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Zhou Z, Birditt KS, Leger KA, Fingerman KL. Daily worry, rumination, and sleep in late life. J Psychosom Res 2024; 179:111622. [PMID: 38484497 DOI: 10.1016/j.jpsychores.2024.111622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Perseverative thinking (e.g., worry/rumination) is a common response to stress, and can be detrimental to well-being. Sleep may represent an important mechanism by which perseverative thinking is disrupted or amplified from day to day. This study examined the associations between older adults' everyday worry, rumination, and sleep. METHODS Older adults (N = 270) aged 65-89 completed a baseline interview and morning and evening assessments each day for 5-6 days. Every morning, they indicated their worry toward the day and their sleep duration and disturbances the prior night. Every evening, they rated worry and rumination experienced that day. RESULTS Multilevel models showed that perseverative thinking predicted worse sleep (i.e., fewer hours of sleep) at the between-person level (B = -0.29, p = .004) but better sleep (i.e., fewer sleep disturbances) at the within-person level (Bs < -0.18, ps < .003). At the within-person level, more hours of sleep (B = -0.06, p = .04) and fewer sleep disturbances (B = 0.10, p < .001) predicted less worry the next morning. Prior night's worry predicted greater next morning's worry, but this association was significant only when older adults reported fewer-than-usual hours of sleep (B = 0.24, p < .001), not when they reported more-than-usual hours of sleep (B = 0.04, p = .61). CONCLUSION Findings suggest that worry and rumination are intimately linked with sleep and highlight the protective role that better sleep may play in reducing older adults' everyday perseverative thinking.
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Affiliation(s)
- Zexi Zhou
- Department of Human Development and Family Sciences, The University of Texas at Austin, USA.
| | - Kira S Birditt
- Institute for Social Research, University of Michigan, USA
| | - Kate A Leger
- Psychology Department, University of Kentucky, USA
| | - Karen L Fingerman
- Department of Human Development and Family Sciences, The University of Texas at Austin, USA
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2
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Guineau MG, Ikani N, Tiemens B, Oude Voshaar R, Fokkema M, Hendriks GJ. Age related differences in symptom networks of overall psychological functioning in a sample of patients diagnosed with anxiety, obsessive compulsive disorder, or posttraumatic stress disorder. J Anxiety Disord 2023; 100:102793. [PMID: 37976726 DOI: 10.1016/j.janxdis.2023.102793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Anxiety disorders, obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) are among the most prevalent mental disorders across the lifespan. Yet, it has been suggested that there are phenomenological differences and differences in treatment outcomes between younger and older adults. There is, however, no consensus about the age that differentiates younger adults from older adults. As such, studies use different cut-off ages that are not well founded theoretically nor empirically. Network tree analysis was used to identify at what age adults differed in their symptom network of psychological functioning in a sample of Dutch patients diagnosed with anxiety disorders, OCD, or PTSD (N = 27,386). The networktree algorithm found a first optimal split at age 30 and a second split at age 50. Results suggest that differences in symptom networks emerge around 30 and 50 years of age, but that the core symptoms related to anxiety remain stable across age. If our results will be replicated in future studies, our study may suggest using the age split of 30 or 50 years in studies that aim to investigate differences across the lifespan. In addition, our study may suggest that age-related central symptoms are an important focus during treatment monitoring.
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Affiliation(s)
- Melissa G Guineau
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Pro Persona Research, Pro Persona Institute for Integrated Mental Health Care, Wolfheze, the Netherlands.
| | - Nessa Ikani
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Pro Persona Research, Pro Persona Institute for Integrated Mental Health Care, Wolfheze, the Netherlands.
| | - Bea Tiemens
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Pro Persona Research, Pro Persona Institute for Integrated Mental Health Care, Wolfheze, the Netherlands; Indigo, Utrecht, the Netherlands.
| | - Richard Oude Voshaar
- University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Marjolein Fokkema
- Methodology and Statistics Department, Institute of Psychology, Leiden University, the Netherlands.
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Pro Persona Research, Pro Persona Institute for Integrated Mental Health Care, Wolfheze, the Netherlands.
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3
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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Cognitive processes associated with emotional disorders: implications for efficient psychological treatments. J Ment Health 2023; 32:54-62. [PMID: 33989506 DOI: 10.1080/09638237.2021.1922651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. AIMS To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. METHODS We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. RESULTS Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. CONCLUSIONS For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Jose F Venceslá
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
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4
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Inness BE, McCabe RE, Green SM. Problematic behaviours associated with generalized anxiety disorder during pregnancy and the postpartum period: A thematic analysis. Psychol Psychother 2022; 95:921-938. [PMID: 35716017 DOI: 10.1111/papt.12410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
UNLABELLED Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in pregnancy and the postpartum (perinatal) period. Perinatal women with GAD engage in problematic behaviours, yet the focus and function of these behaviours remain unknown. OBJECTIVE Given that worry during the perinatal period is largely maternally focused, the objective of this study was to explore the accompanying behavioural features of GAD during pregnancy and the postpartum period. DESIGN A qualitative study was conducted. METHODS Twenty-five pregnant (n = 10) and postpartum (n = 15) women were recruited through clinical referrals and the Hamilton community. Following the completion of a semistructured diagnostic interview and symptom measures, participants participated in one of seven focus groups to learn about behaviours utilized in response to their worries. A thematic analysis was conducted to identify behaviour themes and subthemes in pregnant and postpartum women. RESULTS Five behaviour themes and 12 subthemes were identified. Specifically, participants endorsed engaging in excessive reassurance seeking, checking and repeating, overcontrol, overpreparation and avoidance behaviours. CONCLUSIONS Our results confirm that perinatal women with GAD engage in comparable problematic behaviours to those with GAD in the general population, yet the presentation, frequency and focus of those behaviours differ. These findings have implications for theoretical formulations of GAD, and the clinical management of this disorder during the perinatal period.
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Affiliation(s)
- Briar E Inness
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Sheryl M Green
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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5
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Muacevic A, Adler JR, Ghasib AM, Kabbarah AJ, Alnefaie SA, Hariri N, Altammar MA, Fadhel AM, Altowairqi FM. Social Anxiety Disorder: Associated Conditions and Therapeutic Approaches. Cureus 2022; 14:e32687. [PMID: 36660516 PMCID: PMC9847330 DOI: 10.7759/cureus.32687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
Social anxiety disorder (SAD) is a highly distressing chronic psychiatric disorder characterized by persistent fear of social situations in anticipation of being judged negatively by others. As shyness mimics some of the symptoms of SAD, people suffering from this debilitating disease are often underdiagnosed. It can have a devastating impact on all areas of life including academic performance, social growth, relationship status, and work performance. In recent years, research on anxiety and related disorders has proliferated due to the increased use of cognitive-behavioral models. The understanding of SAD has evolved greatly from distinguishing it from shyness to implementing modalities to comprehend the sophisticated underlying mechanism of disease prevalence and progression as well as methods to treat it. This review summarizes the concept of SAD, its epidemiology, symptoms, and diagnostic tools. Frequent comorbidities including other psychiatric disorders are also discussed. Additionally, we examine the latest evidence related to treatment options including psychotherapy and pharmacotherapy as well as recommendations for managing SAD.
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Schwab R, Droste A, Stewen K, Elger T, Theis S, Heimes AS, Peters K, Schmidt M, Brenner W, Hasenburg A. Resilience as a Source of Easement to Health-Related Worries in Women at Increased Risk for Breast or Ovarian Cancer During the COVID-19 Pandemic. Int J Gen Med 2022; 15:7039-7052. [PMID: 36090707 PMCID: PMC9462434 DOI: 10.2147/ijgm.s373191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The COVID-19 pandemic has affected individuals’ and society’s physical and psychological well-being. The study was conducted in order to assess the predictors for health-related worries during the COVID-19 pandemic in vulnerable populations. Patients and Methods A cross-sectional web-based survey of women who had a higher risk of developing breast cancer (BC) or ovarian cancer (OC) was conducted, regardless of whether they had experienced an active malignant disease during the pandemic. A self-reported questionnaire was designed for this study to assess health-related worries. The PHQ-4 questionnaire was used to evaluate mental health, and the Brief Resilience Scale (BRS) questionnaire was employed to investigate resilience. Results History of BC or OC was recognized as an independent significant risk factor for worries regarding being more susceptible to a more severe course of COVID-19 disease (OR 3.593; 95% CI 1.030–12.536; p = 0.045). High scores in the BRS questionnaire were negatively correlated with health-related worries, such as an increased risk for occurrence of BC or OC (OR 0.332; 95% CI 0.118–0.933; p = 0.37) or worsening of oncological outcome as a result of an infection with the SARS-CoV-2 virus (OR 0.330; 95% I 0.114–0.956; p = 0.041). Conclusion The obtained findings determined resilience as an independent and potent protective parameter in terms of health-related concerns in women at high risk for BC and OC. The results may assist in identifying women at risk for health-related concerns during adverse life events, allowing healthcare providers to respond fast and according to the patients´ needs.
