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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)...

Abstract

Background

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

Aims

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

Method

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.

Results

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.

Conclusions

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

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Copyright

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: isabelle.carriere@inserm.fr

Footnotes

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Declaration of interest

None.

Footnotes

References

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1 Cuijpers, P., Schoevers, RA. Increased mortality in depressive disorders: a review. Curr Psychiatry Rep 2004; 6: 430–7.
2 Schulz, R., Drayer, RA, Rollman, BL. Depression as a risk factor for non-suicide mortality in the elderly. Biol Psychiatry 2002; 52: 205–25.
3 Dewey, ME, Chen, CM. Neurosis and mortality in persons aged 65 and over living in the community: a systematic review of the literature. Int J Geriatr Psychiatry 2004; 19: 554–7.
4 Holwerda, TJ, Schoevers, RA, Dekker, J., Deeg, DJ, Jonker, C., Beekman, AT. The relationship between generalized anxiety disorder, depression and mortality in old age. Int J Geriatr Psychiatry 2007; 22: 241–9.
5 Markkula, N., Härkänen, T., Perälä, J., Partti, K., Peña, S., Koskinen, S., et al Mortality in people with depressive, anxiety and alcohol use disorders in Finland. Br J Psychiatry 2012; 200: 143–9.
6 Eaker, ED, Sullivan, LM, Kelly-Hayes, M., D'Agostino, RB Sr, Benjamin, EJ. Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study. Psychosom Med 2005; 67: 692–6.
7 Lavretsky, H., Mistry, R., Bastani, R., Gould, R., Gokhman, I., Huang, D., et al Symptoms of depression and anxiety predict mortality in elderly veterans enrolled in the UPBEAT program. Int J Geriatr Psychiatry 2003; 18: 183–4.
8 van Hout, HPJ, Beekman, ATF, de Beurs, E., Comijs, H., van Marwijk, H., de Haan, M., et al Anxiety and the risk of death in older men and women. Br J Psychiatry 2004; 185: 399404.
9 Denollet, J., Maas, K., Knottnerus, A., Keyzer, JJ, Pop, VJ. Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women. J Clin Epidemiol 2009; 62: 452–6.
10 Laan, W., Termorshuizen, F., Smeets, HM, Boks, MP, de Wit, NJ, Geerlings, MI. A comorbid anxiety disorder does not result in an excess risk of death among patients with a depressive disorder. J Affect Disord 2011; 135: 284–91.
11 Ostir, GV, Goodwin, JS. High anxiety is associated with an increased risk of death in an older tri-ethnic population. J Clin Epidemiol 2006; 59: 534–40.
12 Phillips, AC, Batty, GD, Gale, CR, Deary, IJ, Osborn, D., MacIntyre, K., et al Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study. Psychosom Med 2009; 71: 395403.
13 Batterham, PJ, Christensen, H., Mackinnon, AJ. Mental health symptoms associated with morbidity, not mortality, in an elderly community sample. Soc Psychiatry Psychiatr Epidemiol 2012; 47: 7985.
14 Mykletun, A., Bjerkeset, O., Dewey, M., Prince, M., Overland, S., Stewart, R. Anxiety, depression, and cause-specific mortality: the HUNT study. Psychosom Med 2007; 69: 323–31.
15 Ritchie, K., Norton, J., Mann, A., Carrière, I., Ancelin, ML. Late-onset agoraphobia: general population incidence and evidence for a clinical subtype. Am J Psychiatry 2013; 170: 790–8.
16 Thiebaut, AC, Benichou, J. Choice of time-scale in Cox's model analysis of epidemiologic cohort data: a simulation study. Stat Med 2004; 23: 3803–20.
17 Ritchie, K., Artero, S., Beluche, I., Ancelin, ML, Mann, A., Dupuy, AM, et al Prevalence of DSM-IV psychiatric disorder in the French elderly population. Br J Psychiatry 2004; 184: 147–52.
18 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
19 Sheehan, DV, Lecrubier, Y., Sheehan, KH, Amorim, P., Janavs, J., Weiller, E., et al The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (suppl 20): 2233; quiz 34–57.
