Search

The papers presented in this issue of Anxiety document various aspects of vulnerability to, and consequences of, anxiety disorders in subjects from different periods of the lifespan. Several themes are represented in one or more of these studies, (1) effects of anxiety disorders on quality of life, (2) effects on presentation and outcome of comorbid depression, and (3) the role of learning processes and early experiences, including abuse, attachment disturbances and personality disorders, in the ongoing predilection to anxiety disorders. We encourage clinicians and researchers to take a life course perspective in working with anxiety disorder patients, in order to better understand, prevent and treat these debilitating conditions.

We examined the prevalence and correlates of comorbid anxiety disorders in two groups of older depressed patients assessed at the University of Pittsburgh. A total of 336 older outpatients and inpatients with major depression were comprehensively evaluated with several instruments including the Hamilton Depression Rating Scale, and either the SADS-L or the SCID for DSM-III-R. These patients presented with major depression, associated with a wide range of functional, cognitive, and medical impairment. One-third to one-half of them also presented with severe symptomatic anxiety. However, only a small proportion (less than 5%) met diagnostic criteria for lifetime or current panic, obsessive-compulsive, or phobic disorders. At baseline, lifetime comorbid anxiety disorders were associated with a higher rate of alcoholism and higher symptomatic anxiety. Lifetime comorbid anxiety disorders did not affect the rate of response of depression, but they were associated with a higher use of benzodiazepines and a 50% increase in the time outpatients needed to respond. These findings suggest that, even in psychiatric patients with major depression, the lifetime prevalence of anxiety disorders is lower in late life, but that it has important clinical and therapeutic implications.

The psychiatric history and presenting clinical characteristics of 276 depressed primary care patients with and without a lifetime comorbid anxiety disorder were studied in a randomized control trial of treatments for major depression. Our findings indicate that distinctive patterns of depressive symptoms and severity, functional impairment, comorbidity of other DSM-III-R Axis I and Axis II disorders, and treatment participation are associated with lifetime histories of panic and generalized anxiety disorder. The most consistent differences are evident between patients with major depression alone and those with major depression and a lifetime panic disorder. The latter presented with greater depressive severity, greater impairment in physical and psychosocial functioning, and were more likely to have a history of alcohol dependence, somatization disorder, and avoidant personality disorder. Discriminant function analysis indicated that 66% of depressed patients with lifetime panic disorder could be correctly distinguished from those without such comorbidity on the basis of the severity of somatic and affective symptoms but not cognitive symptoms of depression. Further, depressed patients with lifetime panic disorder were more likely to prematurely terminate both pharmacotherapy and psychotherapy during each treatment's acute phase. Implications for the diagnosis and treatment of major depression with comorbid anxiety disorder in primary care patients are discussed. Anxiety 2:210–218 (1996). © 1996 Wiley-Liss, Inc.

The purpose of this study was to test the validity and utility of distinguishing symptoms of anxiety from those of depression and grief in recently spousally bereaved elders. We also examined pathways from baseline (six months or less post-spousal death) to follow-up (12 and 18 months post-death) levels of anxiety, depression and grief-related symptoms. Baseline and follow-up data were available from 56 recently widowed elderly subjects recruited for an investigation of physiological changes in bereavement. Confirmatory factor analyses indicated that a model in which anxiety was specified as a third factor, apart from depression and grief factors, fit the data well and significantly better than either the one or two factor models. Path analyses revealed that both baseline severity of grief and anxiety had significant lagged effects and predicted follow-up severity of depression. Symptoms of anxiety appeared distinct from those of depression and grief, and the anxiety, depression and grief factors differentially predicted subsequent symptomatology. These findings suggest a need for more specific identification and treatment of anxiety, depression and grief symptoms within the context of late-life spousal bereavement.

The purpose of this study was to examine the ways in which childhood adversity, attachment and personality styles influenced the likelihood of having an anxiety disorder among aged caregivers for terminally ill spouses. We also sought to determine how childhood adversity and attachment/personality styles jointly influenced the likelihood of developing an anxiety disorder among aged caregivers. Data were derived from semistructured interviews with 50 spouses (aged 60 and above) of terminally ill patients. The Childhood Experience of Care and Abuse (CECA) record provided retrospective, behaviorally based information on childhood adversity. Measures of attachment and personality styles were obtained from self-report questionnaires, and the Structured Clinical Interview for the DSM-III-R (SCID) was used to determine diagnoses for anxiety disorders. Logistic regression models estimated the effects of childhood adversity, attachment/personality disturbances, and the interaction between the two on the likelihood of having an anxiety disorder. Results indicated that childhood adversity and paranoid, histrionic and self-defeating styles all directly increase the odds of having an anxiety disorder as an elderly spousal caregiver. In addition, childhood adversity in conjunction with borderline, antisocial and excessively dependent styles increased the likelihood of having an anxiety disorder. The results indicate the need to investigate further the interaction between childhood experiences and current attachment/personality styles in their effects on the development of anxiety disorders.