Risk factors for late-onset generalized anxiety disorder: results from a 12-year prospective cohort (the ESPRIT study)

Association of Depression With the Progression of Multimorbidity in Older Adults: A Population-Based Cohort Study

BACKGROUND

The relationship between depression and the risk of multimorbidity progression has rarely been studied in older adults. This study was aimed to determine whether depression is associated with progression in the severity and complexity of multimorbidity, considering the influence of depression's severity and subtype.

METHODS

As a part of the Korean Longitudinal Study on Cognitive Aging and Dementia, this population-based cohort study followed a random sample of community-dwelling Koreans aged 60 and older for 8 years at 2-year intervals starting in 2010. Participants included those who completed mood and multimorbidity assessments and did not exhibit complex multimorbidity at the study's outset. Depression was assessed using the Geriatric Depression Scale, while multimorbidity was evaluated using the Cumulative Illness Rating Scale. The study quantified multimorbidity complexity by counting affected body systems and measured multimorbidity severity by averaging scores across 14 body systems.

FINDINGS

The 2,486 participants (age = 69.1 ± 6.5 years, 57.6% women) were followed for 5.9 ± 2.4 years. Linear mixed models revealed that participants with depression had a faster increase in multimorbidity complexity score (β = .065, SE = 0.019, p = 0.001) than those without depression, but a comparable increase in multimorbidity severity score (β = .001, SE = .009, p = 0.870) to those without depression. Cox proportional hazard models revealed that depression was associated with the risk of developing highly complex multimorbidity affecting five or more body systems, particularly in severe or anhedonic depression.

INTERPRETATION

Depression was associated with the worsening of multimorbidity in Korean older adults, particularly when severe or anhedonic. Early screening and management of depression may help to reduce the burden of multimorbidity in older adults.

A new network analysis model in anorexia nervosa patients based on self-reported eating disorder symptoms, psychological distress, and cognitive flexibility

OBJECTIVES

Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample.

METHODS

One hundred and ninety-three treatment-seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self-report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence.

RESULTS

The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non-zero connection between eating concerns/dietary restraint and psychological distress.

CONCLUSIONS

The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co-occurrence.

COVID-19 Pandemic and Food Insecurity Fuel the Mental Health Crisis in Africa

Objective: Providing country-level estimates for prevalence rates of Generalized Anxiety Disorder (GAD), COVID-19 exposure and food insecurity (FI) and assessing the role of persistent threats to survival-exemplified by exposure to COVID-19 and FI-for the mental health crisis in Africa. Methods: Original phone-based survey data from Mozambique, Sierra Leone, Tanzania and Uganda (12 consecutive cross-sections in 2021; n = 23,943) were analyzed to estimate prevalence rates of GAD. Logistic regression models and mediation analysis using structural equation models identify risk and protective factors. Results: The overall prevalence of GAD in 2021 was 23.3%; 40.2% in Mozambique, 17.0% in Sierra Leone, 18.0% in Tanzania, and 19.1% in Uganda. Both COVID-19 exposure (ORadj. 1.4; CI 1.3-1.6) and FI (ORadj 3.2; CI 2.7-3.8) are independent and significant predictors of GAD. Thus, the impact of FI on GAD was considerably stronger than that of COVID-19 exposure. Conclusion: Persistent threats to survival play a substantial role for mental health, specifically GAD. High anxiety prevalence in the population requires programs to reduce violence and enhance social support. Even during a pandemic, addressing FI as a key driver of GAD should be prioritized by policymakers.

Clinical Markers of Panic and Generalized Anxiety Disorder: Overlapping Symptoms, Different Course and Outcome

Generalized Anxiety Disorder (GAD) and Panic Disorder (PD) share underlying neurobiological mechanisms and several clinical features which, with medical comorbidities, may increase misdiagnosis and delay proper treatment. The aim of the study was to evaluate the association between clinical/socio-demographic markers and GAD/PD diagnosis. Outpatients (N = 290) with PD or GAD were identified in mental health services in Monza and Milan (Italy). Descriptive analyses and a binary logistic regression model were performed. Post-onset psychiatric (p = 0.05) and medical (p = 0.02) multiple co-morbidities were associated with GAD; treatment with selective serotonin reuptake inhibitors (SSRIs) was associated with PD, while GAD diagnosis was associated with treatment with atypical antipsychotics or GABAergic drugs (p = 0.03), as well as psychodynamic psychotherapy (p < 0.01). Discontinuation of the last pharmacological treatment was associated with GAD diagnosis rather than the PD one (p = 0.02). GAD patients may have a worse prognosis than PD patients because of more frequent multiple co-morbidities, relapses and poorer treatment compliance. The different treatment approaches were consistent with the available literature, while the association between GAD and psychodynamic psychotherapy is an original finding of our study. Further studies on larger samples are necessary to better characterize clinical factors associated with GAD or PD.

Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study

Background

The association between cardiovascular disease (CVD) and selected psychiatric disorders has frequently been suggested while the potential role of familial factors and comorbidities in such association has rarely been investigated.

Methods

We identified 869,056 patients newly diagnosed with CVD from 1987 to 2016 in Sweden with no history of psychiatric disorders, and 910,178 full siblings of these patients as well as 10 individually age- and sex-matched unrelated population controls (N = 8,690,560). Adjusting for multiple comorbid conditions, we used flexible parametric models and Cox models to estimate the association of CVD with risk of all subsequent psychiatric disorders, comparing rates of first incident psychiatric disorder among CVD patients with rates among unaffected full siblings and population controls.

Results

The median age at diagnosis was 60 years for patients with CVD and 59.2% were male. During up to 30 years of follow-up, the crude incidence rates of psychiatric disorder were 7.1, 4.6, and 4.0 per 1000 person-years for patients with CVD, their siblings and population controls. In the sibling comparison, we observed an increased risk of psychiatric disorder during the first year after CVD diagnosis (hazard ratio [HR], 2.74; 95% confidence interval [CI], 2.62-2.87) and thereafter (1.45; 95% CI, 1.42-1.48). Increased risks were observed for all types of psychiatric disorders and among all diagnoses of CVD. We observed similar associations in the population comparison. CVD patients who developed a comorbid psychiatric disorder during the first year after diagnosis were at elevated risk of subsequent CVD death compared to patients without such comorbidity (HR, 1.55; 95% CI, 1.44-1.67).

Conclusions

Patients diagnosed with CVD are at an elevated risk for subsequent psychiatric disorders independent of shared familial factors and comorbid conditions. Comorbid psychiatric disorders in patients with CVD are associated with higher risk of cardiovascular mortality suggesting that surveillance and treatment of psychiatric comorbidities should be considered as an integral part of clinical management of newly diagnosed CVD patients.

Funding

This work was supported by the EU Horizon 2020 Research and Innovation Action Grant (CoMorMent, grant no. 847776 to UV, PFS, and FF), Grant of Excellence, Icelandic Research Fund (grant no. 163362-051 to UV), ERC Consolidator Grant (StressGene, grant no. 726413 to UV), Swedish Research Council (grant no. D0886501 to PFS), and US NIMH R01 MH123724 (to PFS).

Childhood abuse/neglect and temporal patterns in late-life anxiety

OBJECTIVES

Anxiety has been associated with childhood abuse/neglect, but this relationship and its mechanisms are poorly documented in older adults. This study examined the association between childhood abuse/neglect and late-life anxiety temporal patterns (i.e. absence, remission, incidence, persistence), testing for mediators.

METHODS

Data were derived for 724 French-speaking community-living older adults participating in the Étude sur la santé des ainés - Services study with available information at baseline and 4-year follow-up. Past-month anxiety was based on a cutoff score ≥5 on a French translation of the 7-item Generalized Anxiety Disorder at interviews. Questions on childhood abuse/neglect (e.g. psycho-emotional, physical, sexual) were administered. Adjusted multinomial regression analyses and mediation bootstrapping models were used. Tested mediators included traumatic events (excluding childhood abuse/neglect), daily hassles, psychological resilience, and cortisol activity.

RESULTS

The absence, remission, incidence and persistence of anxiety was found in 45.3%, 25.3%, 8.7% and 20.7% of the sample, respectively. Participants with incident and persistent late-life anxiety experienced more childhood abuse/neglect. Participants with persistent anxiety also reported lower psychological resilience. The association between childhood abuse/neglect with anxiety incidence was mediated by daily hassles, while its association with anxiety persistence was mediated by daily hassles and psychological resilience.

CONCLUSION

Past childhood abuse/neglect was associated with late-life anxiety incidence and persistence, with psychological resilience and daily hassles potentially explaining this relationship. Further research should focus on ascertaining the clinical applications of psychosocial and biological profiles in informing the prevention and personalized treatment of anxiety in older adults.

Within-person increase in pathological worry predicts future depletion of unique executive functioning domains

BACKGROUND

Affective neuroscience and scar theories propose that increased excessive worry, the hallmark symptom of generalized anxiety disorder (GAD), predicts future declines in executive functioning (EF). However, the preponderance of cross-sectional designs used to examine between-person chronic worry-EF relationships has blocked progress on understanding their potentially causal within-person associations. Accordingly, this study used bivariate dual latent change score (LCS) models to test whether within-person increased GAD severity might relate to future reduced EF.

