Article

Anxiety Disorders and Comorbid Medical Illness

University of Washington School of Medicine, Seattle, WA 98195, USA.
General Hospital Psychiatry (Impact Factor: 2.9). 05/2008; 30(3):208-25. DOI: 10.1016/j.genhosppsych.2007.12.006
Source: PubMed

ABSTRACT To provide an overview of the role of anxiety disorders in medical illness.
The Anxiety Disorders Association of America held a multidisciplinary conference from which conference leaders and speakers reviewed presentations and discussions, considered literature on prevalence, comorbidity, etiology and treatment, and made recommendations for research. Irritable bowel syndrome (IBS), asthma, cardiovascular disease (CVD), cancer and chronic pain were reviewed.
A substantial literature supports clinically important associations between psychiatric illness and chronic medical conditions. Most research focuses on depression, finding that depression can adversely affect self-care and increase the risk of incident medical illness, complications and mortality. Anxiety disorders are less well studied, but robust epidemiological and clinical evidence shows that anxiety disorders play an equally important role. Biological theories of the interactions between anxiety and IBS, CVD and chronic pain are presented. Available data suggest that anxiety disorders in medically ill patients should not be ignored and could be considered conjointly with depression when developing strategies for screening and intervention, particularly in primary care.
Emerging data offer a strong argument for the role of anxiety in medical illness and suggest that anxiety disorders rival depression in terms of risk, comorbidity and outcome. Research programs designed to advance our understanding of the impact of anxiety disorders on medical illness are needed to develop evidence-based approaches to improving patient care.

