Anxiety Disorders

Epidemiology

EpdAnxiety disorders are highly prevalent, affecting approximately 9% of the population of the USA (Regier et al, 1988), and estimates suggest that 19.5% of women and 8% of men (Robins et al, 1984) have an anxiety disorder. Depression is commonly concurrent with anxiety disorders, and 20–65% of people with anxiety also become depressed. Furthermore, more than 95% of people with depression have at least one symptom of anxiety: 29% reported panic attacks and 42% experienced somatic anxiety. The most common anxiety disorders accompanying depression are panic disorder, generalised anxiety disorder (GAD) and social anxiety disorder (SAD) (Fawcett and Kravitz, 1993).

Read more about comorbidities of anxiety disorders.

Traditionally, it was thought that anxiety disorders are less prevalent in the elderly than among younger adults and that late-onset anxiety disorders are rare (Palmer et al, 1997). However, estimating the precise prevalence of anxiety disorders in the elderly is greatly complicated by numerous other psychiatric and medical comorbidities found in this age group. Anxiety disorders often present with physical complaints that mask the underlying disorder. Moreover, the diagnostic criteria for anxiety disorders have been developed from studies of younger adults, excluding elderly populations.

Recent epidemiological data suggest that anxiety disorders in the elderly are more prevalent than previously thought. Data on panic disorder, post-traumatic stress disorder (PTSD), phobias, SAD, obsessive compulsive disorder (OCD) and GAD have shown that these disorders are clinically significant in people who are over 65 years of age (Krasucki et al, 1998). The Epidemiologic Catchment Area Study, conducted by the National Institute of Mental Health, indicated that the prevalence of panic disorder, OCD and phobias combined ranged between 5.7% and 33% in the elderly (Jenike, 1996). Phobias were the most common psychiatric disorder in elderly women and the second most common in elderly men and approximately 10–15% of women over the age of 65 experience sufficiently severe anxiety to warrant medical intervention. One survey of community-dwelling elderly subjects found that 20% of the population studied was experiencing troubling levels of anxiety, and in primary care settings anxiety is noted to increase with age, where almost 30% of people in their seventies experience anxiety.

Numerous factors, such as loss of friends and loved ones, failing health, intellectual decline, feelings of helplessness and worthlessness and loss of control over their immediate environment, as well as neurobiological changes with age may make elderly people particularly susceptible to anxiety.