METHODS

Community-dwelling adults (N = 2581, 46 years on average, s.d. = 11.40, 54.71% female) were assessed for GAD symptom severity (Composite International Diagnostic Interview-Short Form) across three waves, spaced about 9 years apart. Three aspects of EF [inhibition, set-shifting, and mixing costs (MCs; a measure related to common EF)], were assessed with stop-and-go switch tasks. Participants responded to 20 normal and 20 reverse single-task block trials and 32 mixed-task switch block trials. EF tests were administered at time 2 (T2) and time 3 (T3), but not at time 1 (T1).

RESULTS

After controlling for T1 depression, LCS models revealed that within-person increased T1 - T2 GAD severity substantially predicted future reduced T2 - T3 inhibition and set-shifting (both indexed by accuracy and latency), and MC (indexed by latency) with moderate-to-large effect sizes (|d| = 0.51-0.96).

CONCLUSIONS

Results largely support scar theories by offering preliminary within-person, naturalistic evidence that heightened excessive worry can negatively predict future distinct aspects of cognitive flexibility. Effectively targeting pathological worry might prevent difficulties arising from executive dysfunction.

Mood Disorders and Anxiety in Parkinson's Disease: Current Concepts

Mood disorders and anxiety significantly impact the prognosis and disease course of Parkinson's disease. Non-motor symptoms of Parkinson's disease such as apathy, anhedonia, and fatigue overlap with diagnostic criteria for anxiety and depression, thus making accurate diagnosis of mood disorders in Parkinson's disease patients difficult. Furthermore, treatment options for mood disorders can produce motor complications leading to poor adherence and impaired quality of life in Parkinson's disease patients. This review aims to clarify the current state of diagnostic and treatment options pertaining to anxiety and mood disorders in Parkinson's disease. It explores both the pharmacologic and non-pharmacologic treatment modalities for various mood disorders in comorbid Parkinson's disease with a brief discussion of the future outlook of the field given the current state of the literature.

Depression and executive functioning bidirectionally impair one another across 9 years: Evidence from within-person latent change and cross-lagged models

BACKGROUND

Scar and vulnerability models assert that increased psychopathology may predict subsequent executive functioning (EF) deficits (and vice versa) over protracted timescales, yet most prior work on this topic has been cross-sectional. Thus, we tested the within- and between-person relations between EF, depression, and anxiety.

METHODS

Older adult participants (n = 856) were assessed across four waves, approximately 2 years apart. Performance-based EF and caregiver-rated symptom measures were administered. Bivariate latent change score and random-intercept cross-lagged panel models were conducted.

RESULTS

Within persons, random-intercept cross-lagged panel models revealed that prior greater depression forecasted lower subsequent EF, and vice versa (d = -0.292 vs. -0.292). Bivariate dual latent change score models showed that within-person rise in depression predicted EF decreases, and vice versa (d = -0.245 vs. -0.245). No within-person, cross-lagged, EF-anxiety relations emerged. Further, significant negative between-person EF-symptom relations were observed (d = -0.264 to -0.395).

CONCLUSION

Prospective, within-person findings offer some evidence for developmental scar and vulnerability models.

Role of SES on the association between childhood parental death and adulthood suicidal ideation: a mediation analysis using longitudinal dataset in South Korea

BACKGROUND

We sought to examine the association between childhood experience of parental death (CEPD) and adulthood suicidal ideation, and the mediating role of adulthood SES in the association.

METHODS

We analyzed a nationally representative dataset of 8609 adults from the Korea Welfare Panel Study, which is a longitudinal cohort dataset in South Korea. CEPD was measured using a question: "During your childhood (0-17 years old), have you experienced the death of parents?" We classified responses of CEPD during 2006-2011 into 'yes,' and the others into 'no.' Suicidal ideation over the past year was assessed annually during 2012-2019. As a potential mediator, adulthood educational attainment and household income in 2011 were included in the analysis. Logistic regression was applied to examine the association of CEPD with adulthood suicidal ideation across age groups (early adulthood, 19-39 years old; middle adulthood, 40-59 years old; late adulthood, ≥60 years old), after excluding people who reported lifetime suicidal ideation in 2011. Causal mediation analysis using a parametric regression model was applied to examine the mediating role of adulthood SES in the association between CEPD and adulthood suicidal ideation.

RESULTS

After adjusting for potential confounders including childhood SES, CEPD was significantly associated with adulthood suicidal ideation among the late adulthood group (OR: 1.43; 95% CI: 1.13-1.81), while the association was not statistically significant among the early; and middle adulthood groups. In mediation analysis of adulthood household income, both indirect association (OR^NIE: 1.05; 95% CI: 1.02-1.09) and direct association (OR^NDE: 1.37; 95% CI: 1.09-1.73) were statistically significant among the late adulthood group. In the mediation analysis of adulthood education attainment among the late adulthood, only a direct association was statistically significant (OR^NDE: 1.43; 95% CI: 1.14-1.80).

