Anxiety diagnoses


LASAd12 / LASAd13

Contact: Hannie Comijs

Background
The prevalence of anxiety disorders in older adults is estimated at 10-12% (Beekman et al 1998; Byers et al. 2010) which is comparable with the prevalence of anxiety disorders in younger age groups in the Netherlands (Bijl et al. 1998). Several studies have shown that anxiety greatly affects the quality of life in older persons (e.g. Wetherell et al. 2004) and that it is also associated with an increased use of (non-mental) health care services, even when controlling for physical health status (De Beurs et al 1999).

Measurement instruments in LASA
Anxiety diagnoses are obtained according to a two-stage procedure. At baseline (B-measurement) all persons with a score > 16 on the Center for Epidemiologic Studies Depression scale (CES-D; Beekman et a. 1997), which also screens well for anxiety disorders, and a similarly sized random sample of persons with a CES-D < 16 were approached to participate in a diagnostic interview. For this, the Diagnostic Interview Schedule (DIS, Robins et al. 1981; Dingemans et al. 1985) was used. The DIS is designed for epidemiological research and has been widely used among the elderly. Interviewers were fully trained by certified staff, using the official Dutch translation of the DIS. At the time LASA started, the DSM-III version of the DIS was available in the Netherlands. For economic reasons, the full DIS was not used. The available diagnostic categories are Panic Disorder (PAN), Obsessive Compulsive Disorder (OCD), Generalized Anxiety Disorder (GAD) and Phobic Disorders (PHOB) (both social- and simple phobias). The DIS also includes questions on age at onset, number of episodes, recency of the last episodes and allows making diagnoses over several time-frames.

During the follow-up of LASA, the classification of anxiety disorders changed; therefore the CIDI was introduced to diagnose anxiety disorders according to DSM-IIIR criteria as of the third LASA cycle (1998/99). Most important changes in DSM criteria concerned the timeframe for diagnosing GAD, which changed from one month to six months. At the D and E measurement also Post-Traumatic Stress Disorders were assessed. From the I-measurement on (2015/16) a new version of the CIDI was introduced to diagnose anxiety according to DSM-IV criteria.

At each measurement all persons with a CES-D > 16 at the baseline measurement (B) and with CES-D > 16 at the current measurement are included for the diagnostic interview, which was part of the medical interview. Later the screening procedure changed, and persons were also included when having a score > 8 on the anxiety subscale of the  Hospital Anxiety Depression Scale (HADS-A). In addition, at the D and E measurement also the self-rating inventory for posttraumatic stress disorder (SRIP; Hovens et al. 2000) was used as a screener for Posttraumatic Stress Disorder (PTSD).

Availability of information per wave 1

 

B

C

D

E


2B*

F

G

H



3B*

MB* I*

DIS, anxiety DSM-III

Me

-

-

-

-

-

-

-

-

- -
CIDI, anxiety, DSM-IIIR - - Me Me Me - Me Me Me - -
CIDI, anxiety, DSM-IV - - - - - - - - - - Me

1More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort (Under Construction);
   I=Under Construction

Me=data collected in medical interview

Previous use in LASA
Studies have been performed on the prevalence of anxiety disorders (Beekman et al 1998) and its comorbidity with depression and its risk factors (Beekman et al. 2000; Van Balkom et al. 2000). Other studies focussed on the consequences of anxiety disorders (De Beurs et al 1999) and the course of anxiety (Schuurmans et al. 2005). In addition, van Hout et al. (2004) studied anxiety disorders and the risk of death. The results showed for men, but not for women, an increased mortality risk anxiety disorders (Hout et al. 2004).

References

  1. Beekman AT, Deeg DJ, Van Limbeek J, Braam AW, De Vries MZ, Van Tilburg W. Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med. 1997, 27(1):231-235.
  2. Beekman AT, Bremmer MA, Deeg DJ, van Balkom AJ, Smit JH, de Beurs E, van Dyck R, van Tilburg W. Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. Int J Geriatr Psychiatry. 1998, 13(10):717-726.
  3. Beekman AT, de Beurs E, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W.Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am J Psychiatry. 2000, 157(1):89-95.
  4. Bijl RV, Ravelli A, Van Zessen G. Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998, 33:587– 595.
  5. Byers AL, Yaffe K, Covinsky KE, Friedman MB, Bruce ML. High occurrence of mood and anxiety disorders among older adults: The National Comorbidity Survey Replication. Arch Gen Psychiatry. 2010, 67(5):489-96.
  6. De Beurs E, Beekman AT, van Balkom AJ, Deeg DJ, van Dyck R, van Tilburg W. Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychol Med. 1999, 29(3):583-593.
  7. Dingemans P, Van Engeland H, Dijkhuis JH & Bleeker JH. De ‘Diagnostic Interview Scale’(DIS). Tijdschrift voor Psychiatrie, 1985, 27 (5): 341-359.
  8. Hovens, JE, Bramsen I, Van der Ploeg HM. Zelfinventarisatielijst Posttraumatische Stressstoornis ZIL Handleiding. Swets Test Publishers, 2000, Lisse.
  9. Robins LN, Helzer JE, Croughan J, Ratcliff K. National Institute of Mental Health Diagnostic Interview Schedule. Arch Gen Psychiatry. 1981, 38:381-390.
  10. Schuurmans J, Comijs HC, Beekman ATF, de Beurs E, Deeg DJH, Emmelkamp PGM, & van Dyck R.  The outcome of anxiety disorders in older people at 6-year follow-up: results from the Longitudinal Aging Study Amsterdam. Act Psychiatr Scand. 2005, 111(6): 420-428.
  11. Van Balkom AJ, Beekman AT, de Beurs E, Deeg DJ, van Dyck R, van Tilburg W.Comorbidity of the anxiety disorders in a community-based older population in The Netherlands. Acta Psychiatr Scand. 2000, 101(1):37-45.
  12. van Hout HP, Beekman AT, de Beurs E, Comijs H, van Marwijk H, de Haan M, van Tilburg W, Deeg DJ. Anxiety and the risk of death in older men and women. Br J Psychiatry. 2004; 185:399-404.
  13. Wetherell JL, Thorp SR, Patterson TL, Golshan S, Jeste DV, Gatz M. Quality of life in geriatric generalized anxiety disorder: a preliminary investigation. J Psychiatr Res 2004, 38:305–312.