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Available from: Karina W Davidson, Aug 22, 2015
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    • "Worldwide, the population of older adults, aged 65 and over, is expected to triple by 2050 (WHO, 2011). This increase in population comes along with an increased need for research and advancements in improved mental health for seniors considering the negative impact of mental health issues on quality of life, functionality , cognition as well as physical health, the latter presenting a suggested bidirectional effect with common mental health problems , such as depression and anxiety (Ramasubbu et al., 2012; Roy-Byrne et al., 2008; Rugulies, 2002; Skoog et al., 1993). Large population based studies in developed countries have reported rates of depression and anxiety ranging from 2.6% to 27% in older adults (Blazer et al., 1987; Scott et al., 2008; Mosier et al., 2010; Kessler et al., 2010). "
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    ABSTRACT: Screening tools that appropriately detect older adults׳ mental disorders are of great public health importance. The present study aimed to establish cutoff scores for the 10-item Kessler Psychological Distress (K10) and the 7-item Generalized Anxiety Disorder (GAD-7) scales when screening for depression and anxiety. We used data from participants (n=1811) in the Enquête sur la Santé des Aînés-Service study. Depression and anxiety were measured using DSM-V and DSM-IV criteria. Receiver operating characteristic (ROC) curve analysis provided an area under the curve (AUC) of 0.767 and 0.833 for minor and for major depression when using K10. A cutoff of 19 was found to balance sensitivity (0.794) and specificity (0.664) for minor depression, whereas a cutoff of 23 was found to balance sensitivity (0.692) and specificity (0.811) for major depression. When screening for an anxiety with GAD-7, ROC analysis yielded an AUC of 0.695; a cutoff of 5 was found to balance sensitivity (0.709) and specificity (0.568). No significant differences were found between subgroups of age and gender. Both K10 and GAD-7 were able to discriminate between cases and non-cases when screening for depression and anxiety in an older adult population of primary care service users. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    04/2015; 228(1). DOI:10.1016/j.psychres.2015.04.019
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    • "Covariates included age, gender, years of education attained, number of somatic illnesses and the presence of a comorbid depressive disorder. Previous research indicated that these covariates are associated with anxiety and disability (Ansseau et al., 2008; Roy-Byrne et al., 2008). Number of somatic illnesses was assessed using self-reports which ascertained the presence of coronary artery disease, cardiac arrhythmia, heart failure, stroke, chronic lung disease, diabetes mellitus, thyroid disease, epilepsy, migraine or other headache, multiple sclerosis, neuropathy , osteoarthritis, rheumatoid arthritis, intestinal disorders, ulcer, and cancer, for which participants were currently under physician control or currently treated. "
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    ABSTRACT: Background This study compares disability levels between different anxiety disorders and healthy controls. We further investigate the role of anxiety arousal and avoidance behaviour in disability, and whether differences in these symptom patterns contribute to disability differences between anxiety disorders. Methods Data were from 1826 subjects from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose anxiety disorders. The World Health Organization Disability Assessment Schedule II was used to measure disability in six domains (cognition, mobility, selfcare, social interaction, life activities, participation). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire. Results All anxiety disorders were associated with higher disability. Disability was generally highest in multiple anxiety disorder (e.g. mean disability in cognition=33.7) and social anxiety disorder (mean=32.7), followed by generalized anxiety disorder (mean=27.2) and panic disorder with agoraphobia (mean=26.3), and lowest in panic disorder without agoraphobia (mean=22.1). Anxiety arousal was more associated with disability in life activities (B=8.5, p<0.001) and participation (B=9.9, p<0.001) whereas avoidance behaviour was more associated with disability in cognition (B=7.4, p<0.001) and social interaction (B=8.6, p<0.001). Different disability patterns between anxiety disorders were not completely explained by anxiety arousal and avoidance behaviour. Limitations The cross-sectional study design precludes any causal interpretations. In order to examine the full range of comorbidity among anxiety, a greater range of anxiety disorders would have been preferable. Conclusions Disability is highest in social anxiety disorder and multiple anxiety disorder. Both anxiety arousal and avoidance behaviour are associated with higher disability levels but do not fully explain the differences across anxiety disorders.
    Journal of Affective Disorders 09/2014; 166:227–233. DOI:10.1016/j.jad.2014.05.006 · 3.71 Impact Factor
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    • "Some existing literature shows an increased risk of suicide attempts linked with physical illness (Druss & Pincus, 2000; Goodwin et al. 2003; Goodwin & Eaton, 2005). However, people with physical conditions have elevated rates of mental illness (Scott et al. 2007; Roy-Byrne et al. 2008), and once the effects of mental disorders are accounted for, the literature becomes divided, with some studies showing an attenuated risk of suicidal behavior and suggesting that the latter is attributable to mental disorder co-morbidity (Rasic et al. 2008; Lossnitzer et al. 2009). Although several studies have specifically examined the relationship between cancer and suicide (Misono et al. 2008; Fall et al. 2009; Robinson et al. 2009; Turaga et al. 2011; Fang et al. 2012), studies of other physical illnesses are few, and again find mixed results (Fredrikson et al. 2003; Bronnum-Hansen et al. 2005; Pompili et al. 2007; Giltay et al. 2010; Webb et al. 2012). "
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    ABSTRACT: Background. The association between physical disorders and suicide remains unclear. The aim of this study was to examine the relationship between physical disorders and suicide after accounting for the effects of mental disorders. Method. Individuals who died by suicide (n = 2100) between 1996 and 2009 were matched 3: 1 by balancing score to general population controls (n = 6300). Multivariate conditional logistic regression compared the two groups across physician-diagnosed physical disorders [asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease, hypertension, diabetes, cancer, multiple sclerosis and inflammatory bowel disease], adjusting for mental disorders and co-morbidity. Secondary analyses examined the risk of suicide according to time since first diagnosis of each physical disorder (1-90, 91-364, 5365 days). Similar analyses also compared individuals with suicide attempts (n = 8641) to matched controls (n = 25 923). Results. Cancer was associated with increased risk of suicide [adjusted odds ratio (AOR) 1.40, 95% confidence interval (CI) 1.03-1.91, p < 0.05] even after adjusting for all mental disorders. The risk of suicide with cancer was particularly high in the first 90 days after initial diagnosis (AOR 4.10, 95% CI 1.71-9.82, p < 0.01) and decreased to non-significance after 1 year. Women with respiratory diseases had elevated risk of suicide whereas men did not. COPD, hypertension and diabetes were each associated with increased odds of suicide attempts in adjusted models (AORs ranged from 1.20 to 1.73). Conclusions. People diagnosed with cancer are at increased risk of suicide, especially in the 3 months following initial diagnosis. Increased support and psychiatric involvement should be considered for the first year after cancer diagnosis.
    Psychological Medicine 07/2014; 45(03):1-10. DOI:10.1017/S0033291714001639 · 5.43 Impact Factor
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