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Affiliation(s)
- Roxana Schwab
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
- Correspondence: Roxana Schwab, Department of Obstetrics and Gynecology, University Medical Center of the Johannes, Gutenberg University Mainz, Mainz, 55131, Germany, Tel +49-6131-17-0, Fax +49-6131-17-5692, Email
| | - Annika Droste
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Kathrin Stewen
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Tania Elger
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Susanne Theis
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Anne-Sophie Heimes
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Katharina Peters
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Walburgis Brenner
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
| | - Annette Hasenburg
- Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, 55131, Germany
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7
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Mizuno A, Karim HT, Newmark J, Khan F, Rosenblatt MJ, Neppach AM, Lowe M, Aizenstein HJ, Mennin DS, Andreescu C. Thinking of Me or Thinking of You? Behavioral Correlates of Self vs. Other Centered Worry and Reappraisal in Late-Life. Front Psychiatry 2022; 13:780745. [PMID: 35815034 PMCID: PMC9256986 DOI: 10.3389/fpsyt.2022.780745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Psychotherapeutic approaches in late-life anxiety have limited effect on reducing worry severity. The self-referential processing of worry contents (self- vs. other-focused worry) and reappraisal styles (internal vs. external locus of control) are important elements in psychotherapy, but little is known about these processes in late-life. We aimed to characterize severe worry from a self-referential processing perspective. We recruited 104 older adults with various levels of worry and used a personalized task to induce and reappraise worry. We analyzed the association between (1) worry severity/frequency for worry content (self- or other-focused) and (2) for reappraisal style (internal vs. external locus of control) with clinical inventories measuring anxiety, worry, depression, rumination, neuroticism, emotion regulation strategies, perceived stress, and physical illness burden. Higher self-worry severity was associated with higher scores of clinical inventories of worry, depression, perceived stress, and neuroticism, whereas other-worry severity did not show any association. Greater self-worry frequency was associated with higher medical burden. External locus of control in reappraisal statements was associated with lower worry severity in men. Overall, more severe and frequent self-focused worry was associated with a greater psychological and physiological burden. These results are useful in tailoring psychotherapy for older adults with severe worry.
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Affiliation(s)
- Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Helmet Talib Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jordyn Newmark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Faiha Khan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Alyssa M. Neppach
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - MaKayla Lowe
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Howard Jay Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Douglas S. Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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8
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Green SM, Inness B, Furtado M, McCabe RE, Frey BN. Evaluation of an Augmented Cognitive Behavioural Group Therapy for Perinatal Generalized Anxiety Disorder (GAD) during the COVID-19 Pandemic. J Clin Med 2021; 11:jcm11010209. [PMID: 35011950 PMCID: PMC8745906 DOI: 10.3390/jcm11010209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
The perinatal period is considered a window of vulnerability given the increased risk of psychiatric difficulties during this time, such as mood and anxiety disorders (ADs). Pre-pandemic rates of ADs in perinatal women were one in five but have since increased with the onset of the COVID-19 pandemic (COVID). In addition, recent research suggests that the focus of worry has shifted during the pandemic, with perinatal women reporting significantly more COVID-specific worries. The objective of this study was to augment our current evidence-based Cognitive Behavioural Group Therapy (CBGT) for perinatal anxiety protocol by targeting intolerance of uncertainty and tailoring existing strategies to address COVID-related worry and impact. Pregnant (n = 19) and postpartum (n = 49) women were recruited from regular clinic patient flow from a university-affiliated teaching hospital between September 2020 and March 2021. Improvements in generalized anxiety symptoms, worry, intolerance of uncertainty, and mood were observed at post-treatment, maintained at 3-months, and the intervention received high ratings of treatment satisfaction. This is the first study to examine an augmented CBGT for perinatal women with GAD during the pandemic and supports the inclusion of strategies that target intolerance of uncertainty as well as specific pandemic and perinatal worry content for effective outcomes.
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Affiliation(s)
- Sheryl M. Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Correspondence: ; Tel.: +1-905-522-1155 (ext. 33672)
| | - Briar Inness
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Melissa Furtado
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
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9
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Green SM, Furtado M, Inness BE, Frey BN, McCabe RE. Characterizing Worry Content and Impact in Pregnant and Postpartum Women with Anxiety Disorders During COVID-19. Clin Psychol Psychother 2021; 29:1144-1157. [PMID: 34931741 DOI: 10.1002/cpp.2703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/04/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022]
Abstract
The novel COVID pandemic has had a substantial impact on global mental health, including those populations that are inherently vulnerable such as pregnant and postpartum (perinatal) women. Anxiety disorders (ADs) are the most common mental health disorders during the perinatal period, affecting up to 1 in 5 women. However, since the onset of the pandemic, up to 60% of perinatal women are experiencing moderate to severe levels of anxiety. Given the substantial increase in perinatal anxiety during COVID, we sought to better understand its phenomenology by characterizing the collective worry content and impact of COVID using a content analysis. Eighty-four treatment-seeking pregnant (n = 35) and postpartum (n = 49) women with a principal AD, participated in this study between April and October 2020. In addition to completing questionnaire measures and a semi-structured diagnostic interview, participants were asked to 1) describe their top excessive and uncontrollable worries; 2) describe additional COVID and non-COVID worries; and 3) describe how the pandemic had affected their lives. All responses were given verbally and transcribed verbatim by assessors. A content analysis led to the emergence of various COVID and non-COVID worry and impact themes. One third of participant's principal worries were specific to COVID, and 40% of COVID worries were specific to the perinatal context. Understanding the worry content and impact of COVID may improve symptom detection and inform the development of targeted treatment strategies to support the mental health needs of perinatal women with ADs throughout the pandemic and thereafter. Understanding pandemic-specific worries is important for perinatal symptom screening and may allow for the development of targeted treatment strategies to address COVID-specific worries and impact.
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Affiliation(s)
- Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario
| | - Briar E Inness
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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10
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Yeung MK, Lee TL, Chan AS. Depressive and anxiety symptoms are related to decreased lateral prefrontal cortex functioning during cognitive control in older people. Biol Psychol 2021; 166:108224. [PMID: 34785277 DOI: 10.1016/j.biopsycho.2021.108224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 11/18/2022]
Abstract
Some studies have found a relationship between negative emotional symptoms and decreased lateral PFC functioning during a cognitive control task in healthy younger adults. Here, we asked whether this relationship is also present in the general older population and across different functional domains of the lateral PFC. Thirty-six older people (13 males) self-reported their recent depressive and anxiety symptoms. They also took two cognitive control tasks known to differentially engage the lateral frontoparietal network (digit n-back task) and the lateral frontotemporal network (Category Fluency Test) while hemodynamic changes in the PFC were monitored by functional near-infrared spectroscopy (fNIRS). Both depressive and anxiety symptoms were associated with decreased activation in the bilateral lateral PFC during cognitive control performance. Interestingly, these relationships were driven by the n-back task. Our findings suggest that depressive and anxiety symptoms are related to decreased lateral PFC functioning in particular domains of cognitive control among older people.
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Affiliation(s)
- Michael K Yeung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tsz L Lee
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Agnes S Chan
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; Research Center for Neuropsychological Well-being, The Chinese University of Hong Kong, Hong Kong, China.
