Anxiety Disorders in Later Life: From Epidemiology to Treatment

Abstract

Ford et al. report findings from the National Survey of American Life (NSAL), an epidemiologic survey of mental disorders in a nationally representative sample of black Americans. In this article, the authors report the lifetime and 12-month prevalence of 13 psychiatric disorders in a subsample of African Americans aged 55 years or older. Of the three classes of disorders examined in this article (anxiety, mood, and substance), anxiety disorders had the highest lifetime and 12-month prevalence. This finding is consistent with surveys of the general elderly population and the general adult population, in the United States and other countries. Most epidemiologic studies have found that phobic disorders and GAD are the two most common anxiety disorders in later life. In contrast, Ford et al. found that posttraumatic stress disorder (PTSD) had the highest lifetime prevalence of any of the anxiety disorders and the highest 12-month prevalence of any mental disorder in their sample of older African Americans. Surprisingly, the 12-month prevalence of panic disorder was higher than that of GAD, which also stands in contrast with the findings of other epidemiologic surveys. Methodological factors, including small cell sizes for individual anxiety disorders, may have contributed to these atypical findings. On the other hand, these results may reflect real differences in the prevalence of mental disorders in the older African American population, compared with nonAfrican Americans. Given that the NSAL surveyed persons aged 18 years or older and included a smaller group of non-Hispanic whites, it would have been of interest to know how the prevalence of mental disorders in this older subsample compared with that in younger African Americans, and how the prevalence of disorders in African Americans compared to that in the white population. Thus, a lifespan approach to the analysis of these data may have shed more light on the intriguing findings regarding older African Americans. Frueh and colleagues took an adult lifespan approach to examine age differences in the prevalence of PTSD, coexisting psychiatric disorders, and health care use among veterans registered at Veterans Affairs primary care clinics. Persons with dementia were excluded from this study. The authors examined three age groups: 18–44 years, 45–64 years, and 65 years and older. In keeping with surveys of the general population, Frueh et al. found that older veterans had a lower prevalence of anxiety disorders, depressive disorders, and substance use disorders compared with veterans less than 65 years of age. Despite having a higher frequency of combat exposure, veterans in the oldest age group had one-half to one-third the prevalence of PTSD, and lower PTSD severity scores, than those in the younger age groups. These differences remained after controlling