Longitudinal association between social anxiety disorder and incident alcohol use disorder : Results from two national samples of US adults
- Authors: Miloyan, Beyon , Van Doorn, George
- Date: 2019
- Type: Text , Journal article
- Relation: Social Psychiatry and Psychiatric Epidemiology Vol. 54, no. 4 (2019), p. 469-475
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- Description: This study assessed the association between subclinical social fears and a 12-month diagnosis of Social Anxiety Disorder (SAD) at baseline and the risk of incident Alcohol Use Disorder (AUD) at follow-up, compared to those without subclinical social fears and a 12-month diagnosis of SAD. We performed an individual participant meta-analysis based on data from two national longitudinal surveys. Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) was conducted in 2001–2002 in a sample of 43,093 adults and Wave 2 was conducted in 2004–2005 in 34,653 of the original respondents. Wave 1 of the National Comorbidity Survey was conducted in 1990–1992 in a sample of 8098 respondents and Wave 2 was conducted in 2001–2002 in 5001 of the original respondents. Binary logistic regression analyses were performed independently in each study and then the effect estimates were combined using random-effects meta-analysis. Neither subclinical social fears nor 12-month SAD at baseline were associated with incident AUD at follow-up. These findings conflict with reports of previous studies that a diagnosis of SAD is a risk factor for AUD in adults, and suggest that subclinical social fears are not associated with differential risk of incident AUD.
A reassessment of the relationship between depression and all-cause mortality in 3,604,005 participants from 293 studies
- Authors: Miloyan, Beyon , Fried, Eiko
- Date: 2017
- Type: Text , Journal article
- Relation: World psychiatry : Official Journal of the World Psychiatric Association (WPA) Vol. 16, no. 2 (2017), p. 219-220
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Future-oriented thought patterns associated with anxiety and depression in later life : The intriguing prospects of prospection
- Authors: Miloyan, Beyon , Pachana, Nancy , Suddendorf, Thomas
- Date: 2017
- Type: Text , Journal article
- Relation: Gerontologist Vol. 57, no. 4 (2017), p. 619-625
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- Description: Anxiety and mood disorders in later life are the focus of an increasing amount of intervention research, however basic mechanisms and paradigms explaining etiology and maintenance warrant further exploration. Research on future-oriented thought patterns associated with anxiety and depression in this age group may prove useful, as these disorders are both characterized by a tendency to generate and fixate on threat-related future scenarios that may or may not materialize. Additionally, depression is associated with a reduced expectancy of positive future events. In this paper, we review the literature relevant to future thinking in anxiety and depression in older adults. We focus on the mental construction and anticipation of negative future events, and their underlying neurocognitive mechanisms. We then consider clinical and research implications of anxious and depressive future-oriented thought patterns for older adults. We believe that more research investigating future-oriented thought patterns associated with emotional disorders in later life could improve conceptualization, measurement, and perhaps potential treatments for late-life anxiety and depression. © 2016 The Author.
Anxiety disorders and all-cause mortality : Systematic review and meta-analysis
- Authors: Miloyan, Beyon , Bulley, Adam , Bandeen-Roche, Karen , Eaton, William , Goncalves-Bradley, Daniela. C.
- Date: 2016
- Type: Text , Journal article
- Relation: Social Psychiatry and Psychiatric Epidemiology Vol. 51, no. 11 (2016), p. 1467-1475
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- Description: PURPOSE: The purpose of this study was to perform a systematic review and meta-analysis of prospective cohort studies that examined the relationship between anxiety disorders, or clinically significant anxiety symptoms, at baseline and all-cause mortality at follow-up relative to control participants without clinically significant anxiety. METHODS: PubMed, EMBASE, PsycInfo, and CINAHL were searched through July 2015, along with manual searches of published reviews and forward and backward snowball searches of included studies. Studies were excluded if anxiety was not defined with a standardized instrument, or if participants were followed-up for 1 year or less. The initial search yielded 7901 articles after the removal of duplicates, of which 328 underwent full-text screening. RESULTS: Forty-two estimates from 36 articles were included in the meta-analysis with a total sample of 127,552 participants and over 11,573 deaths. The overall hazard ratio (HR) estimate of mortality in clinically anxious participants relative to controls was 1.09 (95 % CI 1.01-1.16); however, this was reduced after adjusting for publication bias (1.03; 95 % CI 0.95-1.13). There was no evidence of increased mortality risk among anxious participants derived from community samples (0.99; 95 % CI 0.96-1.02) and in studies that adjusted for a diagnosis of depression (1.01; 95 % CI 0.96-1.06). CONCLUSIONS: These findings suggest that positive associations in the literature are attributable to studies in smaller samples, comorbid depression (or other psychiatric conditions) among participants, and possible confounding in medical patient samples followed-up for short durations.