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11
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Bergman YS, Shrira A, Palgi Y, Shmotkin D. The Moderating Role of the Hostile-World Scenario in the Connections Between COVID-19 Worries, Loneliness, and Anxiety. Front Psychol 2021; 12:645655. [PMID: 33796056 PMCID: PMC8008141 DOI: 10.3389/fpsyg.2021.645655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has had pronounced effects on individuals' psychological well-being around the world. Concerns regarding the consequences of infection, as well as the general uncertainty and governmental regulations have resulted in increased psychological distress among many populations and cultures. In this regard, research has shown that the manner by which individuals perceive such large-scale threats and appraise them significantly contributes to the psychological consequences of such events. According to the Hostile-World Scenario (HWS) model, negative engagement (NE) with such threats weakens one's competence and coping abilities, whereas positive engagement (PE) facilitates resilience and enhances psychological adjustment. Accordingly, the current study examines the moderating role of both NE and PE in the connections of two main features of the current pandemic, COVID-19-related worries and loneliness, with anxiety. Data were collected between March 16 and April 14, 2020, from 1,112 Israelis (age range 17-92, M = 46.90, SD = 16.46), who provided information regarding COVID-19 health worries, loneliness, and anxiety. A special measure assembled items pertinent to the HWS-NE and HWS-PE throughout the survey. Results demonstrated that both HWS-NE and HWS-PE were significant moderators. COVID-19-related health worries/loneliness were linked with anxiety only among individuals with high HWS-NE, and were non-significant among those with low HWS-NE. Moreover, the positive association between loneliness and anxiety was significantly mitigated by high HWS-PE. The discussion highlights the importance of the HWS for understanding the psychological consequences of COVID-19 and offers practical suggestions, which may aid mental health practitioners in providing assistance and support to the general population.
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Affiliation(s)
- Yoav S. Bergman
- Faculty of Social Work, Ashkelon Academic College, Ashkelon, Israel
| | - Amit Shrira
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Yuval Palgi
- Department of Gerontology, University of Haifa, Haifa, Israel
| | - Dov Shmotkin
- School of Psychological Sciences and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
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12
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Wong FHC, Liu T, Leung DKY, Zhang AY, Au WSH, Kwok WW, Shum AKY, Wong GHY, Lum TYS. Consuming Information Related to COVID-19 on Social Media Among Older Adults and Its Association With Anxiety, Social Trust in Information, and COVID-Safe Behaviors: Cross-sectional Telephone Survey. J Med Internet Res 2021; 23:e26570. [PMID: 33523825 PMCID: PMC7879726 DOI: 10.2196/26570] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/20/2022] Open
Abstract
Background COVID-19-related information on social media is overabundant and sometimes questionable, resulting in an “infodemic” during the pandemic. While previous studies suggest social media usage increases the risk of developing anxiety symptoms, how induced anxiety affects attitudes and behaviors is less discussed, let alone during a global pandemic. Little is known about the relationship between older adults using social media during a pandemic and their anxiety, their attitudes toward social trust in information, and behaviors to avoid contracting COVID-19. Objective The goal of this study was to investigate the associations between using social media for COVID-19-related information and anxiety symptoms as well as the mediation effect of anxiety symptoms on social trust in information and COVID-safe behaviors among older adults. Methods A cross-sectional telephone survey was conducted in Hong Kong between May and August 2020. A rapid warm-call protocol was developed to train social workers and volunteers from participant nongovernmental organizations to conduct the telephone surveys. Questions related to COVID-safe behaviors, social trust in information, social media use, anxiety and depressive symptoms, and sociodemographic information were asked. The number of confirmed COVID-19 cases at the community level was used to account for the risk of contracting COVID-19. Ordinary least squares regressions examined the associations between social media use and anxiety symptoms, and how they were associated with social trust in information and COVID-safe behaviors. Structural equation modeling further mapped out these relationships to identify the mediation effects of anxiety symptoms. Results This study collected information regarding 3421 adults aged 60 years and older. Use of social media for COVID-19-related information was associated with more anxiety symptoms and lower social trust in information but had no significant relationship with COVID-safe behaviors. Anxiety symptoms predicted lower social trust in information and higher COVID-safe behaviors. Lower social trust in information was predicted by using social media for COVID-19 information, mediated by anxiety symptoms, while no mediation effect was found for COVID-safe behaviors. Conclusions Older adults who rely on social media for COVID-19-related information exhibited more anxiety symptoms, while showing mixed effects on attitudes and behaviors. Social trust in information may be challenged by unverified and contradictory information online. The negligible impact on COVID-safe behaviors suggested that social media may have caused more confusion than consolidating a consistent effort against the pandemic. Media literacy education is recommended to promote critical evaluation of COVID-19-related information and responsible sharing among older adults.
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Affiliation(s)
- Frankie Ho Chun Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tianyin Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Dara Kiu Yi Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Anna Y Zhang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Walker Siu Hong Au
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wai Wai Kwok
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Angie K Y Shum
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - Terry Yat-Sang Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong.,Sau Po Centre on Aging, The University of Hong Kong, Pokfulam, Hong Kong
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13
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Jang H, Im J, Park K. Adherence to Dietary Guidelines among Diabetes Patients: Comparison between Elderly and Non-Elderly Groups. Clin Nutr Res 2021; 10:14-23. [PMID: 33564649 PMCID: PMC7850814 DOI: 10.7762/cnr.2021.10.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/01/2021] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
This study aimed to compare adherence to dietary guidelines between elderly and non-elderly individuals with type 2 diabetes mellitus (T2DM) in Korea. Data of 4,577 participants with T2DM were collected from the 1998-2015 Korea National Health and Nutrition Examination Surveys. The participants were classified into two groups based on age: non-elderly T2DM group comprising participants aged 30-64 years and elderly T2DM group comprising participants aged ≥ 65 years. Adherence to dietary guidelines was assessed using the Korean Diabetes Association-Korean Ministry of Health and Welfare (KDA-KMHW) index, comprising six components of dietary guidelines for T2DM patients. Multivariable generalized linear regression analysis was performed to analyze the KDA-KMHW index scores. The adherence levels to the individual components of the KDA-KMHW index were mostly lower in non-elderly group (p < 0.001) than elderly group, except for moderate carbohydrate consumption. The total KDA-KMHW index score was significantly lower in non-elderly T2DM group than in the elderly T2DM group (p < 0.001). The study results suggest the need for developing patient-specific education programs that focus on adherence to dietary guidelines, particularly for non-elderly patients, to adequately intervene with the difficulties experienced in T2DM dietary management.
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Affiliation(s)
- Haeun Jang
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
| | - Jihyun Im
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
| | - Kyong Park
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
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14
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Abstract
A prominent feature of anxiety in late life is concerns regarding physical health. Anxiety symptoms among older adults have been connected with various psychological outcomes, including social isolation and loneliness. During the coronavirus disease 2019 (COVID-19) pandemic, many societies have demonstrated increased ageist attitudes, encouraging older adults to distance themselves from society. Accordingly, the current study examined the moderating role of COVID-19-related ageism in the connection between COVID-19 health worries and anxiety symptoms among older adults. Data were collected from 243 older adults (age range 60-92; M = 69.75, SD = 6.69), who completed scales assessing COVID-19-related health worries and ageism, as well as anxiety symptoms. The results demonstrated that both health worries and ageism were positively associated with anxiety symptoms. Moreover, the connection between health worries and anxiety symptoms was more pronounced among older adults with high ageism levels. The study highlights the vulnerability of older adults in general, and ageist older adults in particular, to the negative consequences of COVID-19-related health worries, and emphasizes the role of the increased ageist stance of society during the pandemic in this regard.
