Prevalence of anxiety disorder among older adults in Spain: A meta-analysis

The impact of outdoor blue spaces on the health of the elderly: A systematic review

Research on natural health has identified the potential benefit of outdoor blue spaces for human health and wellbeing. However, the existing evidence has relatively limited attention to the elderly. This study aims to review the available evidence on outdoor blue spaces and health outcomes among older individuals and identify knowledge gaps. In accordance with the PRISMA guidelines, specific keywords were used to search for articles published in English from inception to October 2023. Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched, and 22 studies were identified in this review. We classified articles based on elderly health as general health (e.g., self-reported, perceived health and wellbeing), physical health (e.g., physical activity, physical function index), and mental health and wellbeing (e.g., depression). The findings indicated a positive correlation between outdoor blue space and the health of the elderly. In terms of the characteristics of exposure to outdoor blue spaces, direct contact (e.g., sensory-based) has not been well documented compared to indirect contact (e.g., distance, percentage, region-based). Although encouraging, the available body of evidence is limited and lacks consistency. Future research is needed to provide complementary evidence between outdoor blue spaces and elderly health.

Higher physical activity level and perceived social support is associated with less psychological distress in people with anxiety

Introduction

Anxiety is one of the most prevalent mental illnesses in first world societies, generating discomfort in the people who suffer from it, and high expenses and economic losses in the society. The physical activity (PA) performed, together with the perceived social support (PSS) by people with anxiety could be related to the psychological distress of people with anxiety.

Objectives

To study the relationships between mental health and its dimensions, through Golberg's General Health Questionnaire (GHQ12), and the level of PA (PAL) and the PSS in the Spanish adult population with anxiety.

Hypothesis

A higher PAL, and a higher PSS, is related to a lower psychological distress in this population.

Design and Methodology

This study included 1,661 adults with anxiety, residents in Spain. It was a cross-sectional study with data obtained from the Spanish National Health Survey. A Kolmogorov-Smirnov test was applied to examine the data distribution of the variables. The median and interquartile range were used to characterize the sample for continuous variables, and absolute and relative frequencies were used for categorical variables. The Mann-Whitney U test was used to examine the differences between sexes. Dependence between PAL and sex was studied using the chi-square statistic. A Krustal-Wallis test was used to evaluate the existence of differences in the baseline medians on the GHQ-12, according to PAL level. Finally, the correlations between mental health and its dimensions with PAL and the Duke-UNC-11 scores were analysed, obtaining Spearman's rho and Pearson's correlation coefficient.

Results

Moderate inverse correlations were found between the GHQ-12 and: PAL (rho: -0.219); PSS (r: -0.347). PAL and PSS presented moderate inverse correlations with successful coping (rho: -0.206 and r: -0.325), self-esteem (rho: -0.222 and r: -0.333) and stress (rho: -0.158 and r: -0.288).

Conclusions

Greater PAL and social support are associated with reduced psychological distress in people with anxiety.

Handedness and anxiety: a review

Handedness is a core phenotype in clinical laterality research and several different disorders such as schizophrenia and autism spectrum disorders have been linked to a higher prevalence of non-right-handedness. Moreover, subclinical personality traits like schizotypy have been linked to a higher prevalence of non-right-handedness. The association with handedness is poorly understood for generalized anxiety disorder and specific phobias, as well as for state and trait anxiety and fear of specific stimuli in nonclinical samples. Therefore, we performed a narrative review of studies investigating handedness in anxiety disorders patients and studies that compared anxiety scores between different handedness groups. Unlike schizophrenia and autism spectrum disorders, there seems to be no strong association between anxiety disorders and handedness in adult patients, except for specific phobias. Studies often had small sample sizes and therefore a high risk to report spurious findings. Similar findings were reported in most non-clinical studies. Importantly, familial handedness affects phobia risk and antenatal maternal anxiety increased the probability of mixed-handedness. This suggests that a transgenerational, developmental perspective is essential to better understand the complex interrelations between handedness and anxiety. Familial and especially maternal handedness and anxiety disorders should be integrated into future studies on handedness and anxiety whenever possible.

