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Validation of the Older Adult Social Evaluative Scale (OASES) as a measure of social anxiety
Abstract
Background
Social anxiety disorder (SAD) (formerly called social phobia ) is among the most common mental health diagnoses among older adults; however, the research on late-life social anxiety is scarce. A limited number of studies have examined the assessment and diagnosis of social anxiety disorder in this population, and there are few social anxiety measures that are validated for use with older adults. One such measure, the Older Adult Social Evaluative Scale (OASES), was designed for use with this population, but until now has lacked validation against a gold-standard diagnostic interview.
Methods
Using a sample of 47 community-dwelling older adults (aged 60 years and over) with anxiety, the present study compared OASES performance to that of the Structured Clinical Interview for DSM-5 Disorders (SCID-5), as well as other measures of anxiety and depression.
Results
The OASES demonstrated convergent validity with other measures of anxiety, and demonstrated discriminant validity on other measures (e.g. depression, somatic symptoms). Receiver operating characteristic (ROC) analysis revealed that a cut-point of ≥76 optimized sensitivity and specificity compared to SCID-5 derived diagnoses of social anxiety disorder.
Conclusions
This study is the first study to provide psychometric validation for the OASES and one of the first to administer the SCID-5 to an older adult sample. In addition to establishing a clinically significant cut-off, this study also describes the clinical utility of the OASES, which can be used to identify distressing situations, track anxiety severity, and monitor behavioral avoidance across a variety of social situations.
... A description of all tools identified and the reported ease of use is provided in Supplementary Fifteen studies looked at one index tool, while 12 and 5 studies, respectively, looked at two tools and three or more tools. Index tools were not used for detection in two studies, but rather as a way to identify GAD response/remission [26] and the severity and triggers of SAD [27]. The GAI-20 item (GAI-20) [7, 25, 28-34] (9/32) and GAI-Short Form (GAI-SF) [25,31,33,35] (4/32), HADS-Anxiety Subscale (HADS-A) [22,24,36,37] (4/32) and PSWQ [26,32,38,39] (4/32) and PSWQ-Abbreviated (PSWQ-A) [26,32,38] (3/32) were the index tools investigated across the most studies, while the Generalized Anxiety Disorder Scale-7 item (GAD-7) and GAD-2 were studied in large participant samples (Table 2). ...
... The included literature largely focused on anxiety disorders in general or GAD. No studies, except for one [27], looked at the detection of a singular anxiety disorder outside of GAD (e.g. panic disorder). ...
Background
Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults.
Methods
MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed.
Results
Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70–0.97, specificity = 0.80, 95% CI = 0.67–0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62–0.83, specificity = 0.96, 95% CI = 0.74–1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58–0.79, specificity = 0.60, 95% CI = 0.51–0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60–0.89, specificity = 0.76, 95% CI = 0.60–0.87) to detect anxiety disorders in clinical samples.
Conclusion
The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.
One in five American adults (46.6 million) suffers from a diagnosable mental disorder. Approximately 7.5 million older Americans live with a mental disorder, with projections for this number to double by 2030, reaching 15 million people. This article focuses on the assessment and treatment of mental disorders in older adults. Age-related physiological and cognitive factors that have implications for the assessment and treatment of older adults are initially discussed. Additional considerations for assessment and treatment are presented, with an eye to age-related differences in the experience and presentation of various disorders. This is followed by discussions of evidence-based assessment and treatment of older adults. Finally, we offer a brief conclusion and suggest future directions.
Historically, clinicians and researchers have focused on depression and dementia in older people, paying little attention to anxiety except as a complication of these disorders. However, increased research into late-life anxiety has seen a growth in scientific literature and clinical interest. This important book brings together international experts to provide a comprehensive overview of current knowledge in relation to anxiety in older people, highlighting gaps in both theory and practice, and pointing towards the future. Early chapters cover the broader aspects of anxiety disorders, including epidemiology, risk factors, diagnostic issues, association with insomnia, impaired daily functioning, suicidality, and increased use of healthcare services. The book then explores cross-cultural issues, clinical assessment, and pharmacological and psychological interventions across a variety of settings. An invaluable resource for mental health professionals caring for older people including researchers, psychiatrists, psychologists, specialist geriatric nurses and social workers.
Objectives:
Previous estimates of the prevalence of anxiety disorders in late life vary greatly due to the lack of reliable diagnostic tools. This MentDis_ICF65+ study assessed 12-month prevalence rates of anxiety disorders and age- and gender-related differences in comorbidities, as well as impact on quality of life.
Design:
The study used a cross-sectional multicenter survey.
Participants:
The study sample comprised 3,142 men and women aged 65 to 84 years, living in five European countries and Israel.
