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Anxiety and mortality risk in community-dwelling elderly people

  • Isabelle Carrière (a1), Joanne Ryan (a2), Joanna Norton (a1), Jacqueline Scali (a1), Robert Stewart (a3), Karen Ritchie (a4) and Marie Laure Ancelin (a1)...



There are conflicting data on the role of anxiety in predicting mortality.


To evaluate the 10-year mortality risk associated with anxiety in community-dwelling elderly people.


Using data from 718 men and 1046 women aged 65 years and over, gender-stratified associations of anxiety symptoms (Spielberger State–Trait Anxiety Inventory, third tertile) and current DSM-IV anxiety disorder including generalised anxiety disorder (GAD) and phobia with all-cause and cardiovascular mortality were determined.


In women, mortality risk was increased for anxiety disorder and GAD in multivariate Cox models (hazard ratio (HR) = 1.53, 95% Cl 1.02-2.27 and HR = 2.04, 95% Cl 1.08-3.86 respectively), whereas for phobia it was nearly significant (HR= 1.52, 95% Cl 0.94-2.47). Anxiety trait symptoms became non-significant as a result of the confounding effect of depressive symptoms. Anxiety disorder was associated with cardiovascular mortality in univariate analysis (HR = 2.42, 95% Cl 1.16-5.07). No significant associations were found in men.


Our study suggests a gender-specific association of anxiety and mortality.

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Corresponding author

Isabelle Carrière, Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, Hôpital La Colombière, 39 Avenue Charles Flahault, BP 34493, 34093 Montpellier cedex 05, France. Email:


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Anxiety and mortality risk in community-dwelling elderly people

  • Isabelle Carrière (a1), Joanne Ryan (a2), Joanna Norton (a1), Jacqueline Scali (a1), Robert Stewart (a3), Karen Ritchie (a4) and Marie Laure Ancelin (a1)...


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Anxiety and mortality risk in community-dwelling elderly people

  • Isabelle Carrière (a1), Joanne Ryan (a2), Joanna Norton (a1), Jacqueline Scali (a1), Robert Stewart (a3), Karen Ritchie (a4) and Marie Laure Ancelin (a1)...
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Re:Anxiety and mortality in the elderly

Isabelle Carriere, Research Fellow
07 February 2014

Author's reply: Anxiety and mortality risk in community-dwelling elderly people.

We thank R. Euba for his comment on our paper which gives us the opportunity to clarify several points. We agree that in observational studies residual confounding bias may subsist. However to take into account this potential drawback with anxietybeing a consequence of prior vascular changes we carefully adjusted the models for a large number of confounding factors including vascular risk factors and cardiovascular diseases and the association in women remained significant. The second argument of failing health and proximity of death does not hold as at baseline (time of anxiety evaluation), our sample consisted of high-functioning community-dwelling elderly persons physically and psychologically able to travel to the medical center. A careful examination of the Kaplan Meier curves (fig 1) also indicates thatvery few deaths occurred during the first two years of follow-up. Lastly RE raises the question of statistical power to explain the absence of a significant association in men. In survival analysis, the statistical power depends on the number of events (i.e. deaths) and in our sample the frequency of deaths is higher in men (162/702 vs. 136/1006 in women). A power calculation for anxiety disorders shows that we could have detected an unadjusted relative risk of 1.65 in women and 1.71 in men with an alpharisk of 0.05 and a power of 0.80. The analysis in men is thus not under-powered and if an association with mortality exists in men it is less strong than in women. With ageing, people face multiple adverse events including physical multi-morbidity and loss of capacities. Personal resources, such as self-efficacy, sense of mastery or control beliefs, and psychological resilience are important in the process of coping with a chronic disease. On the other hand anxiety disorders, irrespective of the etiology, could clearly contribute to a worse outcome. This underlines the importance of developing interventions for older persons aimed at maintaining or improving psychological coping resources when health declines.Up to now very few well-designed studies have been performed with such a large population sample, capable of controlling for main confounders and using a validated anxiety diagnosis including anxiety sub-types. Although future research is needed to confirm our results and the gender specific association, our study also stresses the importance of including anxiety diagnostic tools in population based cohorts to improve the understanding of the consequences of anxiety in late life.

Isabelle Carriere on behalf of the authors

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Conflict of interest: None declared

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Anxiety and mortality in the elderly

Rafael Euba, Consultant Old Age Psychiatrist
03 November 2013

Dear Sir,

Carriere et al.'s study shows an interesting association between anxiety and mortality in elderly females. The authors propose a series of possible biological mechanisms for this association, suggesting a direction of causality in which mortality is the consequence of the impactthat anxiety has on the endocrine and cardiovascular systems. However, anxiety can be the psychiatric expression of vascular changes in the brainthat may eventually lead to death. A failing health in old age is also a painful reminder of the proximity of death, which will frequently induce feelings of anxiety in the sufferer. The fact that this association was only significant for females could be an artefact due to the much higher prevalence of anxiety amongst females. Thus, anxiety may well be - at least in a proportion of the cases- the consequence, rather than the causeof ill health.

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Conflict of interest: None declared

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