Elsevier

Journal of Affective Disorders

Volume 172, 1 February 2015, Pages 24-29
Journal of Affective Disorders

Brief report
Generalized anxiety in community-dwelling elderly: Prevalence and clinical characteristics

https://doi.org/10.1016/j.jad.2014.09.036Get rights and content

Abstract

Background

Generalized anxiety disorder (GAD) is a chronic and disabling disorder with a low rate of full remission. As it is commonly assumed that cases in the elderly principally represent the continuing chronic course of early onset illness, there has been little research into the clinical characteristics, including comorbid psychiatric and physical conditions, which may be specific to older people.

Methods

Lifetime GAD and psychiatric comorbidity were diagnosed in 1974 community-dwelling elderly people aged 65 or over using a standardized psychiatric examination, the MINI, based on DSM-IV criteria. Multivariate regression analyses were adjusted for socio-demographic, lifestyle, biological, and clinical variables, as well as adverse life events.

Results

The lifetime prevalence of GAD was 11% (95% CI=9.6–12.4%) of whom 24.6% reported a late onset with a first episode after 50 years of age. The 6-month current prevalence was 4.6% (95% CI=3.7–5.5%). Most of the prevalent cases were recurrent but only 36.3% were receiving treatment. Fourteen percent were comorbid with major depression and 34% with phobia but their associated factors differed. The factors associated with pure GAD were being female, having cognitive impairment, lower body mass index, reporting low affective support during childhood, taking a high number of somatic medications independently of other mental health factors, e.g. psychotropic medication use, major depression, and phobia.

Limitations

The study is limited by cross-sectional design.

Conclusions

Our data indicate that GAD prevalence is high in elderly people with a late-life onset of GAD in 25% of cases. GAD in the elderly is not just a severity marker of depression and is clinically distinct from phobia, the other major anxiety disorder of the elderly.

Introduction

Generalized anxiety disorder (GAD) is a chronic disorder commonly preceding depressive episodes and associated with increased disability and mortality (Kessler et al., 2001). Treatment is difficult with low rates of full remission (Hoge et al., 2012). Despite a high prevalence in primary care, its recognition in general practice is relatively low, especially in older adults (Parmentier et al., 2013). It is indeed commonly assumed that cases in the elderly represent the continuing chronic course of early onset illness and/or a severity marker of depression (Kessler and Wittchen, 2002, American Psychiatric Association, 1994) However, different risk profiles may be expected among the elderly in comparison with younger adults as both the exposure to and the impact of risk factors change with age (Vink et al., 2008). This notably includes lifetime accumulation of traumatic events as well as chronic physical and neuropsychiatric disorders (cognitive decline, depression, and other anxiety disorders which are frequent in the elderly (Ritchie et al., 2004), especially phobia, which also have specific characteristics (Ritchie et al., 2013)).

Previous studies have been mostly carried out in clinical settings, which limits generalizability; community-based studies have tended to use symptom scales as opposed to structured clinical interviews and rarely examine older adults specifically (Vink et al., 2008). Four principal epidemiological studies focusing on GAD in elderly populations mainly found associations with the number of chronic disorders, functional limitations, and psychosocial factors (Beekman et al., 2000, Schoevers et al., 2003, Schoevers et al., 2005, Goncalves et al., 2011, Chou et al., 2011). None of them considered psychotropic use as well as factors associated with early environment, or related to specific age-related chronic disorders.

This study aimed to describe lifetime GAD prevalence for both early and late-life onset cases and their clinical characteristics including comorbidity in a large cohort of over 2000 community-dwelling elderly. Psychiatric disorder was detected using a standardized clinical interview and controlling for a large range of socio-demographic, lifestyle, and clinical variables as well as early and late-life adverse events.

Section snippets

Subjects

Participants ≥65 years old were recruited by random selection from electoral rolls between 1999 and 2001 as part of the ESPRIT study of neuropsychiatric disorders in community-dwelling French elderly people (Ritchie et al., 2004). Of the persons initially contacted, 27.3% refused to participate and were replaced by another participant drawn randomly from the same electoral division so that each division was equally represented. The protocol was approved by the National Ethics Committee and

Socio-demographic and clinical characteristics associated with current GAD

In this elderly sample (58.3% females), the 6-month prevalence of GAD was 4.6% (95% CI=3.7–5.5%). The mean(SD) age of the sample was 72.8(5.3) years with no significant differences between subjects with and without GAD. Current GAD was 2.2-fold more frequent in women (6.0% vs. 2.7%, p=0.0007). Around 36.3% of the GAD cases were taking psychotropic medication (compared to 13.1% without GAD, p<0.0001); 42.5% anxiolytics, 33.3% antidepressants and 24.2% both. In analyses adjusted for age and sex,

Discussion

In this large community-dwelling elderly sample, we observed a 6-month prevalence of GAD of 4.6% (95% CI=3.7–5.5%) with a female to male ratio of 2.2. The lifetime prevalence was 11.0% (95% CI=9.6–12.4%) with a median age of first onset of 35 years with 24.6% of cases occurring over age 50. The higher prevalence rate compared to some studies (Schoevers et al., 2003, Goncalves et al., 2011, Alonso and Lépine, 2007) could be due to differences in reference periods (1, 6, or 12 months),

Role of funding source

The ESPRIT study was funded by an unconditional grant from Novartis and a grant from the French National Agency (ANR, Project 07 LVIE 004). Xiaobin Zhang is the holder of a doctoral fellowship from the Chinese Government (China Scholarship Council No. 201206940015). The funders had no involvement in any aspect of the study.

Conflict of interest

The authors report no competing interests.

Acknowledgment

None.

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