Measurements:
Anxiety disorders were assessed using computer-assisted face-to-face interviews with an age-appropriate diagnostic interview (CIDI65+).
Results:
The prevalence of anxiety disorders was 17.2%. Agoraphobia was the most frequent disorder (4.9%), followed by panic disorder (3.8%), animal phobia (3.5%), general anxiety disorder (3.1%), post-traumatic stress disorder (1.4%), social phobia (1.3%), and obsessive-compulsive disorder (0.8%). The prevalence rate of any anxiety disorder dropped by 40% to 47% in adults aged 75-84 years compared with those aged 65-74 years. Women were twice as likely to present with agoraphobia or general anxiety disorder as men. Only panic disorder and phobia were associated with comorbid major depression. The negative relationship with quality of life was limited to agoraphobia and generalized anxiety disorder.
Conclusions:
The age-appropriate CIDI65+ led to higher prevalence rates of anxiety disorders in the elderly, yet to weaker associations with comorbidities and impaired quality of life compared with previous studies.
Strength and vulnerability integration (SAVI) is a theoretical model that predicts changes in emotional experience across adulthood. A growing number of studies find that as people age, they become more adept at using thoughts and behaviors to avoid or mitigate exposure to negative experiences. People gradually acquire this expertise over a lifetime of experiences and are more motivated to regulate their emotions because of perceptions of time left to live. SAVI further posits that aging is associated with physiological vulnerabilities that make regulating high levels of emotional arousal more difficult. In situations in which people experience high levels of distress, age differences that normally favor older adults in the use of emotion-regulation strategies will be attenuated (and may even be nullified or reversed), and the physiological consequences of sustained emotional arousal will be more costly for older adults. In this article, we describe SAVI and discuss recent studies supporting its predictions.
Background:
The assessment of social anxiety in late life has been examined in few studies (e.g. Gretarsdottir et al., 2004; Ciliberti et al., 2011). The present study describes the creation and initial psychometric evaluation of a new, content valid measure of social anxiety for older adults, the Older Adult Social-Evaluative Situations Questionnaire (OASES).
Methods:
Psychometric properties of the OASES were evaluated in a community dwelling sample of older adults (N = 137; 70.8% female). Convergent validity was established by examining the relation between the OASES and the Liebowitz Social Anxiety Scale (LSAS), Social Phobia and Anxiety Inventory (SPAI), and Beck Anxiety Inventory (BAI). Discriminant validity was established by examining the relation between the OASES and measures of depression (Geriatric Depression Scale, GDS), perceived health status (Short Form Health Survey, SF-12), and demographic variables. The validity analyses of the OASES were based on a smaller sample with n values ranging from 98 to 137 depending on missing data on each questionnaire.
Results:
Internal consistency, measured by Cronbach's α, for the OASES total score was 0.96. All items on the OASES were endorsed by participants. Convergent validity was demonstrated by medium to large correlations with the SPAI, LSAS, and BAI. Support for discriminant validity was evidenced by small to medium correlations between the OASES and GDS, SF-12, and demographic variables.
Conclusions:
Evidence in support of convergent and discriminant validity of the OASES is discussed. Although the results from the present study suggest that this measure may assess anxiety in and avoidance of social situations salient to older adults, future studies are needed to further examine the psychometric properties of the OASES and replicate these results in both clinical and more diverse samples of older adults.
This study explored the convergent and discriminant validity of the Geriatric Anxiety Scale (GAS), a new measure of anxiety symp-toms for older adults. The GAS, Beck Anxiety Inventory (BAI), Geriatric Anxiety Inventory (GAI), Beck Depression Inventory, Second Edition (BDI-II), and Geriatric Depression Scale (GDS) were administered to 117 community-dwelling, predominantly White, older adults (62% female; M age = 74.75 years, range = 60 − 89 years; M years of education = 14.97). Scores on the GAS were strongly associated with scores on measures of anxiety and depres-sion, but not associated with scores on measures of reading ability or processing speed. The GAS possesses strong convergent and dis-criminant validity and shows promise as a measure of anxiety in older adults. KEYWORDS anxiety, assessment, Geriatric Anxiety Scale, late life, older Anxiety disorders in older adults are common, with an estimated preva-lence rate of 15.3% (Kessler et al., 2005). Sub-syndromal anxiety symptoms in later life are even more widespread than anxiety disorders, with a preva-lence ranging from 15% to 52.3% in community samples (Bryant, Jackson, & Ames, 2008). Not only are symptoms of anxiety in older adults com-mon, they also are associated with a diverse array of adverse outcomes including poor physical health, sleep problems, urinary incontinence, and detrimental health behaviors such as smoking, physical inactivity, poor Address correspondence to Brian P.