Inappropriate Medications Use and Polypharmacy among Older Adults with Anxiety Disorder

BACKGROUND

Elderly with mental health conditions usually use multiple medications, which predisposes them to inappropriate use of medications, which is defined as medications that should be avoided due to their risk; this outweighs their benefit given that safer alternatives are available. This study aimed to examine potentially inappropriate medication use among older patients with anxiety disorder.

METHODS

This study used a cross-sectional retrospective study design using twelve months of data extracted from the Electronic Health Record (EHR) database for older adults diagnosed with anxiety disorder and treated in the ambulatory care setting. Potentially inappropriate medications (PIMs) use was evaluated using the 2019 Beers criteria. Descriptive statistics were used to describe the sample. Pearson's chi-square tests (for categorical variables) and t-tests (for continuous variables) were utilized to measure the differences in independent variables between patients with and without PIMs. Binary logistic regression was used to examine the associations between PIMs use and identify potential factors for PIMs use among older adults with anxiety disorder. Analyses were performed using the Statistical Analysis Software version 9.4 (SAS^® 9.4).

RESULTS

The study sample includes 371 older adults (age ≥ 65 years) with anxiety disorder; their average age was (72.1 ± 5.8) years. PIMs use was highly prevalent among older adults with anxiety (66.6%). About 35.6% of the study sample used one PIM, 22.6% used two PIMs, and 8.4% used three PIMs. The most frequently prescribed PIMs were NSAIDs and gastrointestinal agents. The adjusted regression analysis found that PIMs use was less likely among men than women. In addition, PIMs use was more likely among women with diabetes, cancer, and polypharmacy.

CONCLUSIONS

Future studies on strategies and interventions rationing PIMs use in older adults with anxiety disorder are necessary given the high prevalence of PIMs and polypharmacy within this population.

Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial

OBJECTIVES

To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge.

DESIGN

A prospective, multicenter, randomized clinical trial.

SETTING

Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals.

PATIENTS

Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge.

INTERVENTION

The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward.

MEASUREMENTS AND RESULTS

Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes.

CONCLUSIONS

We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials.

TRIAL REGISTRATION

NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).

A Cross-Sectional Study on the Associations between Physical Activity Level, Depression, and Anxiety in Smokers and Ex-Smokers

Introduction: depression and anxiety is one of the most relevant public health problems. The link between smoking and depression has been demonstrated. Regular physical activity (PA) could act as a protector against mental health diseases. Objectives: (1) to explore the prevalence of depression and anxiety in relation to sex and to the condition of smoker and ex-smoker, (2) to study the differences in prevalence proportions according to the frequency and level of PA, and (3) to calculate the probability of presenting depression or anxiety according to the frequency and level of PA. Methods: a cross-sectional study was conducted, based on data extracted from the 2014 and 2020 Spanish European Health Survey and the 2017 Spanish National Health Survey. The sample included 9524, 7813, and 9079 participants, respectively. Descriptive analysis was performed (comparisons using a Chi-square test and z-test for independent proportions). Probability odds ratios of anxiety and depression were calculated according to PA. Results: women had a higher prevalence of depression and anxiety than men (p < 0.001−0.003). Higher levels of prevalence were observed in inactive people versus very active or active people (p < 0.001). Inactive people had a higher risk of depression and anxiety compared to very active people. Conclusion: inactive smokers and ex-smokers had higher levels of prevalence of depression and anxiety than active and very active people. Physical inactivity could increase the risk of suffering these mental disorders in this population. This could affect women more than men.

Prevalence of depression and anxiety and associated factors among geriatric orthopedic trauma inpatients: A cross-sectional study

BACKGROUND

Common mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research.

AIM

To investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic, social and clinical risk factors.

METHODS

This cross-sectional study was performed in geriatric patients (aged ≥ 60 years, both sexes) with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017. Demographic, social, and clinical characteristics were described. Huaxi Emotional-Distress Index (HEI) was used to evaluate the severity of anxiety and depression status. Differences in continuous variables were tested using the t-test, and differences in categorical variables were assessed using the Pearson χ² test. Binary logistic regression analyses were used to identify the factors associated with a HEI score > 8.