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15
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Goldfinger C, Green SM, Furtado M, McCabe RE. Characterizing the nature of worry in a sample of perinatal women with generalized anxiety disorder. Clin Psychol Psychother 2020; 27:136-145. [DOI: 10.1002/cpp.2413] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/11/2019] [Accepted: 11/04/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Corrie Goldfinger
- Women's Health Concerns ClinicSt. Joseph's Healthcare Hamilton Ontario Canada
| | - Sheryl M. Green
- Women's Health Concerns ClinicSt. Joseph's Healthcare Hamilton Ontario Canada
- Department of Psychiatry and Behavioural NeurosciencesMcMaster University Hamilton Ontario Canada
| | - Melissa Furtado
- Women's Health Concerns ClinicSt. Joseph's Healthcare Hamilton Ontario Canada
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural NeurosciencesMcMaster University Hamilton Ontario Canada
- Anxiety Treatment and Research ClinicSt. Joseph's Healthcare Hamilton Ontario Canada
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16
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Correa JK, Brown TA. Expression of Generalized Anxiety Disorder Across the Lifespan. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020; 41:53-59. [PMID: 31938010 DOI: 10.1007/s10862-018-9697-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In generalized anxiety disorder (GAD), both the associated symptoms and worry content have been shown to vary as a function of age (Jeste et al., 2005; Portman et al., 2011). However, few studies have conducted analyses beyond mean comparisons and no studies have examined whether the observed differences in worry content and the associated symptoms are due to the lack of measurement invariance across age groups. The current study evaluated whether the measurement and expression of GAD in adults varied as a function of age, using a clinical sample of 375 participants and dimensional measures of GAD. The sample was divided into three age groups (OLDER = 60+, MID = 40-59, YOUNG = 20-39), matched by sex and GAD status. Two associated symptoms were found to exhibit differential item functioning, overall distress/interference as well as fatigue, with higher levels distress/interference and lower levels of fatigue found in the OLDER age group despite equivalent GAD severity levels across groups. When examining the content of reported worries, differential item functioning was found in four worry domains. Holding the latent dimension of worry severity constant: (a) the YOUNG age group was found to have higher reported rate of social worries, and (b) the OLDER age group was found to have higher levels of reported worries about community/world affairs and health of self. The OLDER age group also exhibited lower levels of worry about work and school. These results are discussed with regard to the assessment of GAD across the lifespan.
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17
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McDowell CP, Dishman RK, Gordon BR, Herring MP. Physical Activity and Anxiety: A Systematic Review and Meta-analysis of Prospective Cohort Studies. Am J Prev Med 2019; 57:545-556. [PMID: 31542132 DOI: 10.1016/j.amepre.2019.05.012] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 01/04/2023]
Abstract
CONTEXT Anxiety symptoms and disorders are highly prevalent and costly. Prospective studies suggest that physical activity may prevent anxiety development; however, this body of literature has not been reviewed comprehensively. EVIDENCE ACQUISITION Studies measuring physical activity at baseline and anxiety at a designated follow-up at least 1 year later were located using MEDLINE, PsycINFO, and CINAHL Complete through June 2018. EVIDENCE SYNTHESIS Data were analyzed July-December 2018. Study quality was assessed using Q-Coh. Among studies of adults, a random-effects meta-analysis was conducted for crude and the most fully adjusted models for three outcomes: self-reported anxiety symptoms, a diagnosis of any anxiety disorder, and a diagnosis of generalized anxiety disorder. As there were few studies with diverse samples and outcome measures, findings were elaborated with a critical narrative review of all studies. Twenty-four studies (median follow-up, 4.75 years) of >80,000 unique individuals were included in the systematic review; thirteen were included in the meta-analyses. Six studies were assessed as low quality, nine as acceptable, and nine as good. From adjusted models, odds of elevated anxiety symptoms (OR=0.8742, 95% CI=0.7731, 0.9886, n=9), any anxiety disorder (OR=0.6626, 95% CI=0.5337, 0.8227, n=3), and generalized anxiety disorder specifically (OR=0.5438, 95% CI=0.3231, 0.9153, n=3) were significantly lower after physical activity exposure. CONCLUSIONS Available evidence suggests that engaging in physical activity protects against anxiety symptoms and disorders. However, notable challenges in the current evidence base include issues regarding exposure and outcome measures, consistent adjustment for putative confounders, representativeness of samples, and attrition bias, which warrant further research.
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Affiliation(s)
- Cillian P McDowell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Rodney K Dishman
- Department of Kinesiology, University of Georgia, Athens, Georgia
| | - Brett R Gordon
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Matthew P Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland; Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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18
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Weisbrod D, Lev-Wiesel R. Under the Shadow of an Iranian Nuclear Threat: Reactions of Holocaust Survivors Versus Non-Holocaust Survivors. JOURNAL OF LOSS & TRAUMA 2019. [DOI: 10.1080/15325024.2018.1507474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dalya Weisbrod
- The Graduate School of Creative Arts Therapies, The Emili Sagol Research Centre for Creative Arts Therapies, University of Haifa, Israel
| | - Rachel Lev-Wiesel
- The Graduate School of Creative Arts Therapies, The Emili Sagol Research Centre for Creative Arts Therapies, University of Haifa, Israel
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19
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McDowell CP, Gordon BR, Andrews KL, MacDonncha C, Herring MP. Associations of physical activity with anxiety symptoms and status: results from The Irish longitudinal study on ageing. Epidemiol Psychiatr Sci 2019; 28:436-445. [PMID: 29382402 PMCID: PMC6998970 DOI: 10.1017/s204579601800001x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/29/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS Anxiety is debilitating and associated with numerous mental and physical comorbidities. There is a need to identify and investigate low-risk prevention and treatment strategies. Therefore, the purpose of this study was to investigate cross-sectional and longitudinal associations between different volumes of moderate-to-vigorous physical activity (PA) and anxiety symptoms and status among older adults in Ireland. METHODS Participants (n = 4175; 56.8% female) aged ⩾50 years completed the International PA Questionnaire (IPAQ) at baseline, and the anxiety subscale of the Hospital Anxiety and Depression Scale at baseline and follow-up (2009-2013). Participants were classified according to meeting World Health Organisation PA guidelines, and divided into IPAQ categories. Respondents without anxiety at baseline (n = 3165) were included in prospective analyses. Data were analysed in 2017. RESULTS Anxiety symptoms were significantly higher among females than males (p < 0.001). Models were adjusted for age, sex, waist circumference, social class, smoking status and pain. In cross-sectional analyses, meeting PA guidelines was associated with 9.3% (OR = 0.91, 95% confidence interval 0.78-1.06) lower odds of anxiety. Compared with the inactive group, the minimally- and very-active groups were associated with 8.4% (OR = 0.92, 0.76-1.10) and 18.8% (OR = 0.81, 0.67-0.98) lower odds of anxiety, respectively. In prospective analyses, meeting guidelines was associated with 6.3% (OR = 0.94, 0.63-1.40) reduced odds of anxiety. Compared with the inactive group, the minimally and very-active groups were associated with 43.5% (OR = 1.44, 0.89-2.32) increased, and 4.3% (OR = 0.96, 0.56-1.63) reduced odds of anxiety. The presence of pain, included in models as a covariate, was associated with a 108.7% (OR = 2.09, 1.80-2.42) increase in odds of prevalent anxiety, and a 109.7% (OR = 2.10, 1.41-3.11) increase in odds of incident anxiety. CONCLUSION High volumes of PA are cross-sectionally associated with lower anxiety symptoms and status, with a potential dose-response apparent. However, significant associations were not observed in prospective analyses. The low absolute number of incident anxiety cases (n = 109) potentially influenced these findings. Further, as older adults may tend to experience and/or report more somatic anxiety symptoms, and the HADS focuses primarily on cognitive symptoms, it is plausible that the HADS was not an optimal measure of anxiety symptoms in the current population.