We conducted one of the few studies that has examined the reliability of the Structured Clinical Interview for DSM-III-R Axis I (SCID-I) with a mixed inpatient and outpatient population of adults 55 years old and over (range, 56–84 years; mean, 67.33 years). All SCID interviews were videotaped or audiotaped and were administered by Master''s-level clinicians working toward their doctorate degrees in clinical psychology. Interrater reliability estimates (kappa and percentage agreement) were calculated for current major depressive episode (47% base rate) and the broad diagnostic categories of anxiety disorders (15% base rate) and somatoform disorders (12% base rate). Kappa values were .70, .77, and 1.0. Respective percentage agreement was 85% for major depression, 94% for anxiety disorders, and 100% for somatoform disorders. Overall percentage agreement was 91%. We conclude that the SCID-I can be effectively administered by relatively inexperienced clinicians to diagnose older psychiatric patients reliably. Directions that future research might take are offered.
Little is known about prevalence rates of DSM-IV disorders across age strata of older adults, including common conditions such as individual and coexisting mood and anxiety disorders.
To determine nationally representative estimates of 12-month prevalence rates of mood, anxiety, and comorbid mood-anxiety disorders across young-old, mid-old, old-old, and oldest-old community-dwelling adults.
The National Comorbidity Survey Replication (NCS-R) is a population-based probability sample of 9282 participants 18 years and older, conducted between February 2001 and April 2003. The NCS-R survey used the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Continental United States.
We studied the 2575 participants 55 years and older who were part of NCS-R (43%, 55-64 years; 32%, 65-74 years; 20%, 75-84 years; 5%, >or=85 years). This included only noninstitutionalized adults, as all NCS-R participants resided in households within the community.
Twelve-month prevalence of mood disorders (major depressive disorder, dysthymia, bipolar disorder), anxiety disorders (panic disorder, agoraphobia, specific phobia, social phobia, generalized anxiety disorder, posttraumatic stress disorder), and coexisting mood-anxiety disorder were assessed using DSM-IV criteria. Prevalence rates were weighted to adjust for the complex design to infer generalizability to the US population.
The likelihood of having a mood, anxiety, or combined mood-anxiety disorder generally showed a pattern of decline with age (P < .05). Twelve-month disorders showed higher rates in women compared with men, a statistically significant trend with age. In addition, anxiety disorders were as high if not higher than mood disorders across age groups (overall 12-month rates: mood, 5% and anxiety, 12%). No differences were found between race/ethnicity groups.
Prevalence rates of DSM-IV mood and anxiety disorders in late life tend to decline with age, but remain very common, especially in women. These results highlight the need for intervention and prevention strategies.
For decades, scholars have wrestled with the notion that old age is characterized by social isolation. However, there has been no systematic, nationally representative evaluation of this possibility in terms of social network connectedness. In this paper, the authors develop a profile of older adults' social integration with respect to nine dimensions of connectedness to interpersonal networks and voluntary associations. The authors use new data from the National Social Life, Health, and Aging Project (NSHAP), a population-based study of non-institutionalized older Americans aged 57-85 conducted in 2005-2006. Findings suggest that among older adults, age is negatively related to network size, closeness to network members, and number of non-primary-group ties. On the other hand, age is positively related to frequency of socializing with neighbors, religious participation, and volunteering. In addition, it has a U-shaped relationship with volume of contact with network members. These findings are inconsistent with the notion that old age has a universal negative influence on social connectedness. Instead, life course factors have divergent consequences for different forms of social connectedness. Some later life transitions, like retirement and bereavement, may prompt greater connectedness. The authors close by urging increased dialogue between social gerontological and social network research.
Little is known about the general population prevalence or severity of DSM-IV mental disorders.
To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents 18 years and older.
Twelve-month DSM-IV disorders.
Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population.
Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.
This research aimed to chart age-related changes in 11 dimensions of social relations during later life. We also examined interpersonal differences in intra-individual changes.
We used hierarchical linear modeling with data from a nationwide survey of 1,103 elders who were interviewed up to four times over a 10-year period.
Age-related changes in social relations varied across the different dimensions, and significant interpersonal differences existed in these trajectories. Emotional support was relatively stable with advancing age, whereas other types of received support (i.e., tangible and informational) increased with age and levels of provided support declined. Furthermore, the findings revealed declines in contact with friends, support satisfaction, and anticipated support. These changes were not uniform throughout the sample, as indicated by significant random effects with respect to the intercepts and slopes in virtually each model. Gender and socioeconomic status accounted for some of this variation.
These findings highlight the dynamic nature of social relationships in late life. In addition, the findings both provide evidence of older adults managing their social ties to meet the challenges of aging and suggest the importance of the interplay between giving and receiving support.