RESULTS

Among the 966 patients, 487 were male and 479 were female, with a mean age of 70.2 ± 7.1 years. The age ranged from 60 to 90 years. Seventy-five patients had an HEI score > 8, accounting for about 7.8% of all patients. A higher Injury Severity Score (4.17 ± 3.10 vs 7.96 ± 6.68, P < 0.001), higher Visual Analog Score (5.05 ± 1.09 vs 6.89 ±1.23, P < 0.001), number of chronic diseases (P < 0.001), injury type (P = 0.038), and education level (P = 0.001) were significantly associated with HEI score > 8. On logistic regression, a higher education level was a protective factor for emotional disorders (P = 0.047), whereas Injury Severity Score (P = 0.024), Visual Analog Score (P < 0.001), two or more chronic diseases (P < 0.001) were the related independent risk factors.

CONCLUSION

Emotional disorders are common in geriatric patients with orthopedic trauma. Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.

A Systematic Review and Meta-Analysis of Symptoms of Anxiety, Depression, and Insomnia in Spain in the COVID-19 Crisis

BACKGROUND

General population, frontline healthcare workers (HCWs), and adult students in Spain are at risk of anxiety, depression, and insomnia symptoms during the COVID-19 crisis. A meta-analysis of the individual studies on these symptoms would provide systematic evidence to aid policymakers and researchers in focusing on prevalence, risk, and best interventions.

OBJECTIVE

This paper aims to be the first meta-analysis and systematic review to calculate the prevalence of anxiety, depression, and insomnia symptoms in Spain's adult population (general population, frontline healthcare workers (HCWs), and adult students) during the Covid-19 epidemic.

METHOD

Random-effect meta-analysis was used to estimate the prevalence of anxiety, depression, and insomnia.

RESULTS

The meta-analysis includes 28 studies with 38 individual samples in Spain. The pooled prevalence of anxiety symptoms in 22 studies comprising a sample population of 82,024 was 20% (95% CI: 15-25%), that of depression symptoms in 22 articles with a total sample comprising 82,890 individuals was 22% (95% CI: 18-28%), and that of insomnia symptoms in three articles with a sample population of 745 was 57% (95% CI: 48-66%.

CONCLUSIONS

The accumulative evidence reveals that adults in Spain suffered higher prevalence rates of mental symptoms during the COVID-19 crisis, with a significantly higher rate relative to other countries such as China. Our synthesis also reveals a relative lack of studies on frontline and general HCWs in Spain.

Transtornos de Ansiedade em Idosos

Objetivos: descrever a prevalência de transtornos de ansiedade e avaliar o perfil e os fatores associados em uma amostra de idosos atendidos no ambulatório de psiquiatria geriátrica de um hospital de Porto Alegre, Brasil.Métodos: trata-se de um estudo transversal que avaliou 69 idosos com diagnóstico de transtornos de ansiedade, atendidos no ambulatório de psiquiatria geriátrica, no período de 2014 a 2019.Resultados: a prevalência de transtornos de ansiedade foi de 21,9% e a média de idade 73,4±8,7 anos. Houve predomínio de indivíduos do sexo feminino (81,2%), com 5 a 8 anos de estudo (33,8%), casados (47,7%) e residentes de Porto Alegre (65,2%). Em relação a variáveis clínicas, a maior frequência dos idosos não apresentaram histórico familiar de doença ou de internação psiquiátrica. Do total, 92,6% relataram ter alguma comorbidade clínica, sendo a mais frequente as doenças cardiovasculares (69,8%). Os principais psicofármacos utilizados foram os antidepressivos (66,7%) e os benzodiazepínicos (44,9%).Conclusões: os transtornos de ansiedade são frequentes entre os idosos. Dessa forma, são necessários mais estudos na população geriátrica e padronizações das ferramentas de avaliação.