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Affiliation(s)
- C. P. McDowell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - B. R. Gordon
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - K. L. Andrews
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - C. MacDonncha
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - M. P. Herring
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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20
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Affiliation(s)
- Raymond Pary
- a Veterans Administration Medical Center , Louisville , KY , USA
| | - Simrat Kaur Sarai
- b University of Louisville School of Medicine , Louisville , KY , USA
| | - Riley Sumner
- c University of Louisville , Louisville , KY , USA
| | - Steven Lippmann
- b University of Louisville School of Medicine , Louisville , KY , USA
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21
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Jing HG, Madore KP, Schacter DL. Not to worry: Episodic retrieval impacts emotion regulation in older adults. Emotion 2019; 20:590-604. [PMID: 30816741 DOI: 10.1037/emo0000581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Interventions that increase the specificity of episodic memory and future-oriented problem solving have been shown to help both young adults and clinical populations regulate their emotions toward potential stressors. However, little is known about how episodic specificity impacts anxiety levels in older adults, who show reduced specificity of episodic memory, future simulation, and problem-solving performance. Although emotion regulation generally improves with age, older adults still experience worries pertaining to their health and interpersonal relationships. The current studies test how episodic specificity affects emotion regulation in older adults. In Experiment 1, participants received an episodic specificity induction (ESI)-brief training in recollecting details of past experiences-prior to generating steps to solve worrisome problems. Older adults provided more relevant steps and episodic details after the specificity induction relative to a control induction, but we found no difference in emotion regulation ratings between induction conditions. In Experiment 2, we contrasted performance on a personal problem-solving task (i.e., generating steps to solve one's own problems) intended to draw on episodic retrieval with an advice task focused on semantic processing (i.e., listing general advice for an acquaintance worried about similar problems). Participants provided more relevant steps and episodic details in the personal problem-solving task relative to the advice task, and boosts in detail were related to larger reductions in anxiety toward the target worrisome events. These results indicate that solving worrisome problems with greater levels of episodic detail can positively influence emotion regulation in older adults. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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22
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Grenier S, Desjardins F, Raymond B, Payette MC, Rioux MÈ, Landreville P, Gosselin P, Richer MJ, Gunther B, Fournel M, Vasiliadis HM. Six-month prevalence and correlates of generalized anxiety disorder among primary care patients aged 70 years and above: Results from the ESA-services study. Int J Geriatr Psychiatry 2019; 34:315-323. [PMID: 30418683 DOI: 10.1002/gps.5023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/03/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To estimate the 6-month prevalence of generalized anxiety disorder (GAD) in primary care patients aged 70 years and above and to describe their clinical profile, including types of worries. METHODS/DESIGN Participants (N = 1193) came from the Étude sur la Santé des Aînés (ESA) services study conducted in Quebec, Canada. An in-person structured interview was used to identify GAD and other anxiety/depressive disorders as well as to identify types of worries. Three groups were created (ie, patients with GAD, patients with another anxiety disorder, and patients without anxiety disorders) and compared on several sociodemographic and clinical characteristics using multinomial logistic regression analyses. RESULTS The 6-month prevalence of GAD was 2.7%. Findings also indicated that the most common types of worries were about health, being a burden for loved ones, and losing autonomy. Compared with respondents without anxiety disorders, older patients with GAD were more likely to be women, be more educated, suffer from depression, use antidepressants, be unsatisfied with their lives, and use health services. In comparison with respondents with another anxiety disorder, those with GAD were 4.5 times more likely to suffer from minor depression. CONCLUSIONS GAD has a high prevalence in primary care patients aged 70 years and above. Clinicians working in primary care settings should screen for GAD, since it remains underdiagnosed. In addition, it may be associated with depression and life dissatisfaction. Screening tools for late-life GAD should include worry themes that are specific to aging.
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Affiliation(s)
- Sébastien Grenier
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Frédérique Desjardins
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Béatrice Raymond
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Marie-Christine Payette
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Marie-Ève Rioux
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | | | - Patrick Gosselin
- Département de psychologie, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Josée Richer
- Département de psychoéducation, Université de Montréal, Montreal, Quebec, Canada
| | - Bruno Gunther
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada.,Département de psychologie, Université de Montréal, Montreal, Canada
| | - Mélanie Fournel
- Centre de recherche, Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Faculté de Médecine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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23
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Wilson GA, Koerner N, Antony MM. An Examination of Feedback Seeking in Individuals With Social Anxiety Disorder, Generalized Anxiety Disorder, or No History of Mental Disorder Using a Daily Diary Method. J Cogn Psychother 2018; 32:15-37. [DOI: 10.1891/0889-8391.32.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined excessive reassurance seeking (or positive feedback seeking; PFS) and negative feedback seeking (NFS) in individuals with social anxiety disorder (SAD), generalized anxiety disorder (GAD), or no history of mental health difficulties. A 2-week daily diary method was used to examine potential group differences in the frequency, topics, and targets of PFS and NFS. The SAD and GAD groups reported significantly higher feedback seeking (FS) than the healthy group on self-report questionnaires. The most common targets of FS in each group were other people (e.g., romantic partner, family members). According to diary data, there were no significant group differences in the frequency of PFS, NFS, overall FS, or overall FS adjusted for self-reported compliance with diary completion (after applying Bonferroni correction). There were also no significant group differences in FS topics according to diary data. Future research directions and potential implications of these findings are discussed.
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24
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Altunoz U, Kokurcan A, Kirici S, Bastug G, Ozel-Kizil ET. Clinical characteristics of generalized anxiety disorder: older vs. young adults. Nord J Psychiatry 2018; 72:97-102. [PMID: 29065768 DOI: 10.1080/08039488.2017.1390607] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in older people. Although GAD in older adults seems to differ in many aspects like clinical presentation, severity and treatment response, there is a paucity of comparative research. AIMS The aim of the study is to compare the clinical presentation of GAD between older and young adults. METHODS One hundred and two non-demented older patients (age ≥65) and 64 young patients (age <45) who were diagnosed with GAD according to the DSM-IV-TR criteria were included to the study. Socio-demographic Data Form, the Structured Clinical Interview for DSM Disorders-1 (SCID-1), the Questionnaire for the Suggested Behavioral Criteria of GAD for DSM-5, the Hamilton Depression Scale (HAM-D), the Generalized Anxiety Disorder Severity Scale (GADSS) and the Sheehan Disability Scale (SDS) were applied to both groups. RESULTS AND CONCLUSIONS Older GAD patients had more disturbances of sleep, less reassurance seeking behaviors, higher rates of depression and higher depression severity when compared to the young patients. Although older people seemed to have a lower severity of GAD, they had higher disability due to worries. Older patients worried more about their own health and family well-being, whereas young patients worried more about future and other's health.
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Affiliation(s)
- Umut Altunoz
- a Department of Transcultural Psychiatry & Psychotherapy , Wahrendorff Clinic , Hannover , Germany
| | - Ahmet Kokurcan
- b Psychiatry Clinic , Corum Sungurlu State Hospital , Corum , Turkey
| | - Sevinc Kirici
- c Department of Psychiatry, Geriatric Psychiatry Unit , Ankara University School of Medicine , Ankara , Turkey
| | - Gulbahar Bastug
- d Vocational School of Health , Ankara University , Ankara , Turkey
| | - Erguvan Tugba Ozel-Kizil
- c Department of Psychiatry, Geriatric Psychiatry Unit , Ankara University School of Medicine , Ankara , Turkey
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25
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Beaunoyer E, Landreville P, Carmichael PH. Older Adults’ Knowledge of Anxiety Disorders. J Gerontol B Psychol Sci Soc Sci 2017; 74:806-814. [DOI: 10.1093/geronb/gbx128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/26/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Philippe Landreville
- École de psychologie, Université Laval, Québec, Canada
- Centre d’excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada
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26
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Sun X, Zhu C, So SHW. Dysfunctional metacognition across psychopathologies: A meta-analytic review. Eur Psychiatry 2017; 45:139-153. [PMID: 28763680 DOI: 10.1016/j.eurpsy.2017.05.029] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dysfunctions in metacognition have been reported in individuals with anxiety disorders. Although recent studies have examined metacognition in other disorders, how dysfunctional metacognition compares across disorders is not clear. This review aimed to ascertain the importance of dysfunctional metacognition in various psychopathologies, and to identify similarities and differences in metacognitive profiles across disorders. METHODS Forty-seven studies were selected from 586 articles published between 1990 and August 2015, including a total sample of 3772 patients and 3376 healthy individuals. Studies that measured metacognition using the Meta-Cognitions Questionnaire (MCQ) and its variants were included. We conducted five meta-analyses including 49 to 55 effect sizes, comparing psychiatric patients to healthy individuals on respective metacognitive dimensions of the MCQ. RESULTS We found elevated metacognitive dysfunctions in patients, as a group, on all MCQ dimensions. Group effects were large and robust for the two negative beliefs (i.e., beliefs about the uncontrollability and danger of thoughts, and beliefs about the need to control thoughts), and moderate and unstable for the positive beliefs. Patients showed decreased cognitive confidence and heightened cognitive self-consciousness on moderate to large levels. Moderator analyses revealed that negative beliefs about uncontrollability and danger of thoughts were most prevalent in generalized anxiety disorder, whereas heightened cognitive self-consciousness was more characteristic in obsessive-compulsive disorder. Generalized anxiety disorder, obsessive-compulsive disorder and eating disorders manifested more similar metacognitive profiles than other disorders. CONCLUSIONS Our findings supported dysfunctional metacognition as common processes across psychopathologies, with certain dimensions being more prevalent in particular disorders.
