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Comorbid anxiety disorders in late-life depression: results of a cohort study

Published online by Cambridge University Press:  05 November 2014

D.C. van der Veen ,
W.H. van Zelst ,
R.A. Schoevers ,
H.C. Comijs  and
R.C. Oude Voshaar
D.C. van der Veen*
Affiliation:
University of Groningen, University Medical Center Groningen, Center for Psychiatry & Interdisciplinary Center of Psychiatric Epidemiology, Groningen, the Netherlands
W.H. van Zelst
Affiliation:
University of Groningen, University Medical Center Groningen, Center for Psychiatry & Interdisciplinary Center of Psychiatric Epidemiology, Groningen, the Netherlands
R.A. Schoevers
Affiliation:
University of Groningen, University Medical Center Groningen, Center for Psychiatry & Interdisciplinary Center of Psychiatric Epidemiology, Groningen, the Netherlands
H.C. Comijs
Affiliation:
Department for Psychiatry, EMGO Institute for Health and Care Research / Institute for Neurosciences, VU University, Amsterdam, the Netherlands GGZ inGeest, Amsterdam, the Netherlands
R.C. Oude Voshaar
Affiliation:
University of Groningen, University Medical Center Groningen, Center for Psychiatry & Interdisciplinary Center of Psychiatric Epidemiology, Groningen, the Netherlands
*
Correspondence should be addressed to: Date C. van der Veen, University of Groningen, University Medical Center Groningen, Center for Psychiatry & Interdisciplinary Center of Psychiatric Epidemiology, Groningen, Post office box 30.001 9700 RB, Groningen, the Netherlands. Phone: +31-50-3614124. Email: [email protected].
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Abstract

Background:

Comorbid anxiety disorders are common in late-life depression and negatively impact treatment outcome. This study aimed to examine personality characteristics as well as early and recent life-events as possible determinants of comorbid anxiety disorders in late-life depression, taking previously examined determinants into account.

Methods:

Using the Composite International Diagnostic Interview (CIDI 2.0), we established comorbid anxiety disorders (social phobia (SP), panic disorder (PD), generalized anxiety disorder (GAD), and agoraphobia (AGO)) in 350 patients (aged ≥60 years) suffering from a major depressive disorder according to DSM-IV-TR criteria within the past six months. Adjusted for age, sex, and level of education, we first examined previously identified determinants of anxious depression: depression severity, suicidality, partner status, loneliness, chronic diseases, and gait speed in multiple logistic regression models. Subsequently, associations were explored with the big five personality characteristics as well as early and recent life-events. First, multiple logistic regression analyses were conducted with the presence of any anxiety disorder (yes/no) as dependent variable, where after analyses were repeated for each anxiety disorder, separately.

Results:

In our sample, the prevalence rate of comorbid anxiety disorders in late-life depression was 38.6%. Determinants of comorbid anxiety disorders were a lower age, female sex, less education, higher depression severity, early traumatization, neuroticism, extraversion, and conscientiousness. Nonetheless, determinants differed across the specific anxiety disorders and lumping all anxiety disorder together masked some determinants (education, personality).

Conclusions:

Our findings stress the need to examine determinants of comorbid anxiety disorder for specific anxiety disorders separately, enabling the development of targeted interventions within subgroups of depressed patients.