Associations between the Severity of Sarcopenia and Health-Related Quality of Life in Community-Dwelling Middle-Aged and Older Adults

(1) Background: The aim of this study was to analyze the associations between severity of sarcopenia and health-related quality of life (HRQoL) among community-dwelling middle-aged and older adults. (2) Methods: A cross-sectional study involving 304 older-adult participants was used to assess the severity of sarcopenia by measuring muscle strength (handgrip dynamometer), muscle mass (bioelectrical impedance analysis), and physical performance (Timed Up-and-Go test). The generic 36-item Short-Form Health Survey (SF-36) was used to evaluate HRQoL. Anxiety and depression (Hospital Anxiety and Depression Scale) as well as age were considered as possible confounders. Probable sarcopenia was determined by low muscle strength; confirmed sarcopenia was defined by the presence of both low muscle strength and muscle mass; and severe sarcopenia was defined by low muscle strength and mass along with poor physical performance. (3) Results: The linear regression analysis showed that the presence of probable sarcopenia was associated with the SF-36 domains physical role (adjusted R² = 0.183), general health (adjusted R² = 0.290), and social functioning (adjusted R² = 0.299). As for the SF-36 mental (MCS) and physical (PCS) component summary scores, probable sarcopenia, as well as depression and anxiety, remained associated with MCS (adjusted R² = 0.518), and these three variables, together with age, were linked to PCS (adjusted R² = 0.340). (4) Conclusions: Probable sarcopenia, but not confirmed or severe sarcopenia, was independently associated with poor HRQoL. More precisely, it was related to PCS and MCS, as well as to the physical role, general health, and social functioning of SF-36 domains.

Analysis of Personality Traits in Patients with Hodgkin Lymphoma

Hodgkin lymphoma (HL) is a highly-curable malignancy mostly affecting young people. As far as we know, there is no published study that has analyzed personality profiles in HL nor their potential role in lymphomagenesis, natural history, or response to treatment. We aim to explore the personality traits of HL patients, as well as the prevalence of mental disorders and suicide ideas. We retrospectively identified all alive HL patients from three centers (Son Espases and Son Llatzer University Hospitals and Hospital del Mar of Barcelona) for using NEO Five-Factor Inventory (NEO-FFI) and Personality Inventory for DSM-5 Brief Form. Patients with HL showed significantly higher neuroticism scores and lower conscientiousness, extraversion, and openness. Considering maladaptive personality traits, HL patients showed higher levels of detachment and psychoticism. All of these translated into the fact that HL patients showed more than double the prevalence of mental illnesses (41%) and more than triple the prevalence of suicidal ideation or attempts than the general population (15 and 6%, respectively). An exploratory analysis of biomarkers associated with HL personality traits showed that higher scores of neuroticism correlated with more elevated erythrocyte sedimentation rate (ESR) and red cell distribution width (RDW), suggesting a potential link between neuroticism and proinflammatory activity in HL.

Mental Illness Inequalities by Multimorbidity, Use of Health Resources and Socio-Economic Status in an Aging Society

BACKGROUND

Mental illness, multi-morbidity, and socio-economic inequalities are some of the main challenges for the public health system nowadays, and are further aggravated by the process of population aging. Therefore, it is widely accepted that health systems need to focus their strategies for confronting such concerns. With guaranteed access to health care services under universal coverage in many health systems, it is expected that all services be provided equally to patients with the same level of need.

METHODS

In this paper, we explore the existence of inequalities in the access to services of patients with mental illness taking into account whether they are multimorbid patients, their socioeconomic status, and their age. We take advantage of a one-year (2010-2011) database on individual healthcare utilization and expenditures for the total population (N = 2,262,698) of the Basque Country.

RESULTS

More comorbidity leads to greater inequality in prevalence, being the poor sicker, although with age, this inequality decreases. All health services are more oriented towards greater utilization of the poor and sicker, particularly in the case of visits to specialists and emergency care.

CONCLUSIONS

Mental health inequalities in prevalence have been identified as being disproportionally concentrated in the least affluent areas of the Basque Country. However, inequalities in the utilization of publicly-provided health services present a pro-poor orientation. As this region has adopted a system-wide transformation towards integrated care, its mental health delivery model offers excellent potential for international comparisons and benchlearning.

Effectiveness of a web-based decision aid for patients with generalised anxiety disorder: a protocol for a randomised controlled trial

INTRODUCTION

Patients with generalised anxiety disorder (GAD) have concerns and needs about their health and the healthcare they receive. Patient decision aids (PtDAs) are tools that assist patients in making health decisions, when there is uncertainty about treatment choice, incorporating their personal preferences and values about the available treatment options. PtDAs can improve shared decision-making and lead to better treatment outcomes. The aim of this study is to evaluate the effectiveness of a web-based PtDA for patients with GAD in primary care (PC).

