[Diagnosis, epidemiology and comorbidity of anxiety disorders]

[Article in German]

Wacker HR.

Psychiatrische Universitatspoliklinik Basel.

Fears and apprehensions which significantly impair a person's everyday life and which cannot be attributed to an organic brain disturbance or to other mental disorders or physical problems are grouped together in the class of "anxiety disorders". Three types of anxiety disorders can be distinguished on the basis of clinical picture and the course of development of symptoms: phobias, panic disorder and generalized anxiety disorder. Recent epidemiological studies indicate that anxiety disorders are one of the most common kinds of mental disorder. More than a fourth of the persons surveyed in a general population have suffered from an anxiety disorder at some point in their lives. Phobias occur most frequently, with social phobias being the most common according to the latest studies (lifetime prevalence of 13.3% to 16%). The lifetime prevalence of panic disorder is estimated at 1.2% to 3.5%, depending on the diagnostic system (DSM-III-R, ICD-10) and survey instruments used. Generalized anxiety disorder is estimated to have a lifetime prevalence of between 1.9% and 6.6%. Overall, anxiety disorders tend to occur more often in women than in men. Onset is usually in childhood or adolescence. All anxiety disorders have a high lifetime comorbidity with other mental disorders. The frequency of anxiety disorders occurring in combination with affective disorders and substance abuse and dependence over the span of a lifetime is significantly high. Increased risk of suicide is an important factor to consider when assessing these patients, especially in the case of panic disorder or social phobias.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9432744&dopt=Abstract anxiety medicine




Characterizing generalized anxiety: temporal and symptomatic thresholds.

Bienvenu OJ, Nestadt G, Eaton WW.

School of Hygiene and Public Health, Department of Mental Hygiene, Johns Hopkins University, Baltimore, Maryland 21205-1999, USA.

We compared demographic and comorbidity profiles of subjects with varying levels of anxiety pathology to test if the clinical characteristics of generalized anxiety disorder (GAD) subjects differed from those of other subjects with generalized anxiety. Using Diagnostic Interview Schedule data from the 1993 follow-up study of the Baltimore cohort of the Epidemiologic Catchment Area Program, we divided subjects into the following five mutually exclusive symptom categories: a) DSM-III-R GAD; b) 6 months of worry or anxiety with six associated symptoms; c) 1 month of anxiety with or d) without six symptoms; and e) no anxiety. The first three groups were homogeneous with regard to demographic and comorbidity profiles, but their profiles differed from those of subjects with no anxiety or fewer than six symptoms. Thus, requiring six symptoms produced a group with a particular epidemiologic profile. Neither the nature of the subjects' worries nor the duration of symptoms influenced this profile. These results are discussed in terms of GAD's construct validity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9457147&dopt=Abstract anxiety medicine




The Japanese adaptation of the STAI Form Y in Japanese working adults--the presence or absence of anxiety.

Iwata N, Mishima N, Shimizu T, Mizoue T, Fukuhara M, Hidano T, Spielberger CD.

Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.

Symptom endorsements and response patterns of 1,862 Japanese adult workers (1,509 males and 353 females) to the Japanese adaptation of the State-Trait Anxiety Inventory Form Y (STAI-JY) items, were examined in this study. The mean STAI-JY State and Trait anxiety scores of Japanese workers were substantially higher than those of American workers reported in the Manual, due primarily to the much higher scores of Japanese workers in responding to the anxiety-absent items. The correlations between the State and Trait anxiety-present scales and those of their anxiety-absent scales' counterparts were higher than those between the State anxiety-present and -absent scales and those of their Trait scales' counterparts. These findings suggested that responses to anxiety-present and -absent items should be considered independently in scoring the STAI-JY scales in Japanese working adults.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9473852&dopt=Abstract anxiety medicine




Confirmatory factor analysis of the Beck Anxiety and Depression Inventories in patients with major depression.

Enns MW, Cox BJ, Parker JD, Guertin JE.

Department of Psychiatry, PZ 430 PsycHealth Centre, University of Manitoba, Winnipeg, Canada.

The Beck Anxiety Inventory (BAI; Beck, A.T., Epstein, N., Brown, G., Steer, R.A., 1988. An inventory for measuring clinical anxiety: psychometric properties. J. Consult. Clin. Psychol. 56, 893-897) is intended to assess clinical anxiety symptoms that are distinct from depressed mood, and there is some preliminary empirical support for this differential assessment. The BAI may serve a useful complementary role when used with the popular Beck Depression Inventory (BDI; Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G., 1979. Cognitive Therapy of Depression: A Treatment Manual. Guilford Press, New York, NY; Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., Erbaugh, J., 1961. An inventory for measuring depression. Arch. Gen. Psychiatry 4, 561-571), in patients with mood and/or anxiety disorders. Accordingly, the present paper reports the results of the first confirmatory factor analysis of the Beck scales in a homogeneous, clinically depressed sample (137 outpatients with non-psychotic major depressive disorder). Results indicated that a multidimensional model of separate anxiety and depression factors had good fit to the data. However, the parameter estimate was very high (0.784) and a unidimensional, single-factor model of negative affectivity approached the criteria for good fit. It was concluded that the Beck Anxiety and Depression Inventories assess distinct anxiety and depression phenomena to a limited extent when used in a clinically depressed sample.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9476761&dopt=Abstract anxiety medicine




Submarine escape: the effect of training on anxiety.

van Wijk C.

