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.
Cognitive behaviour therapy for older adults experiencing insomnia and depression in a community mental health setting: Study protocol for a randomised controlled trial
- Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Jenkins, Megan , Harvey, Jack
- Date: 2015
- Type: Text , Journal article
- Relation: Trials Vol. 16, no. 1 (2015), p.1-12
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- Description: Background: Cognitive behaviour therapy for insomnia (CBT-I) is a well-established treatment; however, the evidence is largely limited to homogenous samples. Although emerging research has indicated that CBT-I is also effective for comorbid insomnia, CBT-I has not been tested among a complex sample of older adults with comorbid insomnia and depression. Furthermore, no study has explored whether modifying CBT-I to target associated depressive symptoms could potentially enhance sleep and mood outcomes. Therefore, this study aims to report a protocol designed to test whether an advanced form of CBT for insomnia and depression (CBT-I-D) is more effective at reducing insomnia and depressive symptoms compared to a standard CBT-I and psychoeducation control group (PCG) for older adults in a community mental health setting. Methods/Design: We aim to recruit 150 older adults with comorbid insomnia who have presented to community mental health services for depression. Eligible participants will be randomly allocated via block/cluster randomisation to one of three group therapy conditions: CBT-I, CBT-I-D, or PCG. Participants who receive CBT-I will only practice strategies designed to improve their sleep, whereas participants who receive CBT-I-D will practice additional strategies designed to also improve their mood. This trial will implement a mixed-methods design involving quantitative outcome measures and qualitative focus groups. The primary outcome measures are insomnia and depression severity, and secondary outcomes are anxiety, hopelessness, beliefs about sleep, comorbid sleep conditions, and health. Outcomes will be assessed at pre-intervention (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Discussion: This CBT study protocol has been designed to address comorbid insomnia and depression for older adults receiving community mental health services. The proposed trial will determine whether CBT-I is more effective for older adults with comorbid insomnia and depression compared to a PCG. It will also establish whether an advanced form of CBT-I-D generates greater reductions in insomnia and depression severity compared to standard CBT-I. The results from the proposed trial are anticipated to have important clinical implications for older adults, researchers, therapists, and community mental health services. Trial registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN: 12615000067572 , Date Registered 12 December 2014. © 2015 Sadler et al.
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.
A 12-month prospective cohort study of symptoms of common mental disorders among European professional footballers
- Authors: Gouttebarge, Vincent , Aoki, Haruhito , Verhagen, Evert , Kerkhoffs, Gino
- Date: 2017
- Type: Text , Journal article
- Relation: Clinical Journal of Sport Medicine Vol. 27, no. 5 (2017), p. 487-492
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- Description: Objective: To determine the 12-month incidence and comorbidity of symptoms of common mental disorders (CMD) among European professional footballers and to explore the association of potential stressors with the health conditions under study among those European professional footballers. Design: Observational prospective cohort study with a follow-up period of 12 months. Participants: Male professional footballers from 5 European countries (n = 384 at baseline). Assessment of Risk Factors: Adverse life events, conflicts with trainer/coach, and career dissatisfaction were explored by using validated questionnaires. Main Outcome Measures: Symptoms of distress, anxiety/depression, sleep disturbance, and adverse alcohol use were assessed using validated questionnaires. Results: A total of 384 players (mean age of 27 years old; mean career duration of 8 years) were enrolled, of which 262 completed the follow-up period. The incidence of symptoms of CMD were 12% for distress, 37% for anxiety/depression, 19% for sleep disturbance, and 14% for adverse alcohol use. Over the follow-up period of 12 months, approximately 13% of the participants reported 2 symptoms, 5% three symptoms, and 3% four symptoms. Professional footballers reporting recent adverse life events, a conflict with trainer/coach, or career dissatisfaction were more likely to report symptoms of CMD, but statistically significant associations were not found. Conclusions: The 12-month incidence of symptoms of CMD among European professional footballers ranged from 12% for symptoms of distress to 37% for symptoms of anxiety/depression. A professional football team typically drawn from a squad of 25 players can expect symptoms of CMD to occur among at least 3 players in one season.
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.