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Affiliation(s)
- X Sun
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan
| | - C Zhu
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan
| | - S H W So
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan.
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Aggarwal R, Kunik M, Asghar-Ali A. Anxiety in Later Life. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2017; 15:157-161. [PMID: 31975848 DOI: 10.1176/appi.focus.20160045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The spectrum of anxiety disorders occurring in later life is diverse and includes the same disorders that occur with younger adults-such as generalized anxiety disorder, panic disorder, specific phobias, and social anxiety disorder-but also unique presentations, including a fear of falling and the anxiety often seen in various neurocognitive disorders. Therefore, diagnosis and treatment are arguably more challenging in older populations. In addition, many older adults have subthreshold symptoms that can benefit from proper management. This article summarizes the literature on anxiety disorder presentations in later life and offers key recommendations to assist clinicians working with this growing population.
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Affiliation(s)
- Ruchi Aggarwal
- The authors are with the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Aggarwal is also with the Mental Health Careline, Michael E. DeBakey Veterans Affairs Medical Center (VAMC), Houston. Dr. Asghar-Ali is also with the South Central Mental Illness Research, Education and Clinical Center, and Dr. Kunik is also chief of the Behavioral Health and Implementation Program, VA Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC
| | - Mark Kunik
- The authors are with the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Aggarwal is also with the Mental Health Careline, Michael E. DeBakey Veterans Affairs Medical Center (VAMC), Houston. Dr. Asghar-Ali is also with the South Central Mental Illness Research, Education and Clinical Center, and Dr. Kunik is also chief of the Behavioral Health and Implementation Program, VA Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC
| | - Ali Asghar-Ali
- The authors are with the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston. Dr. Aggarwal is also with the Mental Health Careline, Michael E. DeBakey Veterans Affairs Medical Center (VAMC), Houston. Dr. Asghar-Ali is also with the South Central Mental Illness Research, Education and Clinical Center, and Dr. Kunik is also chief of the Behavioral Health and Implementation Program, VA Health Services Research and Development (HSR&D) Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC
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H. Roberts M, Merrick PL, Fletcher RB, Furness K. Understanding the Experiences of Anxiety in Community Dwelling Older Adults—Understanding Anxiety in Older Adults. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ojn.2017.711087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jones SL, Hadjistavropoulos HD, Soucy JN. A randomized controlled trial of guided internet-delivered cognitive behaviour therapy for older adults with generalized anxiety. J Anxiety Disord 2016; 37:1-9. [PMID: 26561733 DOI: 10.1016/j.janxdis.2015.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 09/21/2015] [Accepted: 10/28/2015] [Indexed: 11/24/2022]
Abstract
This study aimed to establish the efficacy of guided Internet-delivered cognitive-behaviour therapy (ICBT) for older adults with generalized anxiety disorder (GAD) or subclinical GAD. Participants were randomized to receive seven modules of ICBT (n=24) or to a waiting list condition (WLC; n=22). Faster improvements in symptoms of anxiety and depression were observed for participants in the ICBT condition relative to the WLC, with large between-group effect sizes on the Generalized anxiety disorder-7 (d=.85) and the Patient health questionnaire (d=1.17) obtained at post-treatment. Further reduction in generalized anxiety symptoms was reported over the one-month follow-up. Treatment effects were replicated when control participants subsequently underwent treatment. Higher ratings of treatment credibility, but not expectancy, prior to ICBT predicted improvements over time. The results support the efficacy of ICBT as treatment for older adults with GAD.
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Affiliation(s)
- Shannon L Jones
- Southport Psychology, 1150-10201 Southport Road S.W., Calgary, AB T2W 4X9, Canada; Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
| | | | - Joelle N Soucy
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
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Salivary Cortisol Levels and Depressive Symptomatology in Consumers and Nonconsumers of Self-Help Books: A Pilot Study. Neural Plast 2015; 2016:3136743. [PMID: 26839713 PMCID: PMC4709678 DOI: 10.1155/2016/3136743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/26/2015] [Accepted: 09/29/2015] [Indexed: 11/17/2022] Open
Abstract
The self-help industry generates billions of dollars yearly in North America. Despite the popularity of this movement, there has been surprisingly little research assessing the characteristics of self-help books consumers, and whether this consumption is associated with physiological and/or psychological markers of stress. The goal of this pilot study was to perform the first psychoneuroendocrine analysis of consumers of self-help books in comparison to nonconsumers. We tested diurnal and reactive salivary cortisol levels, personality, and depressive symptoms in 32 consumers and nonconsumers of self-help books. In an explorative secondary analysis, we also split consumers of self-help books as a function of their preference for problem-focused versus growth-oriented self-help books. The results showed that while consumers of growth-oriented self-help books presented increased cortisol reactivity to a psychosocial stressor compared to other groups, consumers of problem-focused self-help books presented higher depressive symptomatology. The results of this pilot study show that consumers with preference for either problem-focused or growth-oriented self-help books present different physiological and psychological markers of stress when compared to nonconsumers of self-help books. This preliminary study underlines the need for additional research on this issue in order to determine the impact the self-help book industry may have on consumers' stress.
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Deimling GT, Brown SP, Albitz C, Burant CJ, Mallick N. The relative importance of cancer-related and general health worries and distress among older adult, long-term cancer survivors. Psychooncology 2015; 26:182-190. [DOI: 10.1002/pon.4015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 07/31/2015] [Accepted: 09/25/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Casey Albitz
- Case Western Reserve University; Cleveland OH USA
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Abstract
Anxiety disorders are highly prevalent among the elderly and are associated with increased disability, poor quality of life, and cognitive impairment. Despite this high prevalence and associated morbidities, anxiety disorders in late life are underreported and understudied. In this article, we discuss the epidemiology, disease presentation, and current treatment of anxiety disorders in older adults. We also discuss limitations in the current understanding of such disorders in this population, as well as future research directions that may reveal the mechanisms and rationale for treatment regimens for anxiety disorders in late life. We present material on the application of the Research Domain Criteria (RDoC) model to geriatric anxiety. Finally, we describe optimal management strategies of anxiety disorders.
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Using virtual reality to improve the efficacy of cognitive-behavioral therapy (CBT) in the treatment of late-life anxiety: preliminary recommendations for future research. Int Psychogeriatr 2015; 27:1217-25. [PMID: 25381697 DOI: 10.1017/s1041610214002300] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive-behavioral therapy (CBT) using traditional exposure techniques (i.e. imaginal and in vivo) seems less effective to treat anxiety in older adults than in younger ones. This is particularly true when imaginal exposure is used to confront the older patient to inaccessible (e.g. fear of flying) or less tangible/controllable anxiety triggers (e.g. fear of illness). Indeed, imaginal exposure may become less effective as the person gets older since normal aging is characterized by the decline in cognitive functions involved in the creation of vivid/detailed mental images. One way to circumvent this difficulty is to expose the older patient to a virtual environment that does not require the ability to imagine the frightening situation. In virtuo exposure has proven to be efficient to treat anxiety in working-age people. In virtuo exposure could be employed to improve the efficacy of CBT with exposure sessions in the treatment of late-life anxiety? The current paper explores this question and suggests new research avenues.
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Clifford KM, Duncan NA, Heinrich K, Shaw J. Update on managing generalized anxiety disorder in older adults. J Gerontol Nurs 2015; 41:10-20. [PMID: 25848826 DOI: 10.3928/00989134-20150313-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
With the recent updates to the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5), there are many questions on how to care for older adults with generalized anxiety disorder (GAD) and other psychiatric conditions. The current article reviews the new changes to the DSM-5 for diagnosis of GAD, discusses new anxiety assessment scales that are validated in older adults, evaluates pharmacological agents that have been studied in older adults for GAD treatment, and provides monitoring recommendations to help those who provide care to older adults experiencing GAD.