CONCLUSIONS

These results suggest that CEPD could be a risk factor for adulthood suicidal ideation. Furthermore, the findings imply that income security policy might be necessary to reduce suicide among the late adulthood group.

Larger increase in trait negative affect is associated with greater future cognitive decline and vice versa across 23 years

BACKGROUND

Trait negative affect (NA) is a central feature of anxiety and depression disorders. Neurocognitive and scar models propose that within-person increase in NA across one period of time relates to a decline in cognitive functioning at a future period of time and vice versa. Yet, there has been little research on whether a within-person change in trait NA across one time-lag precedes and is associated with a change in cognition across a future time lag and vice versa. Due to a growing aging population, such knowledge can inform evidence-based prevention.

METHODS

Participants were 520 dementia-free community-dwelling adults (mean age = 59.76 years [standard deviation = 8.96], 58.08% females). Trait-level NA (negative emotionality scale), spatial cognition (block design and card rotations), verbal working memory (WM; digit span backward), and processing speed (symbol digit modalities) were assessed at five time points (waves) across 23 years. Bivariate dual latent change score (LCS) approaches were used to adjust for regression to the mean, lagged outcomes, and between-person variability.

RESULTS

Unique bivariate LCS models showed that within-person increase in trait NA across two sequential waves was related to declines in spatial cognition, verbal WM, and processing speed across the subsequent two waves. Moreover, within-person reductions in spatial cognition, verbal WM, and processing speed across two sequential waves were associated with future increases in trait NA across the subsequent two waves.

CONCLUSIONS

Findings concur with neurobiological and scar theories of psychopathology. Furthermore, results support process-based emotion regulation models that highlight the importance of verbal WM, spatial cognition, and processing speed capacities for downregulating NA.

The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semi-structured interviews

BACKGROUND

Generalized anxiety disorder (GAD) is one of the most reported diagnoses in psychiatry, but there is some discrepancy between the cases identified in community studies and those identified in tertiary care. This study set out to evaluate whether the use of clinicians as interviewers may provide estimates in a community survey close to those observed in primary or specialized care.

METHODS

This is a community survey on a randomly selected sample of 2338 adult subjects. The Advanced Neuropsychiatric Tools and Assessment Schedule (ANTAS) was administered by clinicians, providing lifetime diagnosis based on the DSM-IV-TR. Health-related quality of life (HR-QoL) was measured with the Short-Form Health Survey (SF-12).

RESULTS

Overall, 55 (2.3%) subjects met the criteria for GAD, with greater prevalence in women (3.6%) than in men (0.9%): OR = 4.02; 95%CI: 1.96-8.26. Up to 40% of those with GAD had at least another diagnosis of mood, anxiety, or eating disorders. The mean score of SF-12 in people with GAD was 32.33 ± 6.8, with a higher attributable burden than in other conditions except for major depressive disorder.

CONCLUSIONS

We found a relatively lower lifetime prevalence of GAD than in community surveys based on lay interviewers and a structured interview. The identified cases of GAD showed a strong impact on the quality of life regardless of co-morbidity and high risk in women, suggesting a profile similar to the one identified from studies in primary and specialized care.

Moderate to severe generalized anxiety disorder symptoms are associated with physical inactivity in people with HIV/AIDS: a study from Uganda

The aim of this cross-sectional study was to explore the prevalence of moderate to severe generalized anxiety disorder (GAD) symptoms and its association with physical activity in people living with HIV (PLHIV) in Uganda. Two hundred and ninety-five PLHIV (median [interquartile range] age = 37.0 years [16.0]; 200 women) completed the GAD-7, Physical Activity Vital Sign, Patient Health Questionnaire-9, and the Alcohol Use Disorders Identification Test. An adjusted odds ratio for physical inactivity in people with moderate to severe GAD symptoms was calculated using binary logistic regression analyses. The prevalence of moderate to severe GAD symptoms was 9.1%. Those with moderate to severe GAD symptoms had a 16.8 times higher odds (95% CI = 5.0-55.9) for not complying with the physical activity recommendations. The current study shows that moderate to severe GAD symptoms are strongly associated with physical inactivity in PLHIV living in a country such as Uganda.

Generalized anxiety disorder symptoms among persons with diagnosed HIV in the United States

OBJECTIVE

To estimate the prevalence of generalized anxiety disorder (GAD) symptoms among adults with diagnosed HIV (PWH) in the United States in order to inform effective HIV prevention and care efforts.