Clinical significance of individual GAD symptoms in later life
- Authors: Miloyan, Beyon , Pachana, Nancy
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Geriatric Psychiatry and Neurology Vol. 29, no. 2 (2016), p. 92-98
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- Description: Background: There are age-related differences in the manifestation of generalized anxiety disorder (GAD) symptoms and their associated impact on psychosocial and functional status. However, it remains unclear whether specific symptoms (or symptom patterns) are of comparable clinical significance across different functional domains. Methods: A sample of 865 self-reported worriers (aged 60 years and older) who endorsed GAD screening questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were derived from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. Results: Being easily fatigued was significantly associated with occupational disability and a functional disability variable (restricting usual activity in any way). Irritability was significantly associated with social friction (arguments with friends, family, or colleagues) and a functional disability variable (found was unable to do something wanted to do), and poor self-perceived health was also associated with the same functional disability variable. Excessive worry, despite being among the least reported symptoms, was significantly associated with distress. Conclusions: These findings suggest that individual GAD symptoms are differentially associated with aspects of clinical significance relevant to daily life, such as social, occupational, and functional ability. The differential impact of individual symptoms on functional status may be diluted when using symptom sum scores. A nuanced approach to assessing the clinical significance of individual GAD symptoms in older adults may be fruitful for efforts aimed at early detection and treatment. © 2015 SAGE Publications.
Clinical significance of worry and physical symptoms in late-life generalized anxiety disorder
- Authors: Miloyan, Beyon , Pachana, Nancy
- Date: 2015
- Type: Text , Journal article
- Relation: International Journal of Geriatric Psychiatry Vol. 30, no. 12 (2015), p. 1186-1194
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- Description: Objective Worry is a hallmark feature of generalized anxiety disorder (GAD). However, age-related changes in symptom presentation raise questions about the clinical significance of these symptom clusters in later life. The aim of this study was to explore the relative contribution of worry and physical symptom frequency to clinical significance associated with late-life GAD. Methods A sample of 637 self-reported worriers (aged 65 years and older) was extracted from Wave 1 of the National Epidemiological Survey of Alcohol and Related Conditions. Results Consistent with previous findings, we observed reductions in worry frequency and increases in physical symptom frequency with increasing age of participants. Physical symptoms, but not worry symptoms, distinguished older adults with clinical and sub-threshold GAD. Whereas physical symptom count was associated with distress, occupational, and functional disability, worry count was only associated with distress. Conclusions Among self-reported worriers, worry frequency provides limited clinical utility over and above physical symptom frequency. These findings suggest that physical symptom frequency may become an increasingly important feature of GAD in later life. Copyright © 2015 John Wiley & Sons, Ltd.
Threshold and subthreshold generalized anxiety disorder in later life
- Authors: Miloyan, Beyon , Byrne, Gerard , Pachana, Nancy
- Date: 2015
- Type: Text , Journal article
- Relation: American Journal of Geriatric Psychiatry Vol. 23, no. 6 (2015), p. 633-641
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- Description: Objective Symptoms and disorders of anxiety are highly prevalent among older adults; however, late-life anxiety disorders remain underdiagnosed. The objective of this study was to (1) estimate the prevalence of late-life threshold and subthreshold generalized anxiety disorder (GAD), (2) examine sociodemographic and health correlates associated with membership in these groups, (3) assess 3-year conversion rates of these groups, and (4) explore characteristics associated with 3-year conversion to GAD. Methods Using Waves 1 and 2 of the National Epidemiological Survey of Alcohol and Related Conditions, 13,420 participants aged 55-98 years were included in this study. Results Subthreshold GAD was more highly prevalent than threshold GAD and was interposed between asymptomatic and GAD groups in terms of severity of health characteristics. Although most participants with subthreshold and threshold GAD were asymptomatic by Wave 2, differences in disability persisted. Subthreshold GAD at baseline was not a predictor of threshold GAD at follow-up. Conclusion These findings suggest that late-life GAD should be conceptualized as a dimensional rather than categorical construct. The temporal stability of anxiety-associated disability further suggests that subthreshold GAD bears clinical significance. However, the suitability and efficacy of interventions for minimizing negative sequelae in this group remain to be determined.