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Wright A, Hurt CS, Gorniak S, Brown RG. An exploration of worry content and catastrophic thinking in middle-aged and older-aged adults with and without Parkinson's disease. Int J Geriatr Psychiatry 2015; 30:376-83. [PMID: 24931116 DOI: 10.1002/gps.4146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/25/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Worry is a common and distressing problem in Parkinson's disease (PD). However, little is known about the nature and content of worry in PD and how it might differ to non-PD populations. The study aimed to explore the content and nature of worry in middle-aged and older-aged adults with and without PD. METHOD Four groups of participants, 20 PD patients (10 high worry and 10 low worry) and 19 middle-aged and older-aged adults (10 high worry and nine low worry), completed the catastrophising interview (CI) for three worry topics. Worriers were classified (high/low) on the basis of Penn State Worry Questionnaire scores. Data were analysed using framework analysis. RESULTS High worriers showed a greater diversity of worry topics than low worriers. Health worries differentiated high and low worriers in the non-PD sample but were common across all PD participants. The CI revealed that the root concern of worry was often different to that initially described. In particular, PD high worriers were more likely to express underlying concerns about negative self-perception and death/severe incapacity. CONCLUSION The CI was able to identify the root cause of worry, demonstrating the value of this technique in the exploration and treatment of worry and psychological distress. Exploring worry content may help to distinguish patients with problematic worry, with worries about self-perception and death/severe incapacity characteristic of high worriers. Therapeutic interventions designed to alleviate problematic worry and distress in PD need to take account of the realities of living with PD and the potentially realistic nature of worries that may appear catastrophic in a healthy population.
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Affiliation(s)
- Anwen Wright
- School of Medicine, University of Nottingham, UK
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Mohlman J, Price R. Recognizing and treating late-life generalized anxiety disorder: distinguishing features and psychosocial treatment. Expert Rev Neurother 2014; 6:1439-45. [PMID: 17078785 DOI: 10.1586/14737175.6.10.1439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Generalized anxiety disorder is a highly prevalent and under-recognized public health problem associated with significant impairment and serious disability. Generalized anxiety disorder is the most common anxiety disorder among adults over the age of 60 years. This article discusses distinguishing features of generalized anxiety disorder, such as disorder-specific worry domains and associated features. The relation of the disorder to normal aging, major depression and health is also discussed. Current psychosocial treatment strategies are outlined, with a particular focus on cognitive behavior therapy.
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Affiliation(s)
- Jan Mohlman
- Rutgers University, Department of Psychology, Rutgers University, NJ, USA.
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Wilkes CM, Wilson HW, Woodard JL, Calamari JE. Do negative affect characteristics and subjective memory concerns increase risk for late life anxiety? J Anxiety Disord 2013; 27:608-18. [PMID: 23623610 PMCID: PMC3773246 DOI: 10.1016/j.janxdis.2013.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 11/28/2022]
Abstract
To better understand the development and exacerbation of late-life anxiety, we tested a risk model positing that trait negative affect (NA) characteristics would interact with cognitive functioning, thereby increasing some older adults' risk for increased anxiety symptoms. The moderator-mediator model consisted of measures of NA, cognitive functioning, and their interaction, as predictors of later Hamilton Anxiety Rating Scale scores (HARS) via a mediational process, subjective memory concerns (SMCs). Older adults (aged 65-years and over; M(age)=76.7 years, SD=6.90 years) completed evaluations four times over approximately 18 months. A latent growth curve model including Anxiety Sensitivity Index total score (ASI), Mattis Dementia Rating Scale-2 (DRS) total raw score, the ASI×DRS interaction, a SMC measure as mediator, HARS intercept (scores at times 3 and 4), and HARS slope provided good fit. The ASI×DRS-2 interaction at Time 1 predicted HARS slope score (β=-.34, p<.05). When ASI score was high, stronger cognitive functioning was associated with fewer anxiety symptoms. The indirect effect of ASI score predicting HARS score 18-months later through the SMC mediator was statistically significant (β=.08, p<.05). Results suggest that the cognitive functioning changes associated with aging might contribute to the development of anxiety symptoms in older adults with specific NA traits. Implications for predicting and preventing late life anxiety disorders are discussed.
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Affiliation(s)
- Chelsey M. Wilkes
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Helen W. Wilson
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | | | - John E. Calamari
- Department of Psychology, Rosalind Franklin University of Medicine and Science
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Sociodemographic correlates of depression and anxiety disorders among physically ill elderly patients. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000427044.15345.7b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gonçalves DC, Byrne GJ. Who worries most? Worry prevalence and patterns across the lifespan. Int J Geriatr Psychiatry 2013; 28:41-9. [PMID: 22374912 DOI: 10.1002/gps.3788] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 01/13/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the age-related worry patterns in a population-based sample of self-reported worriers. METHODS The National Survey of Mental Health and Well-Being is a multistage stratified epidemiologic survey of mental health conducted in Australia in 2007. Participants were surveyed using the Composite International Diagnostic Interview. All participants who reported a period of pervasive worry were included in this study (N = 3735, 16-85 years of age, 61% female). RESULTS Compared with younger adults (16-29 years of age; N = 860), older adults (65-85 years of age; N = 639) reported fewer worries [odds ratio (OR) = 0.36, p < 0.01] and a lower likelihood of worrying about interpersonal relations (OR = 0.66, p < 0.01), health (OR = 0.65, p < 0.05), work (OR = 0.39, p < 0.01), and miscellaneous topics (OR = 0.57, p < 0.01), but a higher likelihood of worrying about the health and welfare of loved ones (OR = 2.46, p < 0.01) after adjusting for socio-demographic and clinical factors. Similar patterns were seen in older persons with and without a lifetime history of generalized anxiety disorder as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders. CONCLUSIONS The findings indicated an overall decrease in worry count with advancing age, as well as a developmental distribution of worry content, and a quantitative but not qualitative distinction between normal and pathological worriers. Overall, these findings might contribute to the understanding of worry processes and the phenomenology of generalized anxiety disorder in older cohorts.
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Staples AM, Mohlman J. Psychometric properties of the GAD-Q-IV and DERS in older, community-dwelling GAD patients and controls. J Anxiety Disord 2012; 26:385-92. [PMID: 22306131 DOI: 10.1016/j.janxdis.2012.01.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 09/22/2011] [Accepted: 01/09/2012] [Indexed: 11/16/2022]
Abstract
Thirty-seven community-dwelling, older generalized anxiety disorder (GAD) patients and 37 nonanxious controls completed the Generalized Anxiety Disorder Questionnaire for DSM-IV (GAD-Q-IV; Newman et al., 2002), the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), and other measures of anxiety and depression. The GAD-Q-IV and DERS were assessed for internal consistency reliability, construct validity, and test-retest reliability, with results indicating good psychometric performance. Receiver operating characteristic (ROC) analysis conducted on the full sample suggested that the optimal GAD-Q-IV cutoff for classifying GAD cases was 3.71, with .97 sensitivity and .92 specificity. The cutoff score for classifying those participants with GAD and comorbid conditions was higher, however. ROC analysis with the full sample revealed an optimal DERS cutoff score of 62.5, with .76 sensitivity and .86 specificity. Findings support the use of the GAD-Q-IV and DERS as screening instruments for GAD in older, community-dwelling adults in a research setting.
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Affiliation(s)
- Alison M Staples
- Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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Calleo JS, Kunik ME, Reid D, Kraus-Schuman C, Paukert A, Regev T, Wilson N, Petersen NJ, Snow AL, Stanley M. Characteristics of generalized anxiety disorder in patients with dementia. Am J Alzheimers Dis Other Demen 2011; 26:492-7. [PMID: 22062223 DOI: 10.1177/1533317511426867] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Overlap of cognitive and anxiety symptoms (i.e., difficulty concentrating, fatigue, restlessness) contributes to inconsistent, complicated assessment of generalized anxiety disorder (GAD) in persons with dementia. METHODS Anxious dementia patients completed a psychiatric interview, the Penn State Worry Questionnaire-Abbreviated, and the Rating for Anxiety in Dementia scale. Analyses to describe the 43 patients with and without GAD included the Wilcoxon Mann-Whitney two-sample test, Fisher's exact test. Predictors of GAD diagnosis were identified using logistic regression. RESULTS Those with GAD were more likely to be male, have less severe dementia and endorsed more worry, and anxiety compared to patients without GAD. Gender, muscle tension and fatigue differentiated those with GAD from those without GAD. CONCLUSIONS Although this study is limited by a small sample, it describes clinical characteristics of GAD in dementia, highlighting the importance of muscle tension and fatigue in recognizing GAD in persons with dementia.
