Research report
Clinical correlates of anxious depression among elderly patients with depression

https://doi.org/10.1016/j.jad.2005.10.007Get rights and content

Abstract

Objective

The purpose of this study was to determine the clinical correlates of comorbid anxiety and depression in a sample of older patients with major depression.

Methods

352 patients aged 59 and older with major depression were enrolled in the Study of Depression in Later Life at Duke University, of whom 148 met criteria for lifetime generalized anxiety disorder. Participants completed self-report assessments of performance in basic and instrumental activities of daily living, social support, suicidal ideation, life satisfaction, and stressful life events. Cognitive assessment was done with the Mini-Mental State Examination.

Results

The prevalence of lifetime anxiety in our depressed sample was 42%. Patients with anxious depression were significantly younger, and had greater suicidal ideation, more impairment of subjective social support, and more severe depressive symptoms.

Conclusion

In elderly patients with anxious depression, psychosocial support and suicidal ideation should be assessed. Whether improvement of subjective social support leads to reduction in anxious depression should be investigated.

Introduction

Published studies report contradictory findings in terms of the prevalence of comorbid anxiety and depression and its association with clinical variables such as suicidal risk and response to treatment in elderly persons. Flint (1994) reviewed eight random-sample community surveys of anxiety disorders among patients 60 years or older, and noted the prevalence of anxiety disorders among the elderly to be lower than that in younger adults. He found that generalized anxiety disorder (GAD) and phobias accounted for most anxiety disorders in later life, and that panic disorder was rare. Mulsant et al. (1996) examined 336 older patients with major depression and estimated that one-third to one-half of them presented with severe symptomatic anxiety, but fewer than 5% met diagnostic criteria for lifetime or current phobic, panic, or obsessive–compulsive disorders. Lenze et al. (2000) studied 182 elderly depressed patients and found higher rates of current (23%) and lifetime (35%) anxiety disorders, mostly phobias and panic disorder. They estimated that one-third of the patients with major depression met symptomatic or inclusion criteria for GAD. In an investigation of 3056 elderly persons in the Netherlands, 47.5% of individuals with depression met criteria for anxiety disorders as well (Beekman et al., 2000).

Several studies have reported an association between anxious depression in elderly with higher levels of somatic symptoms (Lenze et al., 2000), disability (Ormel et al., 1998, Lenze et al., 2001), rate of suicide (Allgulander and Lavori, 1993), and impaired social function (Lenze et al., 2000), compared to non-anxious depressed patients. In contrast, Flint and Rifat (2002) found that only severity of depression, but not chronic medical burden, cognitive function, or psychosocial support, had a clinically significant association with anxiety in elderly patients. Beekman et al. (2000) observed that functional limitations, external locus of control, bereavement, and family histories of affective disorders, anxiety disorders, substance abuse, and conduct disorders were associated with anxious depression. Some investigators have reported greater risk of suicide in adults with depression plus anxiety disorder than in those with either condition alone (Fawcett, 1992, Andrade et al., 1994, Allgulander and Lavori, 1993). Lenze et al. (2000) noted that symptoms of GAD during episodes of depression were associated with greater severity of depressive symptoms including suicidal ideation, but subjects with comorbid anxiety disorders other than GAD did not have increased suicidal ideation. Several reports suggest that adults with anxious depression tend to have less positive treatment outcomes including slower or diminished responses (Gorman, 1997, Flint and Rifat, 1997, Mulsant et al., 1996) compared to non-anxious depressed subjects. On the other hand, Lenze et al. (2003) found no association between comorbidity and treatment response. In a recent study, Schoevers et al. (2005) suggested a dimensional rather than a categorical classification of anxiety and depression.

The present study sought to determine the prevalence and clinical correlates of anxious depression among elderly patients with major depression. We hypothesized that a family history of psychiatric disorder or treatment, suicidal ideation, and impaired social interaction would be associated with anxious depression.