DESIGN

The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States.

METHODS

We used MMP data collected during June 2015 to May 2016 to calculate the weighted prevalence of GAD symptoms among PWH (N = 3654) and prevalence ratios with predicted marginal means to evaluate significant differences between groups.

RESULTS

The estimated prevalence of GAD symptoms among PWH was 19%. GAD symptoms were associated with significantly lower antiretroviral therapy prescription and adherence, medical HIV care engagement, and sustained viral suppression. Persons with GAD symptoms were over three times as likely to have an unmet need for mental health services (23 vs. 7%) and had significantly more emergency room visits and hospitalizations than those without these symptoms. GAD symptoms were associated with significantly higher prevalence of condomless sex while not sustainably virally suppressed with a person not known to be taking preexposure prophylaxis (9 vs. 6%).

CONCLUSION

GAD symptom prevalence among PWH was considerably higher than among the US general adult population, indicating an excess burden of anxiety among PWH. Outcomes along the HIV care continuum were poorer, and risk for HIV transmission was higher, among persons with symptoms. Incorporating routine screening for GAD in HIV clinical settings may help improve health outcomes, reduce HIV transmission, and save healthcare costs.

Dispositional negativity, cognition, and anxiety disorders: An integrative translational neuroscience framework

When extreme, anxiety can become debilitating. Anxiety disorders, which often first emerge early in development, are common and challenging to treat, yet the underlying mechanisms have only recently begun to come into focus. Here, we review new insights into the nature and biological bases of dispositional negativity, a fundamental dimension of childhood temperament and adult personality and a prominent risk factor for the development of pediatric and adult anxiety disorders. Converging lines of epidemiological, neurobiological, and mechanistic evidence suggest that dispositional negativity increases the likelihood of psychopathology via specific neurocognitive mechanisms, including attentional biases to threat and deficits in executive control. Collectively, these observations provide an integrative translational framework for understanding the development and maintenance of anxiety disorders in adults and youth and set the stage for developing improved intervention strategies.

Physical exercise augmented cognitive behaviour therapy for older adults with generalised anxiety disorder (PEXACOG): study protocol for a randomized controlled trial

Background

Generalised anxiety disorder (GAD) is a frequent and severe anxiety disorder among older adults. GAD increases the risk of developing other disorders such as depression and coronary heart disease. Older adults with GAD exhibit a poorer response to cognitive behaviour therapy (CBT) compared to younger patients with GAD. The normal age-related cognitive decline can be a contributor to reduced treatment efficacy. One strategy for improving treatment efficacy is to combine CBT with adjunctive interventions targeted at improving cognitive functions. Physical exercise is a viable intervention in this regard. Increased levels of brain-derived neurotrophic factor may mediate improvement in cognitive function. The present study aims to investigate the proposed effects and mechanisms related to concomitant physical exercise.

Methods

The sample comprises 70 participants aged 60–75 years, who have GAD. Exclusion criteria comprise substance abuse and unstable medication; inability to participate in physical exercise; and conditions which precludes GAD as primary diagnosis. The interventions are individual treatment in the outpatient clinic at the local psychiatric hospital, with two experimental arms: (1) CBT + physical exercise and (2) CBT + telephone calls. The primary outcome measure is symptom reduction on the Penn State Worry Questionnaire. Other measures include questionnaires, clinical interviews, physiological, biological and neuropsychological tests. A subset of 40 participants will undergo magnetic resonance imaging (MRI). After inclusion, participants undergo baseline testing, and are subsequently randomized to a treatment condition. Participants attend five sessions of the add-on treatment in the pre-treatment phase, and move on to interim testing. After interim testing, participants attend 10 sessions of CBT in parallel with continued add-on treatment. Participants are tested post-intervention within 2 weeks of completing treatment, with follow-up testing 6 and 12 months later.

Discussion

This study aims to develop better treatment for GAD in older adults. Enhancing treatment response will be valuable from both individual and societal perspectives, especially taking the aging of the general population into account.

Trial registration

ClinicalTrials.gov, NCT02690441. Registered on 24 February 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3268-9) contains supplementary material, which is available to authorized users.

Executive function and other cognitive deficits are distal risk factors of generalized anxiety disorder 9 years later

OBJECTIVE

The cognitive model (Hirsch & Mathews, 2012) and attentional control theory (Eysenck & Derakshan, 2011) postulate that compromised executive function (EF) and other cognitive constructs are negatively linked to increased excessive and uncontrollable worry, the core symptom of generalized anxiety disorder (GAD). However, the prospective link between neuropsychological constructs and GAD are not well understood.