METHODS AND ANALYSIS

The general study design is comprised of two stages: (1) development of a web-based PtDA for patients with GAD, derived from an evidence-based Clinical Practice Guideline and (2) assessment of the effectiveness of the PtDA in a randomised controlled trial (RCT) design, in PC centres in Tenerife (Spain). This RCT will be carried out with 124 patients with GAD, comparing the PtDA to a fact sheet with general information on mental health. Patients will review the PtDA in one session accompanied by a researcher. Post-intervention measures will be administered immediately after the intervention and at 3-month follow-up. The primary outcome will be decisional conflict. Secondary outcomes will include knowledge about GAD and its treatment, treatment preference, concordance between treatment preference and choice, and decision quality (knowledge ≥60% and concordant decision).

ETHICS AND DISSEMINATION

The project received ethics approval from the local committee at Nuestra Señora de la Candelaria (HUNSC) University Hospital in Santa Cruz de Tenerife (code: CHUNSC_2019_58). Informed consent will be obtained from each participant before randomisation. Results from the trial will be submitted for publication in international peer-reviewed scientific journals and will be disseminated through workshops and local and international conferences.

TRIAL REGISTRATION NUMBER

NCT04364958.

Does Anxiety Increase the Risk of All-Cause Dementia? An Updated Meta-Analysis of Prospective Cohort Studies

Background: Anxiety has been suggested as a potentially modifiable risk factor for dementia, but results are still controversial. Our main objectives are to develop an updated meta-analysis of prospective population-based studies on the relationship between anxiety and risk of dementia, and to estimate the population fraction of dementia attributable to anxiety (PAF). Methods: We searched for cohort studies listed on PubMed or Web of Science from January 2018 to January 2020 that reported risk estimates for the association between anxiety and incident dementia. These were added to cohort studies published before January 2018 that were used in a previously published meta-analysis. Fully adjusted RRs were pooled using random effects models. We estimated the proportion of incident dementia attributable to anxiety by using PAF. Results: The meta-analysis included nine prospective cohorts from eight studies, representing 29,608 participants. The overall relative risk (RR) of dementia was 1.24 (95% CI: 1.06–1.46) and the PAF of dementia due to anxiety was 3.9%. Conclusions: Anxiety is significantly associated with an increased risk of all-cause dementia. The treatment or prevention of anxiety might help to reduce dementia incidence rates, but more research is needed to clarify whether anxiety is a cause of dementia rather than a prodrome.

Updating the evidence for an association between anxiety and risk of Alzheimer's disease: A meta-analysis of prospective cohort studies

OBJECTIVES

Anxiety is postulated to be a modifiable risk factor for Alzheimer's disease (AD). Our primary aim was to conduct a meta-analysis of prospective cohort studies investigating the association between anxiety and AD risk.

DESIGN

We searched multiple scientific databases to identify relevant papers published up to March 2019. Inclusion criteria were: prospective cohort studies with a minimum follow-up period of 1 year, baseline anxiety assessment, absence of dementia at baseline, investigated the association between anxiety and AD incidence, and reporting Relative Risks (RRs), or equivalents (HRs and SHRs), for the association between anxiety and AD risk. We excluded studies that: focused on subjective memory or mild cognitive impairment samples, review and meta-analyses, not reporting original, published peer-reviewed results. We used a random-effects model that accommodated the differences in association statistics.

RESULTS

7 prospective cohorts (reported in 6 studies), with a total of 24,528 participants, were included in our meta-analysis. A marginally significant association between anxiety and AD risk was found, with a pooled RR of 1.45 (95% CI: 1.00-2.12), and a population attributable fraction for AD of 2.8% (95% CI: 1.2%-4.3%).

LIMITATIONS

There was a high level of heterogeneity across the studies, which may be associated with differences in the covariates adjusted for. Studies also differed considerably in how they measured anxiety.

CONCLUSION

Anxiety is marginally associated with an increased risk of AD in this meta-analysis. Future research is needed to determine the extent to which anxiety might be a cause of AD rather than a prodrome or marker.