Objectives: The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders.
Method: Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder (PD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and/or social anxiety disorder (SAD).
Results: Approximately one third of older adults with anxiety disorders reported feeling like they were better off dead. Older adults with PD and SAD were more likely to endorse suicidal ideation lasting at least more than half the prior week compared to younger adults with these disorders. Older adults with SAD endorsed higher rates of suicidal ideation compared to older adults with other anxiety disorders. Multivariate analyses revealed the importance of physical health, social support, and comorbid MDD in this association.
Conclusions: Suicidal ideation is common in anxious, older, primary care patients and is particularly prevalent in socially anxious older adults. Findings speak to the importance of physical health, social functioning, and MDD in this association.
Clinical implications: When working with anxious older adults it is important to conduct a thorough suicide risk assessment and teach skills to cope with death and suicidal ideation related thoughts.
Errors in Byline, Author Affiliations, and Acknowledgment. In the Original Article titled “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication,” published in the June issue of the ARCHIVES (2005;62:617-627), an author’s name was inadvertently omitted from the byline on page 617. The byline should have appeared as follows: “Ronald C. Kessler, PhD; Wai Tat Chiu, AM; Olga Demler, MA, MS; Kathleen R. Merikangas, PhD; Ellen E. Walters, MS.” Also on that page, the affiliations paragraph should have appeared as follows: Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Kessler, Chiu, Demler, and Walters); Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, Md (Dr Merikangas). On page 626, the acknowledgment paragraph should have appeared as follows: We thank Jerry Garcia, BA, Sara Belopavlovich, BA, Eric Bourke, BA, and Todd Strauss, MAT, for assistance with manuscript preparation and the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on the data analysis. We appreciate the helpful comments of William Eaton, PhD, Michael Von Korff, ScD, and Hans-Ulrich Wittchen, PhD, on earlier manuscripts. Online versions of this article on the Archives of General Psychiatry Web site were corrected on June 10, 2005.
Data on the prevalence of psychiatric disorders in late life are lacking. The present study addresses this gap in the literature by examining the prevalence of the broadest range of psychiatric disorders in late life to date; comparing prevalences across older adult age groups using the largest sample of adults aged 85+; and exploring gender differences in the prevalence of psychiatric disorders in late life. Using data from
Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, we examined the prevalence of past-year mood, anxiety, and substance use disorders, and lifetime personality disorders in a nationally representative sample of 12,312 U.S. older adults. We stratified our analyses by gender and by older age groups: young-old (ages 55-64), middle-old (ages 65-74), old-old (ages 75-84), and oldest-old
(ages 85+). The proportion of older adults who experienced any past-year anxiety disorder was 11.4%, while the prevalence of any past-year mood disorder was 6.8%. A total of 3.8% of older adults met criteria for any past-year substance use disorder, and 14.5% of older adults had one or more personality disorder. We observed a general pattern of decreasing rates of psychiatric disorders with increasing age. Women experienced higher rates of mood and anxiety disorders, while men had higher rates of substance use disorders and any personality disorder. Gender differences in rates of most psychiatric disorders decreased with increasing age. These data indicate that psychiatric disorders are prevalent among U.S. older adults, and support the importance of prevention, diagnosis, and treatment of psychiatric disorders in this population.
Objective:
While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.
Measurements:
The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
Results:
As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples.
Conclusion:
In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Importance
Somatic symptoms are the core features of many medical diseases, and they are used to evaluate the severity and course of illness. The 8-item Somatic Symptom Scale (SSS-8) was recently developed as a brief, patient-reported outcome measure of somatic symptom burden, but its reliability, validity, and usefulness have not yet been tested.Objective
To investigate the reliability, validity, and severity categories as well as the reference scores of the SSS-8.Design, Setting, and Participants
A national, representative general-population survey was performed between June 15, 2012, and July 15, 2012, in Germany, including 2510 individuals older than 13 years.Main Outcomes and Measures
The SSS-8 mean (SD), item-total correlations, Cronbach α, factor structure, associations with measures of construct validity (Patient Health Questionnaire–2 depression scale, Generalized Anxiety Disorder–2 scale, visual analog scale for general health status, 12-month health care use), severity categories, and percentile rank reference scores.Results
The SSS-8 had excellent item characteristics and good reliability (Cronbach α = 0.81). The factor structure reflects gastrointestinal, pain, fatigue, and cardiopulmonary aspects of the general somatic symptom burden. Somatic symptom burden as measured by the SSS-8 was significantly associated with depression (r = 0.57 [95% CI, 0.54 to 0.60]), anxiety (r = 0.55 [95% CI, 0.52 to 0.58]), general health status (r = −0.24 [95% CI, −0.28 to −0.20]), and health care use (incidence rate ratio, 1.12 [95% CI, 1.10 to 1.14]). The SSS-8 severity categories were calculated in accordance with percentile ranks: no to minimal (0-3 points), low (4-7 points), medium (8-11 points), high (12-15 points), and very high (16-32 points) somatic symptom burden. For every SSS-8 severity category increase, there was a 53% (95% CI, 44% to 63%) increase in health care visits.Conclusions and Relevance
The SSS-8 is a reliable and valid self-report measure of somatic symptom burden. Cutoff scores identify individuals with low, medium, high, and very high somatic symptom burden.