METHODS

A nationally representative sample of 2605 community-dwelling adults whose average age was 55.20 (s.d. = 11.41, range 33-84; 56.31% females) participated at baseline and 9-year follow-up. Baseline neuropsychological function and symptoms were measured using the Brief Test of Adult Cognition by Telephone and Composite International Diagnostic Interview - Short Form. Multivariate Poisson and negative binomial regression analyses were conducted with 11 baseline covariates entered simultaneously: age, gender, years of formal education, perceived control, hypertension/diabetes, body mass index, exercise status, as well as GAD severity, panic disorder severity, and depression severity. Those with baseline GAD were also removed.

RESULTS

Lower Time 1 composite global cognition z-score independently predicted higher Time 2 GAD severity and diagnosis [odds ratio (OR) 0.60, 95% confidence interval (CI) 0.40-0.89, p = 0.01]. Poor inhibition, set-shifting, working memory (WM) updating, inductive reasoning, and global cognition sequentially forecasted heightened GAD. However, processing speed, verbal WM, verbal fluency, and episodic memory did not predict future GAD.

CONCLUSION

Global cognition, inductive reasoning, inhibition, set-shifting, and WM updating EF impairments may be distal risk factors for elevated GAD nearly a decade later.

A strong sense of coherence associated with reduced risk of anxiety disorder among women in disadvantaged circumstances: British population study

OBJECTIVE

Many patients receiving medical treatment for anxiety relapse or do not improve. Research has therefore been turning to coping mechanisms as a way to decrease anxiety rates. Previously, we showed that living in a deprived area significantly increases the risk of anxiety in women, but not in men. The objective of this study is to assess whether sense of coherence (coping mechanism) buffers the influence of area deprivation on women's risk of generalised anxiety disorder using data from the European Prospective Investigation of Cancer-Norfolk.

DESIGN

Large, population study.

SETTING

UK population-based cohort.

PARTICIPANTS

30 445 people over the age of 40 years were recruited through general practice registers in England. Of these, 20 919 completed a structured health and lifestyle questionnaire used to assess generalised anxiety disorder and sense of coherence. Area deprivation was measured using 1991 Census data, and sense of coherence and anxiety were examined in 1996-2000. 10 183 women had data on all variables.

MAIN OUTCOME MEASURE

Past-year generalised anxiety disorder defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

RESULTS

In this study, 2.6% (260/10 183) of women had generalised anxiety disorder. In those with a strong sense of coherence, area deprivation was not significantly associated with anxiety (OR 1.29, 95% CI 0.77 to 2.17). However, among women with a weak sense of coherence, those living in deprived areas were almost twice as likely to have generalised anxiety disorder compared with those living in more affluent areas (OR 1.99, 95% CI 1.37 to 2.91).

CONCLUSION

The number of women living in deprived conditions is large worldwide, and significant numbers are affected by generalised anxiety disorder. Sense of coherence moderates the association between area deprivation and anxiety in women; therefore, interventions targeting coping mechanisms may need to be considered for people with anxiety.

Neurobiological Mechanisms of Stress Resilience and Implications for the Aged Population

BACKGROUND

Stress is a common reaction to an environmental adversity, but a dysregulation of the stress response can lead to psychiatric illnesses such as major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and anxiety disorders. Yet, not all individuals exposed to stress will develop psychiatric disorders; those with enhanced stress resilience mechanisms have the ability to adapt successfully to stress without developing persistent psychopathology. Notably, the potential to enhance stress resilience in at-risk populations may prevent the onset of stress-induced psychiatric disorders. This novel idea has prompted a number of studies probing the mechanisms of stress resilience and how it can be manipulated.

METHODS

Here, we review the neurobiological factors underlying stress resilience, with particular focus on the serotoninergic (5-HT), glutamatergic, and γ-Aminobutyric acid (GABA) systems, as well as the hypothalamic-pituitary axis (HPA) in rodents and in humans. Finally, we discuss stress resiliency in the context of aging, as the likelihood of mood disorders increases in older adults.

RESULTS

Interestingly, increased resiliency has been shown to slow aging and improved overall health and quality of life. Research in the neurobiology of stress resilience, particularly throughout the aging process, is a nascent, yet, burgeoning field.

CONCLUSION

Overall, we consider the possible methods that may be used to induce resilient phenotypes, prophylactically in at-risk populations, such as in military personnel or in older MDD patients. Research in the mechanisms of stress resilience may not only elucidate novel targets for antidepressant treatments, but also provide novel insight about how to prevent these debilitating disorders from developing.