South African Medical Services, Department of Psychology, Institute of Maritime Medicine, Simon's Town, Republic of South Africa.

Student submariners in the South African Navy often report increased anxiety when confronted with the complicated nature of the submarine escape equipment and procedures. It was hypothesized that training should reduce this anxiety. This report describes part of the training process of the South African Navy, as well as a short investigation of the effect of training on anxiety. The investigation focused on state and trait anxiety, as well as overt and covert anxiety. Student submariners in the South African Navy were evaluated with the IPAT Anxiety Scale and the State-Trait Anxiety Inventory before their submarine escape training. On the completion of their training, these instruments were again administered. Results suggested a decrease in overt and covert anxiety as well as trait anxiety. Although the first two results can be attributed to the effect of training, the change in subjects' trait anxiety remains unexplained.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9503894&dopt=Abstract anxiety medicine




Gender differences in anxiety disorders and anxiety symptoms in adolescents.

Lewinsohn PM, Gotlib IH, Lewinsohn M, Seeley JR, Allen NB.

Oregon Research Institute, Eugene 97403-1983, USA. pete ori.org

Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means.

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The nature and prevalence of anxiety disorders in primary care.

Nisenson LG, Pepper CM, Schwenk TL, Coyne JC.

Department of Psychiatry, University of Michigan Medical Center, Ann Arbor 48109-0708, USA.

Primary goals of this study were to 1) establish the prevalence, nature, and correlates of anxiety disorders in primary care, and 2) examine the comorbidity of anxiety disorders with major depressive disorder. A weighted sample of 425 patients drawn from the waiting rooms of primary care physicians was used. Anxiety disorders were highly prevalent, relatively mild, and often comorbid with depression. Anxiety disorders aided physicians in their detection of depression. However, anxiety disorders were also misdiagnosed as depression. Although anxiety disorders are common in primary care, their relative mildness may generally not warrant increased attention by primary care physicians to detection and treatment. Instead, efforts should be focused on the more severe and impairing cases of anxiety disorder.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9506251&dopt=Abstract anxiety medicine




Functional status in coronary artery disease: a one-year prospective study of the role of anxiety and depression.

Sullivan MD, LaCroix AZ, Baum C, Grothaus LC, Katon WJ.

Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA.

PURPOSE: Although coronary disease is the second most common cause of work and functional disability, little is known about the relative contributions of biomedical and psychosocial factors to this disability. This study was conducted to determine the associations of depression and anxiety with self-reported physical function and activity interference in patients with coronary artery disease. METHODS: This was a 1-year prospective cohort study of 198 HMO members who had elective cardiac catheterization for coronary artery disease in 1992. Measures included: severity of coronary artery stenosis from cardiac catheterization reports; anxiety and depression severity using interviewer-administered Hamilton Anxiety and Depression Rating Scales; and self-reported physical function and activity interference. RESULTS: At the time of catheterization, patients' self-reported physical function differed significantly by number of main coronary vessels stenosed >70% (P <0.03), by anxiety quartiles (P = 0.001), and by depression quartiles (P = 0.001). At 1 year, physical function was no longer associated with the number of main coronary vessels stenosed at baseline, but still was significantly associated with baseline anxiety (P <0.001) and depression quartiles (P = 0.01). Moreover, change in physical function scores from baseline to 12 months was associated with baseline anxiety (P <0.001) or depression (P <0.001) quartiles, but not with baseline number of occluded coronaries. Results for activity interference were similar to those for physical function. These associations were largely unchanged when corrected for age, sex, education, social class, medical versus surgical management of CAD, and degree of medical comorbidity. CONCLUSION: Anxiety and depression have a significant and persistent effect on physical function in patients with coronary artery disease. Although current treatment methods appear to neutralize the influence of coronary stenosis on physical function during the year following catheterization, this is not true for anxiety and depression.

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Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital.

Aass N, Fossa SD, Dahl AA, Moe TJ.

Department of Medical Oncology and Radiotherapy, Oslo, Norway.

The aim of this study was to investigate the prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital, using the Hospital Anxiety and Depression Scale (HADS), the EORTC QLQ-C33 and an ad hoc designed questionnaire. In addition, information about the patients' malignant disease and treatment was obtained. The prevalence of anxiety and depression among 716 evaluable patients was 13% and 9% respectively, as assessed with HADS. In hospitalised patients, the risk of psychiatric distress was approximately twice that of patients in the outpatient clinic. Female patients reported significantly more anxiety than men. Patients < 30 or > 70 years old expressed less anxiety than all other patients. Age or gender had no influence on the occurrence of depression. Impaired ability to continue professional work and/or daily life activities, impaired social life and previous psychiatric problems were significantly correlated with anxiety and depression as were impaired physical function, fatigue and pain. The prevalence of depression, but not anxiety, increased in the presence of distant metastases, with less than a month since diagnosis, and with relapse or progression. In the logistic regression analysis, a history of previous psychiatric problems and impaired social life were correlated with both anxiety and depression. Female gender, impaired physical activity and impaired social role function were additional predictive parameters for anxiety, whereas fatigue predicted depression. Careful attention should be paid to cancer patients displaying these problems in order to diagnose and treat depression and anxiety disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9389921&dopt=Abstract anxiety medicine