Keywords

mixed anxiety depressionanxious depressionlate-life depressionanxiety disorderscomorbiditydeterminants
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Special Issue 7: Late Life Anxiety , July 2015 , pp. 1157 - 1165
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Abbelan van Kan, G. et al. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people. An international academy on nutrition and aging (IANA) task force. Journal of Nutrition, Health and Aging, 13, 881–889.Google Scholar
Allgulander, C. and Lavori, P. W. (1993). Causes of death among 936 elderly patients with “pure” anxiety neurosis in Stockholm county, Sweden, and in patients with depressive neurosis or both diagnoses. Comprehensive Psychiatry, 34, 299–302.CrossRefGoogle ScholarPubMed
Andrade, L., Eaton, W. W. and Chilcoat, H. (1994). Lifetime comorbidity of panic attacks and major depression in a population-based study. Symptom profiles. British Journal of Psychiatry, 165, 363–369.CrossRefGoogle Scholar
Andreescu, C. et al. (2007). Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study. British Journal of Psychiatry, 190, 344–349. doi: 10.1192/bjp.bp.106.027169.Google Scholar
Bartels, S. J. et al. (2002). Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. American Journal of Geriatric Psychiatry, 10, 417–427.Google Scholar
Beekman, A. T. F., de Beurs, E., van Balkom, A. J. L. M., Deeg, D. J. H., van Dyck, R. and van Tilburg, W. (2000). Anxiety and depression in later life: co-occurrence and communality of risk factors. American Journal of Psychiatry, 157, 89–95.CrossRefGoogle ScholarPubMed
Brugha, T. S. and Cragg, D. (1990). The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiatrica Scandinavica, 82, 77–81.Google Scholar
Brugha, T., Bebbington, P., Tennant, C. and Hurry, J. (1985). The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine, 15, 189–194.Google Scholar
Byers, A. L., Yaffe, K., Covinsky, K. E., Friedman, M. B. and Bruce, M. L. (2010). High occurrence of mood and anxiety disorders among older adults: the national comorbidity survey replication. Archives of General Psychiatry, 67, 489–496. doi: 10.1001/archgenpsychiatry.2010.35.Google Scholar
Cairney, J., Corna, L. M., Veldhuizen, S., Herrmann, N. and Streiner, D. L. (2008). Comorbid depression and anxiety in later life: patterns of association, subjective well-being, and impairment. American Journal of Geriatric Psychiatry, 16, 201–208. doi: 10.1097/01.JGP.0000300627.93523.c8.Google Scholar
Cesari, M. et al. (2005). Prognostic value of usual gait speed in well-functioning older people – results from the health, aging and body composition study. Journal of the American Geriatrics Society, 53, 1675–1680. doi: 10.1111/j.1532-5415.2005.53501.x.CrossRefGoogle ScholarPubMed
Chambless, D. L., Fydrich, T. and Rodebaugh, T. L. (2008). Generalized social phobia and avoidant personality disorder: meaningful distinction or useless duplication? Depression and Anxiety, 25, 8–19. doi: 10.1002/da.20266.CrossRefGoogle ScholarPubMed
Comijs, H. C., van Exel, E., van der Mast, R. C., Paauw, A., Oude Voshaar, R. and Stek, M. L. (2013). Childhood abuse in late-life depression. Journal of Affective Disorders, 147, 241–246. doi: 10.1016/j.jad.2012.11.010.Google Scholar
Comijs, H. C. et al. (2011). The Netherlands study of depression in older persons (NESDO): a prospective cohort study. BMC Research Notes, 4, 524–534. doi: 10.1186/1756-0500-4-524.Google Scholar
Costa, P. T. J., Bagby, R. M., Herbst, J. H. and McCrae, R. R. (2005). Personality self-reports are concurrently reliable and valid during acute depressive episodes. Journal of Affective Disorders, 89, 45–55. doi: 10.1016/j.jad.2005.06.010.Google Scholar
Costa, P. T. J. and McCrae, R. R. (1995). Domains and facets: hierarchical personality assessment using the revised NEO personality inventory. Journal of Personality Assessment, 64, 21–50. doi: 10.1207/s15327752jpa6401_2.CrossRefGoogle ScholarPubMed
de Graaf, R., Bijl, R., Ten Have, M., Beekman, A. and Vollebergh, W. (2004). Pathways to comorbidity: the transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study. Journal of Affective Disorders, 82, 461–467. doi: 10.1016/j.jad.2004.03.001.CrossRefGoogle Scholar
de Jong-Gierveld, J. and Kamphuis, F. H. (1985). The development of a rasch-type loneliness scale. Applied Psychological Measurement, 9, 289–299.Google Scholar
Dew, M. A. et al. (1997). Temporal profiles of the course of depression during treatment. Predictors of pathways toward recovery in the elderly. Archives of General Psychiatry, 54, 1016–1024.Google Scholar