Anxiety Disorders in Late Life

Anxiety disorders in later life are some of the most significant mental health problems affecting older adults. Prevalence estimates of anxiety disorders in late life vary considerably based on multiple methodological issues. Current diagnostic criteria may not adequately capture the nature and experience of anxiety in older people, particularly those in ethnic and racial minority groups. This article reviews late-life anxiety disorders. Pharmacologic and psychotherapy approaches to treat late-life anxiety are reviewed, including a summary of current innovations in clinical care across settings, treatment models, and treatment delivery.

Clinical characteristics of generalized anxiety disorder: older vs. young adults

BACKGROUND

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older people. Although GAD in older adults seems to differ in many aspects like clinical presentation, severity and treatment response, there is a paucity of comparative research.

AIMS

The aim of the study is to compare the clinical presentation of GAD between older and young adults.

METHODS

One hundred and two non-demented older patients (age ≥65) and 64 young patients (age <45) who were diagnosed with GAD according to the DSM-IV-TR criteria were included to the study. Socio-demographic Data Form, the Structured Clinical Interview for DSM Disorders-1 (SCID-1), the Questionnaire for the Suggested Behavioral Criteria of GAD for DSM-5, the Hamilton Depression Scale (HAM-D), the Generalized Anxiety Disorder Severity Scale (GADSS) and the Sheehan Disability Scale (SDS) were applied to both groups.

RESULTS AND CONCLUSIONS

Older GAD patients had more disturbances of sleep, less reassurance seeking behaviors, higher rates of depression and higher depression severity when compared to the young patients. Although older people seemed to have a lower severity of GAD, they had higher disability due to worries. Older patients worried more about their own health and family well-being, whereas young patients worried more about future and other's health.

Brain structural changes in late-life generalized anxiety disorder

Late-life Generalized Anxiety Disorder (GAD) is relatively understudied and the underlying structural and functional neuroanatomy has received little attention. In this study, we compare the brain structural characteristics in white and gray matter in 31 non-anxious older adults and 28 late-life GAD participants. Gray matter indices (cortical thickness and volume) were measured using FreeSurfer parcellation and segmentation, and mean diffusivity was obtained through Diffusion Tensor Imaging (DTI). We assessed both macroscopic white matter changes [using white matter hyperintensity (WMH) burden] and microscopic white matter integrity [using fractional anisotropy (FA)]. No differences in macro- or microscopic white matter integrity were found between GAD and non-anxious controls (HC). GAD participants had lower cortical thickness in the orbitofrontal cortex (OFC), inferior frontal gyrus, and pregenual anterior cingulate cortex (ACC). Higher worry severity was associated with gray matter changes in OFC, ACC and the putamen. The results did not survive the multiple comparison correction, but the effect sizes indicate a moderate effect. The study suggests that late-life GAD is associated with gray matter changes in areas involved in emotion regulation, more so than with white matter changes. We conclude that anxiety-related chronic hypercortisolemia may have a dissociative effect on gray and white matter integrity.

Modified Suanzaorentang Had the Treatment Effect for Generalized Anxiety Disorder for the First 4 Weeks of Paroxetine Medication: A Pragmatic Randomized Controlled Study

Background. Paroxetine does not show satisfactory therapeutic effect for generalized anxiety disorder (GAD) patients for the first 2–4 weeks of medication. Diazepam is always concurrently used although it has some shortcomings such as physical dependence and withdrawal reactions. In this study, we aimed to identify whether modified Suanzaorentang (MSZRT), a combined Chinese formula including Suanzaorentang (SZRT) and Zhizichitang (ZZCT), could control the anxiety of GAD for the first 4 weeks of paroxetine medication. Methods. 156 GAD patients were randomized to the treatment of paroxetine, paroxetine-diazepam, or paroxetine-MSZRT for 4 weeks. Hamilton Anxiety Scale (HAMA) Test and Self-Rating Anxiety Scale (SAS) Test were determined each week as the evaluation of clinical efficacy. Adverse events (AEs) were also closely observed by performing the Treatment Emergent Symptom Scale (TESS) Test. Results. Both paroxetine-MSZRT and paroxetine-diazepam decreased more HAMA and SAS total scores than paroxetine from weeks 1 to 3. Paroxetine-MSZRT as well as paroxetine-diazepam had an obviously higher onset rate than paroxetine in each week. After 4 weeks' treatment, the overall effectiveness rate in the paroxetine-MSZRT group (90.00%) was obviously higher than those of the paroxetine group (74.42%) but did not significantly differ from the paroxetine-diazepam group (93.88%). Conclusion. MSZRT had the treatment effect for GAD when paroxetine was used for the first 4 weeks.

Sex differences in the association between area deprivation and generalised anxiety disorder: British population study

OBJECTIVE

Studies have shown that area-level deprivation measured by factors, such as non-home ownership, non-car ownership and household overcrowding, can increase the risk for mental disorders over and above individual-level circumstances, such as education and social class. Whether area-level deprivation is associated with generalised anxiety disorder (GAD) independent of personal circumstances, and whether this association is different between British women and men is unknown.