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Affiliation(s)
- Jessica S Calleo
- Houston Veterans Affairs Health Services Research & Development Center of Excellence, TX 77030, USA.
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Butters MA, Bhalla RK, Andreescu C, Wetherell JL, Mantella R, Begley AE, Lenze EJ. Changes in neuropsychological functioning following treatment for late-life generalised anxiety disorder. Br J Psychiatry 2011; 199:211-8. [PMID: 21727232 PMCID: PMC3633554 DOI: 10.1192/bjp.bp.110.090217] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Generalised anxiety disorder (GAD) in older adults is associated with neuropsychological impairment. Aims We examined neuropsychological functioning in older adults with GAD in comparison with psychiatrically healthy older adults at baseline, and we examined changes following a 12-week placebo-controlled trial of escitalopram. METHOD A total of 160 participants without dementia aged ≥60 with current GAD and 37 individuals in a comparison group without psychiatric history underwent neuropsychological assessment. Of these, 129 participants with GAD were reassessed post-treatment (trial registration: NCT00105586). RESULTS The participants with GAD performed worse than the comparison group in information processing speed, working memory, inhibition, problem-solving (including concept formation and mental flexibility) and immediate and delayed memory. Neuropsychological functioning was correlated with everyday functioning. After treatment, those with low cognitive scores experienced working memory, delayed memory and visuospatial ability improvement and those who reported clinical improvement in anxiety exhibited improvement in the ability to engage inhibition and episodic recall. These improvements were modest and of similar magnitude in both treatment conditions. CONCLUSIONS Generalised anxiety disorder in older adults is associated with neuropsychological impairments, which are associated with functional impairment. Those with GAD who either have a low cognitive performance or report clinical improvement in anxiety post-treatment, show improvement in multiple cognitive domains. These findings underscore the importance of treatments that aid cognition as well as anxiety symptoms.
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Affiliation(s)
- Meryl A Butters
- Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213, USA.
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Brock K, Clemson L, Cant R, Ke L, Cumming RG, Kendig H, Mathews M. Worry in Older Community-Residing Adults. Int J Aging Hum Dev 2011; 72:289-301. [DOI: 10.2190/ag.72.4.a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
With rising longevity, increasing numbers of older people are experiencing changes in their everyday family and social life, changes in their financial status, and a greater number of chronic conditions affecting their health. We took the opportunity to explore these relationships with worry in a group of volunteer community-living elderly ( n = 310). Findings showed that that those people under 75 years of age had a higher risk of worrying (OR = 1.8, 95% CI = 1.0–3.1) compared to the older age groups. Women worried more than men and an important finding was that those with chronic health conditions such as arthritis of the hip and knee were more prone to worry than those who were healthy or had acute conditions (OR = 3.5, 95% CI = 1.4–8.9). This latter finding suggests the importance placed on the role of the hip and knee in maintaining functional capacity to perform life skills.
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Lee S, Ma YL, Tsang A. A community study of generalized anxiety disorder with vs. without health anxiety in Hong Kong. J Anxiety Disord 2011; 25:376-80. [PMID: 21109390 DOI: 10.1016/j.janxdis.2010.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 10/27/2010] [Accepted: 10/28/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although generalized anxiety disorder (GAD) is characterized by multiple worries, anxiety about one's health is absent in the DSM-IV description of the illness. METHOD A random community-based telephone survey (N = 2005) that covered DSM-IV symptoms of GAD, two core symptoms of major depression, Rome-III criteria of Irritable Bowel Syndrome (IBS), Sheehan Disability Scale (SDS), and help-seeking behavior was conducted. RESULTS The 1-year prevalence of 3-month GAD was 5.4%. Among affected individuals, 78.9% reported worry about personal health while 21.1% did not. The former subgroup was significantly older, had higher mean numbers of associated anxiety symptoms and worries, more likely to have worry about finances and sought professional help than the latter subgroup. The two subgroups had similar sex distribution, core depressive symptoms, IBS, distress and SDS impairment profiles. CONCLUSION Health anxiety is common in GAD. Some but not all illness severity indicators differed between GAD with and without health anxiety.
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Affiliation(s)
- Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
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45
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Andreescu C, Gross JJ, Lenze E, Edelman KD, Snyder S, Tanase C, Aizenstein H. Altered cerebral blood flow patterns associated with pathologic worry in the elderly. Depress Anxiety 2011; 28:202-9. [PMID: 21394853 PMCID: PMC3225118 DOI: 10.1002/da.20799] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder among the elderly and has high functional and cognitive morbidity. However, late-life GAD is relatively understudied and its functional neuroanatomy is uncharted. Several imaging studies have suggested abnormalities in the cognitive control systems of emotion regulation in anxiety disorders in young adults. The aim of this study was to examine the neural correlates of emotion regulation in late-life GAD. METHOD We compared 7 elderly GAD subjects and 10 elderly nonanxious comparison subjects using functional MRI. Regional cerebral blood flow (rCBF) was measured using pulsed arterial spin labeling perfusion MRI at rest and during an emotion regulation paradigm. RESULTS Relative to the rest condition, elderly nonanxious comparison subjects had increased rCBF during worry induction (WI) in the right insula, bilateral amygdala, and associative temporooccipital areas. Elderly GAD subjects had increased rCBF during WI in the associative temporooccipital areas, but not in the insula or the amygdala. During worry suppression (WS), elderly nonanxious comparison subjects had increased rCBF in the prefrontal cortex (PFC) and dorsal ACC. Elderly GAD subjects had no changes in rCBF during WS in the PFC. CONCLUSIONS When attempting to regulate their emotional responses, elderly anxious subjects failed to activate prefrontal regions involved in the downregulation of negative emotions. These results, showing that elderly anxious subjects are not effectively engaging the PFC in suppressing worry, may be clinically relevant for developing personalized therapeutic strategies for the treatment of late-life GAD.
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Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic,3811 O’Hara Street, Pittsburgh, PA, USA.
| | - James J. Gross
- Department of Psychology, Stanford University, Saint Louis
| | - Eric Lenze
- Department of Psychiatry, Washington University School of Medicine, Saint Louis
| | | | - Sara Snyder
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh
| | - Costin Tanase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Imaging Research Center, University of California Davis
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Bioengineering Department, University of Pittsburgh
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Worry, emotion control, and anxiety control in older and young adults. J Anxiety Disord 2010; 24:759-66. [PMID: 20708492 DOI: 10.1016/j.janxdis.2010.05.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 05/12/2010] [Accepted: 05/16/2010] [Indexed: 11/23/2022]
Abstract
Young adults worry more than older adults; however, few studies have examined why age differences may exist in the frequency of worry. The present study aimed to identify age differences in worry frequency, and examine the relation of age and worry to control over one's emotions and control over anxiety. Older adults worried less often than young adults; however, young women worried more often than young men and older adults. Also, young women reported less control over their anxiety and less control over the external signs of their emotions compared to young men and older adults. Worriers had less perceived control over their anxiety, less control over the inner experience of emotions, and less control over the external signs of emotion.
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Olatunji BO, Wolitzky-Taylor KB, Sawchuk CN, Ciesielski BG. Worry and the anxiety disorders: A meta-analytic synthesis of specificity to GAD. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.appsy.2011.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, Rapee RM, Ruscio AM, Stanley MA. Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety 2010; 27:134-47. [PMID: 20058241 DOI: 10.1002/da.20658] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM-III. The majority of these revisions have been in response to its poor inter-rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM-IV GAD criteria for DSM-V. METHOD First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM-III-R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM-IV criteria for GAD was examined. CONCLUSIONS The review presents a number of options to be considered for DSM-V. One option is for GAD to be re-labeled in DSM-V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM-V validity tests and field trials.
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Affiliation(s)
- Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales, Sydney, Australia.
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Wolitzky-Taylor KB, Castriotta N, Lenze EJ, Stanley MA, Craske MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety 2010; 27:190-211. [PMID: 20099273 DOI: 10.1002/da.20653] [Citation(s) in RCA: 353] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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.
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