Dong, M., Anda, R. F., Dube, S. R., Giles, W. H. and Felitti, V. J. (2003). The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse and Neglect, 27, 625–639.Google Scholar
Flint, A. J. (2005). Anxiety and its disorders in late life: moving the field forward. American Journal of Geriatric Psychiatry, 13, 3–6. doi: 10.1176/appi.ajgp.13.1.3.CrossRefGoogle ScholarPubMed
Flint, A. J. and Rifat, S. L. (1997). The effect of treatment on the two-year course of late-life depression. British Journal of Psychiatry, 170, 268–272.Google Scholar
Flint, A. J. and Rifat, S. L. (2002). Relationship between clinical variables and symptomatic anxiety in late-life depression. American Journal of Geriatric Psychiatry, 10, 292–296.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Goes, F. S. et al. (2011). Co-morbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder. Psychological Medicine, 42, 1449–1459. doi: 10.1017/S0033291711002637.Google Scholar
Goodwin, R. D., Fergusson, D. M. and Horwood, L. J. (1999). Childhood abuse and familial violence and the risk of panic attacks and panic disorder in young adulthood. Psychological Medicine, 35, 881–890. doi: 10.1017/S0033291704003265.CrossRefGoogle Scholar
Greenlee, A., Karp, J. F., Dew, M. A., Houck, P., Andreescu, C. and Reynolds, C. F., III (2010). Anxiety impairs depression remission in partial responders during extended treatment in late-life. Depression and Anxiety, 27, 451–456. doi: 10.1002/da.20672.Google Scholar
Hegel, M. T. et al. (2005). Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. American journal of geriatric psychiatry, 13, 48–58. doi: 10.1176/appi.ajgp.13.1.48.Google Scholar
Hoekstra, H. A., Ormel, J. and De Fruyt, F. (1996). NEO personality questionnaires NEO-PI-R, NEO-FFI: manual. Swet & Zeitlinger BV, Lisse Google Scholar
Johnson, J., Weissman, M. M. and Klerman, G. L. (1990). Panic disorder, comorbidity, and suicide attempts. Archives of General Psychiatry, 47, 805–808.CrossRefGoogle ScholarPubMed
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602. doi: 10.1001/archpsyc.62.6.593.Google Scholar
Kim, S. W. et al. (2013). Impact of childhood adversity on the course and suicidality of depressive disorders: the crescend study. Depression and Anxiety, 30, 965–974. doi: 10.1002/da.22088.Google ScholarPubMed
Kriegsman, D. M., Penninx, B. W., van Eijk, J. T., Boeke, A. J. and Deeg, D. J. (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. Journal of Clinical Epidemiology, 49, 1407–1417.Google Scholar
Lampe, L. and Sunderland, M. (2013). Social phobia and avoidant personality disorder: similar but different? Journal of Personality Disorders. doi: 10.1521/pedi_2013_27_079.Google Scholar
Lenze, E. J. (2000). Comorbid anxiety disorders in depressed elderly patients. American Journal of Psychiatry, 157, 722–728. doi: 10.1176/appi.ajp.157.5.722.Google Scholar
Lenze, E. J. et al. (2005). Generalized anxiety disorder in late life: lifetime course and comorbidity with major depressive disorder. American Journal of Geriatric Psychiatry, 13, 77–80. doi: 10.1176/appi.ajgp.13.1.77.Google Scholar
Mohlman, J. et al. (2012). Improving recognition of late life anxiety disorders in diagnostic and statistical manual of mental disorders, fifth edition: observations and recommendations of the advisory committee to the lifespan disorders work group. International Journal of Geriatric Psychiatry, 27, 549–556. doi: 10.1002/gps.2752.Google Scholar
Morse, J. Q., Pilkonis, P. A., Houck, P. R., Frank, E. and Reynolds, C. F. III. (2005). Impact of cluster C personality disorders on outcomes of acute and maintenance treatment in late-life depression. American Journal of Geriatric Psychiatry, 13, 808–814. doi: 10.1176/appi.ajgp.13.9.808.CrossRefGoogle ScholarPubMed
Mulsant, B. H., Reynolds, C. F. 3., Shear, M. K., Sweet, R. A. and Miller, M. (1996). Comorbid anxiety disorders in late-life depression. Anxiety, 2, 242–247.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Nelson, J. C., Delucchi, K. and Schneider, L. S. (2009). Anxiety does not predict response to antidepressant treatment in late life depression: results of a meta-analysis. International Journal of Geriatric Psychiatry, 24, 539–544. doi: 10.1002/gps.2233.Google Scholar
Newton-Howes, G., Tyrer, P. and Johnson, T. (2006). Personality disorder and the outcome of depression: meta-analysis of published studies. British Journal of Psychiatry, 188, 13–20. doi: 10.1192/bjp.188.1.13.CrossRefGoogle ScholarPubMed