Self-presentational concerns and their sequelae are not unique to the young. Considerable research suggests that older adults are also motivated to engage in strategic self-presentation. This article reviews evidence that numerous self-presentational concerns of older adults stem from age- and health-related changes and are associated with concerns about one's physical appearance, being perceived as competent and self-reliant, and ascribing to behavioral norms. For each of these areas, self-presentational concerns and impression management strategies are identified. In addition, the implications of using a self-presentational approach to examine the physical and psychological well-being of older individuals are discussed.
Objective:
To present nationally representative data on 12-month and lifetime prevalence, correlates and comorbidity of social anxiety disorder (SAD) among adults in the United States as determined by the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions.
Design:
Face-to-face survey.
Setting:
The United States.
Participants:
Adults (aged 18 and over) residing in households and group quarters (N = 43,093).
Main outcome measures:
Prevalence and associations of SAD with sociodemographic and psychiatric correlates and Axis I and II disorders.
Results:
The prevalence of 12-month and lifetime DSM-IV SAD was 2.8% (95% CI = 2.5 to 3.1) and 5.0% (95% CI = 4.6 to 5.4), respectively. Being Native American, being young, or having low income increased risk, while being male, being of Asian, Hispanic, or black race/ethnicity, or living in urban or more populated regions reduced risk. Mean age at onset of SAD was 15.1 years, with a mean duration of 16.3 years. Over 80% of individuals with SAD received no treatment, and the mean age at first treatment was 27.2 years. Current and lifetime SAD were significantly related to other specific psychiatric disorders, most notably generalized anxiety, bipolar I, and avoidant and dependent personality disorders. The mean number of feared social situations among individuals with SAD was 7.0, with the majority reporting anxiety in performance situations.
Conclusions:
Social anxiety disorder was associated with substantial unremitting course and extremely early age at onset. Social anxiety disorder often goes untreated, underscoring the need for health care initiatives geared toward increasing recognition and treatment. Comprehensive evaluation of patients with SAD should include a systematic assessment of comorbid disorders, and novel approaches to the treatment of comorbid SAD are needed.
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.
MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples.
CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Objectives. To review the major community-based epidemiological studies that have reported data on anxiety disorders in individuals aged 65 and over and to examine age-related changes in their prevalence and incidence.Data sources and study selection. All English language entries relating to anxiety in the BIDS, EMBASE, Medline and PsychLit computerized databases, together with a search of relevant citations.Data synthesis. The prevalence of phobic disorders in the population aged 65 or over lies between 0.7% and 12% over a 1–6-month period. As the rates for social phobia, 1%, and simple phobia, 4%, are fairly consistent, much of this variation is due to agoraphobia, whose prevalence lies between 1.4% and 7.9%. The prevalence of obsessive-compulsive disorder is 0.1–0.8%, panic disorder 0.1% and generalized anxiety 4%. Women do have a higher prevalence of anxiety disorders than men but this difference diminishes with increasing age, as does the apparent prevalence of all anxiety disorders apart from generalized anxiety, measured without hierarchical rules, which appears to be maintained or increase. The relative importance of various explanations for this apparent reduction is discussed, including the three that are of greatest public health and clinical importance: cohort effects, anxiety-related mortality and comorbidity between anxiety and cognitive impairment. A tri-dimensional approach (psychic, somatic and behavioural) to anxiety measurement is advocated in order to facilitate future studies of age-related changes which may lead to a reappraisal of the status of generalized anxiety as a ‘residual category’. © 1998 John Wiley & Sons, Ltd.
This review aims to address issues unique to older adults with anxiety disorders in order to inform potential changes in the DSM-V. Prevalence and symptom expression of anxiety disorders in late life, as well as risk factors, comorbidity, cognitive decline, age of onset, and treatment efficacy for older adults are reviewed. Overall, the current literature suggests: (a) anxiety disorders are common among older age individuals, but less common than in younger adults; (b) overlap exists between anxiety symptoms of younger and older adults, although there are some differences as well as limitations to the assessment of symptoms among older adults; (c) anxiety disorders are highly comorbid with depression in older adults; (d) anxiety disorders are highly comorbid with a number of medical illnesses; (e) associations between cognitive decline and anxiety have been observed; (f) late age of onset is infrequent; and (g) both pharmacotherapy and CBT have demonstrated efficacy for older adults with anxiety. The implications of these findings are discussed and recommendations for the DSM-V are provided, including extending the text section on age-specific features of anxiety disorders in late life and providing information about the complexities of diagnosing anxiety disorders in older adults. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.