Section snippets

Methods

All the study subjects were participants in the Mental Health Clinical Research Center for the Study of Depression in Later Life at Duke University from 1995 through 2003. We screened inpatients and outpatients of the Duke University Psychiatric Service aged 59 or older, with a previous diagnosis of mood disorder or those with clinically significant depressive symptoms — i.e., a score of 16 or above on the Center for Epidemiologic Studies of Depression (CES-D) scale (Radloff, 1977). All the

Results

Of the 352 patients with major depression, 42% endorsed comorbid anxiety. Individuals with anxious depression were significantly younger (Table 1). With each additional year of life, subjects were 5% less likely to exhibit comorbid anxious depression. The anxious depressed patients had more suicidal ideation, more severely impaired subjective social support, and also had a higher CES-D score (mean 33.1, SD 11.2 compared to 28.5, with SD 11.9; df = 346; t = 3.31; p < .001) than non-anxious depressed

Discussion

The prevalence of anxious depression in our sample of older adults with unipolar depression was 42%. This is similar to that reported by Beekman et al. (2000), but much higher than that noted by Mulsant et al. (1996) and Lenze et al. (2000). Patients with anxious depression in our sample were significantly younger than those with non-anxious depression. Unlike Beekman et al. (2000), we found that family histories of mental disorder, psychiatric treatment, or alcohol abuse were not related to

Acknowledgement

This work was supported, in part, by the National Institute of Mental Health grants P50 MH60451, R01, MH54846, and K24 MH70026.

References (24)

  • A.T. Beekman et al.

    Anxiety and depression in later life: co-occurrence and communality of risk factors

    Am. J. Psychiatry

    (2000)
  • J. Fawcett

    Suicide risk factors in depressive disorders and in panic disorder

    J. Clin. Psychiatry

    (1992)
  • Cited by (53)

    • Disruption of the structural and functional connectivity of the frontoparietal network underlies symptomatic anxiety in late-life depression

      2020, NeuroImage: Clinical
      Citation Excerpt :

      Depressed elderly individuals frequently suffer from concurrent symptoms of anxiety [35]. Evidence suggests that comorbid anxiety in LLD predicts severe, persistent, and treatment-resistant depressive illness [36] and suicidal ideation [37]. A recent neuroimaging study showed that anxiety symptoms are associated with smaller insular and orbitofrontal cortex volumes in LLD patients [38].

    • Anxiety symptoms are associated with smaller insular and orbitofrontal cortex volumes in late-life depression

      2019, Journal of Affective Disorders
      Citation Excerpt :

      Furthermore, among those with late-life depression (LLD), rates of comorbid anxiety symptoms are as high as 50% (Beekman et al., 2000; Lenze et al., 2000; Livingston et al., 1997). Existing studies of adults with LLD suggest that comorbid anxiety predicts more severe, persistent, and treatment-resistant depressive illness (Andreescu et al., 2007; Schoevers et al., 2003), greater cognitive decline (DeLuca et al., 2005), more disability (Schoevers et al., 2003), and more suicidal ideation (Jeste et al., 2006). These results underscore the importance of identifying the psychophysiological correlates of anxiety symptoms in LLD (Fiske et al., 2009; Lenze et al., 2000).

    • Anxiety and somatic symptoms among elderly patients with depression

      2019, Asian Journal of Psychiatry
      Citation Excerpt :

      Some of the studies have estimated that about one-third of elderly patients with depression, if assessed properly have comorbid anxiety disorders, mainly in the form of generalized anxiety disorder (GAD) (Beekman et al., 2000; Lenze et al., 2000). Additionally, these studies suggest that higher prevalence of anxiety symptoms are also associated with more somatic symptoms (Lenze et al., 2000), more disability (Ormel et al., 1998), poorer psychosocial support and more suicidality (Jeste et al., 2006). Due to this close association of co-morbid depression and anxiety or depression with significant anxiety symptoms among elderly is also known as ‘anxious depression’ (Silverstone and Von Studnitz, 2003).

    View all citing articles on Scopus
    View full text