Ormel, J., Oldehinkel, A. J. and Vollebergh, W. (2004). Vulnerability before, during, and after a major depressive episode: a 3-wave population-based study. Archives of general psychiatry, 61, 990–996. doi:10.1001/archpsyc.61.10.990.Google Scholar
Pearlin, L. I. and Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21.Google Scholar
Peel, N. M., Kuys, S.S. and Klein, K. (2012). Gait speed as a measure in geriatric assessment in clinical settings: a systematic review. Journals of Gerontology, 68, 39–46. doi:10.1093/gerona/gls174 Google Scholar
Penninx, B. W. et al. (2008). The Netherlands study of depression and anxiety (NESDA): rationale, objectives and methods. International Journal of Methods in Psychiatric Research, 17, 121–140. doi: 10.1002/mpr.256.Google Scholar
Ritchie, K. et al. (2004). Prevalence of DSM-IV psychiatric disorder in the French elderly population. British Journal of Psychiatry, 184, 147–152.Google Scholar
Roca, M. et al. (2011). Clinical differences between early and late remission in depressive patients. Journal of Affective Disorders, 134, 235–241. doi:10.1016/j.jad.2011.05.051 CrossRefGoogle ScholarPubMed
Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B. and Trivedi, M. H. (1996). The inventory of depressive symptomatology (IDS): psychometric properties. Psychological Medicine, 26, 477–486.Google Scholar
Saghafi, R. et al. (2007). Predicting 6-week treatment response to escitalopram pharmacotherapy in late-life major depressive disorder. International Journal of Geriatric Psychiatry, 22, 1141–1146. doi: 10.1002/gps.1804.Google Scholar
Samuel, D. and Widiger, T. (2008). A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: a facet level analysis. Clinical Psychology Review, 28, 1326–1342. doi: 10.1016/j.cpr.2008.07.002.Google Scholar
Santor, D. A., Bagby, R. M. and Joffe, R. T. (1997). Evaluating stability and change in personality and depression. Journal of Personality and Social Psychology, 73, 1354–1362. doi: 10.1037/0022-3514.73.6.1354.Google Scholar
Sareen, J. et al. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Archives of General Psychiatry, 62, 1249–1257. doi: 10.1001/archpsyc.62.11.1249.Google Scholar
Saulsman, L. M. and Page, A. C. (2004). The five-factor model and personality disorder empirical literature: a meta-analytic review. Clinical Psychology Review, 23, 1055–1085. doi: 10.1016/j.cpr.2002.09.001.Google Scholar
Schoevers, R. A., Van, H. L., Koppelmans, V., Kool, S. and Dekker, J. J. (2008). Managing the patient with co-morbid depression and an anxiety disorder. Drugs, 68, 1621–1634.Google Scholar
Sheikh, J. I., Leskin, G. A. and Klein, D. F. (2002). Gender differences in panic disorder: findings from the national comorbidity survey. American Journal of Psychiatry, 159, 55–58.Google Scholar
Spinhoven, P., Penelo, E., de Rooij, M., Penninx, B.W. and Ormel, J. (2014). Reciprocal effects of stable and temporary components of neuroticism and affective disorders: results of a longitudinal cohort study. Psychological Medicine, 44, 337–348. doi:10.1017/S0033291713000822 Google Scholar
Steunenberg, B., Braam, A. W., Beekman, A. T. F., Deeg, D. J. H. and Kerkhof, A. J. F. M. (2009). Evidence for an association of the big five personality factors with recurrence of depressive symptoms in later life. International Journal of Geriatric Psychiatry, 24, 1470–1477. doi: 10.1002/gps.2291.Google Scholar
van der Veen, D. C., Comijs, H. C., van Zelst, W. H., Schoevers, R. A. and Oude Voshaar, R. C. (2014). Defining anxious depression in later life: a scaring heterogeneity in results. American Journal of Geriatric Psychiatry, 22, 1375–1378. doi: 10.1016/j.jagp.2014.02.012.CrossRefGoogle ScholarPubMed
Veerbeek, M. A., Oude Voshaar, R. C. and Pot, A. M. (2014). Effectiveness and predictors of outcome in routine out-patient mental healthcare for older adults. International Psychogeriatrics, 23, 1–10. doi: 10.1017/S1041610214000647.Google Scholar
Vink, D. et al. (2009). Onset of anxiety and depression in the aging population: comparison of risk factors in a 9-year prospective study. American Journal of Geriatric Psychiatry, 17, 642–652. doi: 10.1097/JGP.0b013e3181a65228.Google Scholar
Yonkers, K. A., Bruce, S. E., Dyck, I. R. and Keller, M. B. (2003). Chronicity, relapse, and illness – course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depression and Anxiety, 17, 173–179. doi: 10.1002/da.10106.Google Scholar
Young, E. A., Abelson, J. L., Curtis, G. C. and Nesse, R. M. (1997). Childhood adversity and vulnerability to mood and anxiety disorders. Depression and Anxiety, 5, 66–72.Google Scholar