—In 1994 there were 33.2 million older adults (65 years of age and older) in the United States, and approximately one quarter of these older adults meet diagnostic criteria for some mental disorder. Anxiety is among the most prevalent psychiatric disorder in older adults. However, insufficient research has been conducted on the assessment of anxiety in older adults. The purpose of this article was to provide an overview of issues to consider in assessing anxiety in older adults. First, a discussion of factors that may influence current prevalence and incidence figures is provided. Second, age-related differences in factors that can influence the experience and presentation of anxiety symptoms are considered. Third, age-related factors that can influence the assessment process or outcome are presented. Fourth, a discussion on the important role of multimethod assessment and the psychometric adequacy of available anxiety assessment instruments is presented. Finally, recommendations for clinical assessment and future research are provided.
To review the major community-based epidemiological studies that have reported data on anxiety disorders in individuals aged 65 and over and to examine age-related changes in their prevalence and incidence.
All English language entries relating to anxiety in the BIDS, EMBASE, Medline and PsychLit computerized databases, together with a search of relevant citations.
The prevalence of phobic disorders in the population aged 65 or over lies between 0.7% and 12% over a 1-6-month period. As the rates for social phobia, 1%, and simple phobia, 4%, are fairly consistent, much of this variation is due to agoraphobia, whose prevalence lies between 1.4% and 7.9%. The prevalence of obsessive-compulsive disorder is 0.1-0.8%, panic disorder 0.1% and generalized anxiety 4%. Women do have a higher prevalence of anxiety disorders than men but this difference diminishes with increasing age, as does the apparent prevalence of all anxiety disorders apart from generalized anxiety, measured without hierarchical rules, which appears to be maintained or increase. The relative importance of various explanations for this apparent reduction is discussed, including the three that are of greatest public health and clinical importance: cohort effects, anxiety-related mortality and comorbidity between anxiety and cognitive impairment. A tri-dimensional approach (psychic, somatic and behavioural) to anxiety measurement is advocated in order to facilitate future studies of age-related changes which may lead to a reappraisal of the status of generalized anxiety as a 'residual category'.
The current study aimed to examine the salience of anxiety-provoking social situations for older adults. A list of potentially anxiety-provoking situations was developed from a review of existing measures of social anxiety. In addition to items derived from existing measures, the investigators generated items thought to be particularly relevant for older adults. One hundred and four older adults were asked, "Please check all situations where you might feel uncomfortable, nervous, scared, worried, embarrassed, or anxious." Participants were also prompted to record any additional situations in which they experienced anxiety. Older adults endorsed items not included on typical measures of social anxiety at high rates. Exploratory analyses of the effects of gender on item endorsement were examined and significant differences were found for several items. The authors discuss these findings and their implications for the assessment of late-life social anxiety.
Anxiety is a common experience among older adults and can be a cause for major clinical concern. Brief and psychometrically sound screening instruments are needed to detect anxiety in later life. The purposes of this study were to develop a brief, self-report measure of anxiety for use with older adults (called the Geriatric Anxiety Scale [GAS]) and to report on its preliminary psychometrics. The GAS includes 30 self-report items of which 25 items represent three common domains of anxiety symptoms among older adults (cognitive, somatic, and affective) and 5 items represent common content areas of worry. The GAS total score and subscale scores demonstrated good internal reliability in community dwelling and in clinical samples. In addition, correlation analyses provided solid evidence of convergent and construct validity for the GAS in both samples. Present results support the preliminary validity of the GAS for clinical and research purposes. We conclude with a discussion of limitations and future research topics.
This study aims to investigate the following: 1) the association of social anxiety disorder with childhood parental loss and recent stressful life events; 2) the coexistence of social anxiety disorder and major depressive disorders (MDD); and 3) the impact of social anxiety disorder on medical conditions, obesity, health service utilization, and health-related quality of life.
Cross-sectional observational study.
The National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002), a national representative survey of the U.S. noninstitutionalized household population.
13,420 respondents aged 55 and above.
Social anxiety disorder was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). Demographic characteristics, psychosocial risk factors, psychiatric disorders, health-related quality of life, obesity, medical conditions, and health service utilization were measured.