20 Lecrubier, Y., Sheehan, D., Weiller, E., Amorim, P., Bonara, I., Sheehan, K., et al The Mini International Neuropsychiatric Interview (MINI), a short diagnostic interview: reliability and validity according to the CIDI. Eur Psychiatry 1997; 12: 232–41.
21 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.
22 Spielberger, C. Manual for the Sate-Trait Anxiety Inventory (Form Y). Consulting Psychologists Press, 1983.
23 Radloff, L. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385401.
24 Ryan, J., Carriere, I., Ritchie, K., Stewart, R., Toulemonde, G., Dartigues, JF, et al Late-life depression and mortality: influence of gender and antidepressant use. Br J Psychiatry 2008; 192: 12–8.
25 Folstein, MF, Folstein, SE, McHugh, PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.
26 Ancelin, ML, Carriere, I., Boulenger, JP, Malafosse, A., Stewart, R., Cristol, JP, et al Gender and genotype modulation of the association between lipid levels and depressive symptomatology in community-dwelling elderly (the ESPRIT study). Biol Psychiatry 2010; 68: 125–32.
27 Rosow, I., Breslau, N. A Guttman health scale for the aged. J Gerontol 1966; 21: 556–9.
28 Lawton, MP, Brody, EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179–86.
29 Mykletun, A., Bjerkeset, O., Øverland, S., Prince, M., Dewey, M., Stewart, R. Levels of anxiety and depression as predictors of mortality: the HUNT study. Br J Psychiatry 2009; 195: 118–25.
30 Roest, AM, Martens, EJ, Denollet, J., de Jonge, P. Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med 2010; 72: 563–9.
31 Meyer, T., Buss, U., Herrmann-Lingen, C. Role of cardiac disease severity in the predictive value of anxiety for all-cause mortality. Psychosom Med 2010; 72: 915.
32 Watkins, LL, Blumenthal, JA, Babyak, MA, Davidson, JR, McCants, CB Jr, O'Connor, C., et al Phobic anxiety and increased risk of mortality in coronary heart disease. Psychosom Med 2010; 72: 664–71.
33 Flint, AJ. Anxiety and its disorders in late life: moving the field forward. Am J Geriatr Psychiatry 2005; 13: 36.
34 Wolitzky-Taylor, KB, Castriotta, N., Lenze, EJ, Stanley, MA, Craske, MG. Anxiety disorders in older adults: a comprehensive review. Depress Anxiety 2010; 27: 190211.
35 Gill, TM, Gahbauer, EA, Han, L., Allore, HG. Trajectories of disability in the last year of life. N Engl J Med 2010; 362: 1173–80.
36 Ryan, J., Scali, J., Carriere, I., Scarabin, PY, Ritchie, K., Ancelin, ML. Estrogen receptor gene variants are associated with anxiety disorders in older women. Psychoneuroendocrinology 2011; 36: 1582–6.
37 Ryan, J., Canonico, M., Carcaillon, L., Carriere, I., Scali, J., Dartigues, JF, et al Hormone treatment, estrogen receptor polymorphisms and mortality: a prospective cohort study. PLoS One 2012; 7: e34112.
38 Chrousos, GP. Stress and disorders of the stress system. Nat Rev Endocrinol 2009; 5: 374–81.
39 Chrousos, GP. Stress and sex versus immunity and inflammation. Sci Signal 2010; 3: pe36.
40 Otte, C., Hart, S., Neylan, TC, Marmar, CR, Yaffe, K., Mohr, DC. A meta-analysis of cortisol response to challenge in human aging: importance of gender. Psychoneuroendocrinology 2005; 30: 8091.
41 Chaudieu, I., Beluche, I., Norton, J., Boulenger, JP, Ritchie, K., Ancelin, ML. Abnormal reactions to environmental stress in elderly persons with anxiety disorders: evidence from a population study of diurnal cortisol changes. J Affect Disord 2008; 106: 307–13.
42 Pitsavos, C., Panagiotakos, DB, Papageorgiou, C., Tsetsekou, E., Soldatos, C., Stefanadis, C. Anxiety in relation to inflammation and coagulation markers, among healthy adults: the ATTICA study. Atherosclerosis 2006; 185: 320–6.
43 Carriere, I., Dupuy, AM, Lacroux, A., Cristol, JP, Delcourt, C. Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people. J Am Geriatr Soc 2008; 56: 840–6.
44 Lenze, EJ, Wetherell, JL. A lifespan view of anxiety disorders. Dialogues Clin Neurosci 2011; 13: 381–99.
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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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eLetters

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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