Comorbid Depression and Anxiety in Later Life: Patterns of Association, Subjective Well-being, and Impairment

Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, ON.
American Journal of Geriatric Psychiatry (Impact Factor: 4.24). 04/2008; 16(3):201-8. DOI: 10.1097/JGP.0b013e3181602a4a
Source: PubMed

ABSTRACT Very little epidemiological work has examined comorbidity between depression and anxiety disorders in community-dwelling older adults, despite the fact these disorders are known to co-occur in younger adults and that this co-occurrence is associated with greater clinical severity. In this study, the authors examine psychiatric comorbidity and associated impairment of four disorders (major depression, panic disorder, social phobia, and agoraphobia) in a community-based sample of adults aged 55 and older.
Population-based sample of older adults (N=12,792) from the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.2).
The World Mental Health Composite International Diagnostic Interview was used to identify cases of 12-month disorder. Descriptive analysis and regression analysis is used to examine patterns of association between disorders and related impairment.
Among adults aged 55 years and older, 4.4% met the criteria for at least one disorder and 0.8% had two or more. Social phobia was the most common comorbid disorder among respondents with depression, and depression was the most common comorbid disorder among respondents with any of the anxiety disorders. Respondents who report comorbid disorders reported significantly lower well-being and greater impairment.
Although comorbidity between physical health conditions and depression, and between dementias and depression, are well documented among older adults, these results suggest that comorbid depression and anxiety are also prevalent in later life. The significant impact of comorbidity on function and well-being underlines the need to screen for comorbid disorders in this population.

Download full-text


Available from: David L Streiner, Jul 02, 2015
36 Reads
    • "The diagnosis and accurate assessment of anxiety in late life is especially challenging because of several complicating factors , including the co-occurrence of anxiety with medical conditions (Kogan et al. 2000) and psychiatric problems, such as depression or personality disorders (e.g., Cairney et al. 2008; Coolidge et al. 2000), higher rates of cognitive impairment among older adults (Seignourel et al. 2008; Wolitzky-Taylor et al. 2010; Yochim et al. 2013), and changes in life circumstances not faced by younger adults (Wolitzky-Taylor et al. 2010). Cognitive impairment requires special consideration when assessing anxiety in this age group as it may, for instance , influence the ability to communicate the experienced symptoms to a clinician as well as the presentation of the symptoms themselves (Therrien and Hunsley 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Anxiety occurs frequently among older adults, and can have deleterious impacts on the quality of daily life. Due to the dearth of well-validated elder-specific anxiety screening instruments available in the German language, this study aimed to translate the Geriatric Anxiety Scale (GAS), a reliable and valid 30-item self-report screening instrument for assessing anxiety based on DSM-IV-TR diagnostic criteria (Segal et al 2010), into German, and to validate the new measure. The German version of the GAS was developed through a translation and back translation process, with careful attention paid to culturally-sensitive expressions of anxiety in the German older adult population. The final version of the German GAS was tested in a sample of 242 community-dwelling older adults (M age = 72.0 years, SD = 6.9 years; 59% women) who completed either an online (26%) or a paper-pencil (74%) version of the questionnaire. The findings confirmed the successful translation of the GAS into German and provided psychometric support for the new measure. The validation of the factor structure based on confirmatory factor analyses was in support of a unidimensional structure of the GAS-G. Correlational analyses with inventories measuring anxiety related and non-anxiety related personality traits additionally confirmed the convergent and discriminant validity of the GAS for use as an assessment measure for anxiety among German older adults.
    Journal of Psychopathology and Behavioral Assessment 08/2015; DOI:10.1007/s10862-015-9504-z · 1.55 Impact Factor
    • "Several studies have indeed identified a higher level of suicidal ideation or higher frequency of suicide attempts in the presence of anxiety, either defined as an increased anxiety level (e.g., Jeste et al., 2006; Fleehart et al., 2014) or as a concurrent anxiety disorder (e.g., Lenze et al., 2000; Bartels et al., 2002). Nonetheless, results are equivocal, and negative results have also been reported (e.g., Cairney et al., 2008). The World Health Organization world mental health survey showed that psychiatric disorders predicted the onset of suicidal ideation and/or suicide attempts (Nock et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Comorbid anxiety in depression increases the risk of suicidal ideation and behavior, although data on death by suicide are scarce. We compared characteristics of depressed elderly patients with and without anxiety disorders who died by suicide. From a 16-year clinical survey of all suicides in the UK (n = 25,128), we identified 1909 cases aged ≥60 years with a primary diagnosis of depression and no comorbidity other than anxiety disorders. Clinical characteristics of cases with (n = 333, 17.4%) and without (n = 1576) comorbid anxiety disorders were compared by logistic regression adjusted for demographic differences. Compared with cases without comorbid anxiety disorders, cases with comorbid anxiety disorders were more likely to have a duration of illness over 1 year (OR1-5 years = 1.4 [95% CI: 1.0-1.9], p = 0.061; OR≥5 years = 1.4 [95% CI: 1.6-2.8], p < 0.001), were more frequently prescribed psychotropic drugs other than antidepressants, lithium, and antipsychotics (OR = 2.1 [95% CI: 1.6-2.7], p < 0.001) and were more distressed during their last contact with services (OR = 1.3 [95% CI: 1.0-1.7], p = 0.037). In contrast, clinicians estimated the immediate and long-term suicidal risks lower in those with comorbid anxiety disorders (OR = 0.6 [95% CI: 0.3-0.9], p = 0.011 and OR = 0.7 [95% CI: 0.6-1.0], p = 0.028, respectively). Among depressed suicide cases, a comorbid anxiety disorder was identified in one out of six cases and associated with a higher prevalence of several suicide risk factors. This is important, as the detection of anxiety disorders comorbid to depression seems rather low and even when recognized clinicians rated such individuals as at low suicide risk. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 06/2015; DOI:10.1002/gps.4304 · 2.87 Impact Factor
  • Source
    • "Mental health problems and psychiatric disorders are associated with lower levels of subjective health and quality of life among individuals.[123] Studies among diverse samples have consistently shown that the presence of anxiety,[456] depression,[789] and problem alcohol use[10] are all inversely correlated with perceived well-being, self-rated health and life satisfaction. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The current study examined race and ethnic differences in the separate and combined (additive) effects of anxiety, depression and problem drinking on the baseline and trajectory of subjective health among adult men in the United States. This longitudinal study used data from the Fragile Families and Child Well-being Study. We included 4,655 men, composed of 2,407 Blacks, 1,354 Hispanic Whites and 894 non-Hispanic Whites. The dependent variable was subjective health, measured four times (i.e., baseline, year 1, year 3 and year 5). Latent growth curve modeling was used for data analysis. When controlling for socio-economics, we tested separate effects of anxiety and depression. Then we tested combined effects of anxiety, depression and problem drinking. Among all race and ethnic groups, anxiety and problem drinking were associated with baseline and trajectory of subjective health. Combined (additive) effects of anxiety and depression, however, varied based on race and ethnicity. Among Blacks, depression and anxiety were associated with a worse trajectory of subjective health. Among non-Hispanic Whites, anxiety was associated with a better baseline and worse trajectory of subjective health, while depression was associated with worse baseline subjective health. Among Hispanic Whites, anxiety was associated with a worse trajectory of subjective health, while depression was not associated with subjective health. Although separate effects of anxiety and problem drinking were similar among race and ethnic groups, race and ethnicity seemed to modify the combined effects of different mental health problems. These results warrant further exploration of these complex links.
    International journal of preventive medicine 03/2014; 5(3):269-79.
Show more