The current and lifetime prevalence rates of specific phobia were found to be 1.83% and 3.50%, respectively. Multivariate analyses revealed that social anxiety disorder was more common among the younger age groups and those who reported stressful life events. In addition, MDD, specific phobia, and personality disorder were significantly related to social anxiety disorder. Lastly, after adjusting for other psychiatric comorbidities, the association of social anxiety disorder with health-related quality of life, medical condition, and health care service utilization became insignificant.
The correlation between social anxiety disorder and MDD raises further questions about the nature of social anxiety disorder among older adults, but this study does not support the notion that this disorder has a strong impact on the quality of life in old age independent of other psychiatric comorbidities.
The aim of the study was to investigate older persons' experiences of using mobility devices.
In this qualitative study, focus group interviews were carried out with participants living in two municipalities in the south of Sweden. Occupational therapists and physiotherapists identified interested participants, 65 years or older. A total of 22 persons participated once in the seven focus group interviews that were arranged.
Five main categories of participant experiences emerged from the data: 'Municipal supply and non-supply of devices', 'Acceptance or non-acceptance of mobility devices', 'Different use of mobility devices supports everyday and social activities', 'Different kinds of obstacles constrain everyday and social activities' and 'Adaptive strategies in order to use mobility devices'.
Since the participants experienced non-acceptance and obstacles related to the use of mobility devices, this highlights the needs for quality development concerning more efficient data-collecting in community-based rehabilitation.
The limitations of diagnostic "accuracy" as a measure of decision performance require introduction of the concepts of the "sensitivity" and "specificity" of a diagnostic test. These measures and the related indices, "true positive fraction" and "false positive fraction," are more meaningful than "accuracy," yet do not provide a unique description of diagnostic performance because they depend on the arbitrary selection of a decision threshold. The receiver operating characteristic (ROC) curve is shown to be a simple yet complete empirical description of this decision threshold effect, indicating all possible combinations of the relative frequencies of the various kinds of correct and incorrect decisions. Practical experimental techniques for measuring ROC curves are described, and the issues of case selection and curve-fitting are discussed briefly. Possible generalizations of conventional ROC analysis to account for decision performance in complex diagnostic tasks are indicated. ROC analysis is shown to be related in a direct and natural way to cost/benefit analysis of diagnostic decision making. The concepts of "average diagnostic cost" and "average net benefit" are developed and used to identify the optimal compromise among various kinds of diagnostic error. Finally, the way in which ROC analysis can be employed to optimize diagnostic strategies is suggested.
A 6-item Orientation-Memory-Concentration Test has been validated as a measure of cognitive impairment. This test predicted the scores on a validated 26-item mental status questionnaire of two patient groups in a skilled nursing home, patients in a health-related facility, and in a senior citizens' center. There was a positive correlation between scores on the 6-item test and plaque counts obtained from the cerebral cortex of 38 subjects at autopsy. This test, which is easily administered by a nonphysician, has been shown to discriminate among mild, moderate, and severe cognitive deficits.
The clinical performance of a laboratory test can be described in terms of diagnostic accuracy, or the ability to correctly classify subjects into clinically relevant subgroups. Diagnostic accuracy refers to the quality of the information provided by the classification device and should be distinguished from the usefulness, or actual practical value, of the information. Receiver-operating characteristic (ROC) plots provide a pure index of accuracy by demonstrating the limits of a test's ability to discriminate between alternative states of health over the complete spectrum of operating conditions. Furthermore, ROC plots occupy a central or unifying position in the process of assessing and using diagnostic tools. Once the plot is generated, a user can readily go on to many other activities such as performing quantitative ROC analysis and comparisons of tests, using likelihood ratio to revise the probability of disease in individual subjects, selecting decision thresholds, using logistic-regression analysis, using discriminant-function analysis, or incorporating the tool into a clinical strategy by using decision analysis.
Somatization is prevalent in primary care and is associated with substantial functional impairment and healthcare utilization. However, instruments for identifying and monitoring somatic symptoms are few in number and not widely used. Therefore, we examined the validity of a brief measure of the severity of somatic symptoms.
The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-15 comprises 15 somatic symptoms from the PHQ, each symptom scored from 0 ("not bothered at all") to 2 ("bothered a lot"). The PHQ-15 was administered to 6000 patients in eight general internal medicine and family practice clinics and seven obstetrics-gynecology clinics. Outcomes included functional status as assessed by the 20-item Short-Form General Health Survey (SF-20), self-reported sick days and clinic visits, and symptom-related difficulty.
As PHQ-15 somatic symptom severity increased, there was a substantial stepwise decrement in functional status on all six SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. PHQ-15 scores of 5, 10, 15, represented cutoff points for low, medium, and high somatic symptom severity, respectively. Somatic and depressive symptom severity had differential effects on outcomes. Results were similar in the primary care and obstetrics-gynecology samples.