DESIGN

Large, population study.

SETTING

UK population-based cohort.

PARTICIPANTS

30 445 people from the general population aged 40 years and older and living in England consented to participate at study baseline, and of these, 21 921 participants completed a structured health and lifestyle questionnaire used to capture GAD. Area deprivation was measured in 1991 using Census data, and GAD was assessed in 1996-2000. 10 275 women and 8219 men had complete data on all covariates.

MAIN OUTCOME MEASURE

Past-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

RESULTS

In this study, 2.5% (261/10 275) of women and 1.8% (145/8219) of men had GAD. Women living in the most deprived areas were over 60% more likely to develop anxiety than those living in areas that were not deprived (OR=1.63, 95% CI 1.21 to 2.21; p=0.001), but this association between deprivation and GAD was not apparent in men (OR=1.13, 95% CI 0.72 to 1.77; p=0.598).

CONCLUSIONS

The absolute numbers of people living in deprived conditions are large worldwide. This, combined with a growing mental health burden, means that the findings obtained in this study remain highly relevant. The WHO has emphasised the need to reduce social and health inequalities. Our findings provide a strong evidence base to this call, showing that the environment needs to be taken into account when developing mental health policy; gender is important when it comes to assessing the influence of the environment on our mental health.

Preliminary evidence for a role of the adrenergic nervous system in generalized anxiety disorder

Generalized anxiety disorder (GAD) is a common chronic condition that is understudied compared to other psychiatric disorders. An altered adrenergic function has been reported in GAD, however direct evidence for genetic susceptibility is missing. This study evaluated the associations of gene variants in adrenergic receptors (ADRs) with GAD, with the involvement of stressful events. Data were obtained from 844 French community-dwelling elderly aged 65 or over. Anxiety disorders were assessed using the Mini-International Neuropsychiatry Interview, according to DSM-IV criteria. Eight single-nucleotide polymorphisms (SNPs) involved with adrenergic function were genotyped; adrenergic receptors alpha(1A) (ADRA1A), alpha(2A) (ADRA2A), and beta2 (ADRB2) and transcription factor TCF7L2. Questionnaires evaluated recent stressful life events as well as early environment during childhood and adolescence. Using multivariate logistic regression analyses four SNPs were significantly associated with GAD. A 4-fold modified risk was found with ADRA1A rs17426222 and rs573514, and ADRB2 rs1042713 which remained significant after Bonferroni correction. Certain variants may moderate the effect of adverse life events on the risk of GAD. Replication in larger samples is needed due to the small case number. This is the first study showing that ADR variants are susceptibility factors for GAD, further highlighting the critical role of the adrenergic nervous system in this disorder.

Stability of Genetic and Environmental Contributions to Anxiety Symptoms in Older Adulthood

Anxiety symptoms are common in later life and are associated with diverse adverse health outcomes. Little is known about how genetic and environmental influences on anxiety symptoms might vary across older adulthood. The purpose of this study was to explore change and stability of contributions to anxiety symptoms across older adulthood. We examined data from the Swedish Adoption/Twin Study of Aging (SATSA). Between the years 1984 and 2010, 2021 participants (including 753 complete twin pairs) completed up to seven assessments containing two measures of anxiety symptoms. Longitudinal genetic simplex models were fit to examine the stability and change in genetic and environmental influences. Amplification of genetic factors at ages 75-80 suggests tentative new genetic contributions to anxiety symptoms. These findings suggest that the heritability of anxiety symptoms may increase later in life. Physiological factors associated with aging are discussed as potential factors explaining this increase.

New research on anxiety disorders in the elderly and an update on evidence-based treatments

Anxiety disorders are frequently encountered in the elderly, but they are largely undetected and untreated. Epidemiological studies indicate a prevalence ranging from 1.2 to 15 %. With the exception of generalized anxiety disorder and agoraphobia, which can often start in late life, most anxiety disorders in older patients are chronic and have their onset earlier in life. Anxiety disorders are an often unrecognized cause of distress, disability, and mortality risk in older adults, and they have been associated with cardiovascular disease, stroke, and cognitive decline. The mechanisms of anxiety in older adults differ from that in younger adults due to age-related neuropathology, as well as the loss and isolation so prominent in late life. Our review intends to provide a comprehensive summary of the most recent research done in the field of anxiety disorders in the elderly. Recent findings in clinical research, neuroimaging, neuroendocrinology, and neuropsychology are covered. An update on treatment options is discussed, including pharmacological and non-pharmacological alternatives.