Brief Report
Generalized Anxiety Disorder in Late Life: Lifetime Course and Comorbidity With Major Depressive Disorder

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Objective

Generalized anxiety disorder (GAD) in elderly persons is highly prevalent, but little is known about its course, age at onset, and relationship to comorbid major depressive disorder (MDD). The authors assessed the course and comorbidity of late-life GAD and MDD.

Methods

Authors assessed elderly subjects in anxiety or depression intervention studies who had a lifetime history of GAD, with current MDD (N=57) or without (N=46). Subjects' lifetime course of illness was charted retrospectively.

Results

The 103 subjects had a mean age of 74.1 years, and a mean age at onset of GAD of 48.8 years; 46% were late-onset. GAD episodes were chronic, and 36% were longer than 10 years. Of the comorbid GAD–MDD patients, most had different times of onset and/or offset of the disorders; typically, GAD preceded MDD.

Conclusions

Elderly subjects with GAD tended to have chronic symptoms lasting years-to-decades, without interruption, and many have late onset. Elderly persons with lifetime GAD and MDD tend to have different onset and offset of the two disorders. Findings characterize late-life GAD as a chronic disorder distinct from MDD.

Section snippets

METHODS

To examine the characteristics of GAD in elderly persons seeking mental health treatment (regardless of whether subjects had comorbid MDD or other diagnoses), we evaluated data from all recent studies that recruited subjects with GAD. The studies ran concurrently at the University of Pittsburgh Intervention Research Center for the study of Late-life Mood Disorders (IRC/LLMD); two studies were of anxiety disorders, and one was of MDD. Subjects were recruited via radio and newspaper

RESULTS

A total of 103 subjects with GAD were examined in this analysis, 46 from the GAD-only group and 57 from the MDD-with-GAD group. Table 1 shows subjects' baseline characteristics. The most common lifetime comorbidities were panic disorder (N=24), dysthymic disorder (N=17), specific phobia (N=14), social phobia (N=10), agoraphobia without panic disorder (N=7), and alcohol abuse or dependence (N=6).

We evaluated age at first onset of GAD; this was obtainable for all but one subject (who had

DISCUSSION

To our knowledge, this is the first report to provide a lifetime perspective on the course and comorbidity of GAD. In this evaluation of treatment-seeking elderly patients, GAD was typically chronic and could be delineated from MDD. Our data did not support our hypothesis that disability, chronic medical illness, and cognitive impairment were more common in late-onset than early-onset cases. Our negative findings are consistent with other work;9 however, our negative findings may have been due

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revised March 26, 2004

This work was supported by NIMH grants K23 MH64196, P30 MH 52247, K01 MH01613, R37 MH43832, R01 MH37869, and T32 MH19986.

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