The PHQ-15 is a brief, self-administered questionnaire that may be useful in screening for somatization and in monitoring somatic symptom severity in clinical practice and research.
We report on the use of the Penn State Worry Questionnaire (PSWQ) to identify individuals with generalized anxiety disorder (GAD). Fifty individuals with primary or secondary GAD and 114 individuals with social anxiety disorder (without GAD) completed the PSWQ. In receiver operating characteristic analyses, a score of 65 simultaneously optimized sensitivity and specificity in discriminating individuals with GAD from individuals with social anxiety disorder. Results support the use of the PSWQ in screening individuals likely to meet criteria for GAD who present for treatment at an anxiety disorders specialty clinic.
Although phobias represent the most common anxiety disorders among the elderly, little is known about their social nature. The present study provides information about the prevalence, measurement, and phenomenology of social anxiety in older adults (n = 283) and compares results to those of younger adults (n = 318). Analyses revealed that social anxiety is less prevalent in old age than it is within younger cohorts and is associated with different symptomatology. The psychopathological profile of those who reach clinical levels of social anxiety is however similar, irrespective of age. Results regarding the psychometric properties of the SPAI when used for the elderly were promising, but the questionnaire appears to be difficult for some older adults to complete. Results are discussed in terms of explanations for age differences in social anxiety, initial psychometrics of the SPAI in an older adult sample, and suggestions for future research.
The subjective sense of future time plays an essential role in human motivation. Gradually, time left becomes a better predictor
than chronological age for a range of cognitive, emotional, and motivational variables. Socioemotional selectivity theory
maintains that constraints on time horizons shift motivational priorities in such a way that the regulation of emotional states
becomes more important than other types of goals. This motivational shift occurs with age but also appears in other contexts
(for example, geographical relocations, illnesses, and war) that limit subjective future time.
Although anxiety disorders, including social phobia (SP), are common among older adults, very little is known about the epidemiology of SP in later life.
Using data drawn from a large, nationally representative sample of older adults from Canada (N=12,792), the authors estimate lifetime and 12-month prevalence of social phobia and examine demographic predictors and patterns of comorbidity of current SP in this population.
The results reveal that SP is a prevalent disorder in later life with lifetime and 12-month prevalence estimates of 4.94% and 1.32%, respectively. Current SP (12-month) declines with age and is more common in individuals with other psychiatric disorders. Interestingly, there is no correlation between current SP and gender, marital status, or socioeconomic status.
SP remains a highly prevalent disorder even in late life with the pattern of feared/avoided situations being strikingly similar to that of younger populations.
A pilot RCT of video-delivered relaxation treatment to reduce late-life anxiety
- C E Gould
- K Mav
- C Kokb
- L Wetherellj
- O'harar
- A Beaudreaus
Gould, C. E., Ma, V. K., Kok, B. C., Wetherell, J. L.,
O'Hara, R. and Beaudreau, S. A. (2017, November). A
pilot RCT of video-delivered relaxation treatment to
reduce late-life anxiety. In J. Gallegos and K. Van Orden
(eds.), CBT in Older Adults: Treatment Targets and Modified
Strategies. Symposium conducted at the meeting of the
Association of Behavioral and Cognitive Therapies, San
Diego, CA.
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association. (2013). Diagnostic and
Statistical Manual of Mental Disorders, 5th edn, Arlington,
VA: American Psychiatric Publishing.
High occurrence of mood and anxiety disorders among older adults: the national comorbidity survey replication
- A L Byers
- K Yaffe
- K E Covinsky
- M B Friedman
- M L Bruce
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.
Structured Clinical Interview for DSM-5-Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV)
- M B First
- J B W Williams
- R S Karg
- R L Spitzer
First, M. B., Williams, J. B. W., Karg, R. S. and Spitzer,
R. L. (2015). Structured Clinical Interview for
DSM-5-Research Version (SCID-5 for DSM-5, Research
Version; SCID-5-RV). Arlington, VA: American Psychiatric
Association.
Index for rating diagnostic tests
- Youden
Youden, W. J. (1950). Index for rating diagnostic tests.
Cancer, 3, 32-35.
at 22:52:42, subject to the Cambridge Core terms of use
- K Kroenke
- R L Spitzer
- J B Williams
Downloaded from https://www.cambridge.org/core. YBP Library Services, on 31 Aug 2018 at 22:52:42, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms.
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001).
The PHQ‐9: validity of a brief depression severity measure
- Kroenke
Self-presentational concerns in older adults: implications for health and well-being
- Martin
High occurrence of mood and anxiety disorders among older adults: the national comorbidity survey replication
- Byers
Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication
- Kessler