1% overall and the lifetime prevalence was found to be 18.6%. The current prevalence rates for particular disorders were found to be 0.4% for panic disorder, 3.2% for obsessive-compulsive disorder, 1.9% for post-traumatic stress disorder, 2.8% for social phobia, 11.5% for specific phobia, 6.9% for generalized anxiety disorder (GAD). Lifetime prevalence rates for these disorders (except GAD) were 1.1%, 3.2%, 3.0%, 2.85%, 11.5% respectively.

CONCLUSIONS

Anxiety disorders are more common among elderly people than was previously thought. The lifetime prevalence of specific phobia amongst the elderly is higher than that of general population; the lifetime prevalence ratios of obsessive-compulsive disorder and social phobia are similar to that of the general population in Sivas. In order to improve the delivery of health services, it is recommended that further studies should be conducted among elderly people, both by applying standardized diagnostic tools, but also taking into account socio-economic factors and using convenient therapy methods developed specifically for this group.

Prevalence and correlates of social fears in Hong Kong

This study examined the 12-month prevalence of social fears and their correlates in Hong Kong. A random telephone survey of 3006 Chinese individuals aged 15-45 years was conducted using a questionnaire that covered sociodemographic information, 14 social fears, age of onset, duration of fear, DSM-IV diagnostic features of social anxiety disorder and other psychosocial features. The prevalence of any social fear was 28.7%. The most common fear was talking to a person of higher status. Respondents with social fears were more likely to be younger and female than those without. A two-step cluster analysis revealed three subgroups with 1-3 (34.0%), 4-7 (43.9%) and 8-13 (22.0%) fears, respectively. As the number of social fears increased across these subgroups, respondents exhibited younger age of onset, more physical symptoms, avoidance behavior, impairment, and suicidality. The prevalence and profile of social fears among Chinese people resembled those of their Western counterparts.

The prevalence of anxiety in older adults: methodological issues and a review of the literature

BACKGROUND

Despite the relative neglect of anxiety in older adults, the growing literature on its prevalence suggests that anxiety is highly prevalent and associated with considerable distress and morbidity in this age group. This review provides a comprehensive overview of this literature and discusses some unresolved controversies in the field.

METHODS

A systematic search of articles published from 1980-2007 was performed. Articles were included for review if they reported the prevalence of anxiety symptoms, anxiety disorder or specified anxiety disorders in adults aged >60 in either community or clinical settings.

RESULTS

The prevalence of anxiety in community samples ranges from 1.2% to 15%, and in clinical settings from 1% to 28%. The prevalence of anxiety symptoms is much higher, ranging from 15% to 52.3% in community samples, and 15% to 56% in clinical samples. These discrepancies are partly attributable to the conceptual and methodological inconsistencies that characterise this literature. Generalised Anxiety Disorder is the commonest anxiety disorder in older adults.

LIMITATIONS

The methodologies used in the studies are so variable as to make comparisons difficult.

CONCLUSIONS

Although anxiety disorder, particularly Generalised Anxiety Disorder is common, issues in relation to comorbidity and the nature of anxiety in old age remain unresolved. This hampers the design of intervention programmes, and highlights the need for further research with a primary focus on anxiety.

The psychometric properties of the Brief Fear of Negative Evaluation Scale

This study examined the psychometric properties of the Brief Fear of Negative Evaluation (BFNE) Scale in a nonclinical, nonstudent sample. Participants were administered the BFNE Scale, Beck Depression Inventory (BDI), and the UCLA Loneliness Scale. No differences were found across age, but women scored significantly higher on the BFNE Scale than men. Confirmatory factor analysis supported a two-factor solution corresponding to positive and reverse scored items. Internal consistency was excellent for the positive scored factor (alpha=.94), acceptable for the reverse scored factor (alpha=.73), and good for the full BFNE Scale (alpha=.80). BFNE scores were significantly correlated in the expected directions with the BDI and the UCLA Loneliness Scale. Implications of these findings for clinical practice and future research are discussed.