Penn State Worry Questionnaire-Abbreviated Research Articles

Physical activity dose for generalized anxiety disorder & worry: Results from the Irish longitudinal study on ageing

The lowest moderate-to-vigorous physical activity (MVPA) dose that conveys protection for Generalized Anxiety Disorder (GAD) and worry is unknown. This study quantified associations of weekly accumulated MVPA doses with GAD and worry across 10 years using data from The Irish Longitudinal Study on Ageing (TILDA). Continuous MVPA (metabolic equivalent of task [MET] minutes per week [MET.min.week−1]; e.g., moderate-intensity brisk walking = 4METs), three-dose and, more precise, five-dose MVPA categories were examined. Worry symptoms and GAD status were measured using the Penn State Worry Questionnaire-Abbreviated and the Composite International Diagnostic Interview. Multivariable negative random effect binomial regression and logistic models adjusted for relevant covariates quantified associations across time. Among the 7,650 participants, compared to no MVPA (0 MET.min.week−1), 18 % (OR: 0.82; 95 %CI: [0.69–0.98]), 22 % (OR: 0.78; [ 0.64–0.95]) and 31 % (OR: 0.69; [0.59–0.79]) lower odds of GAD were found for the doses of 1-<600, 600-<1,200 and ≥2,400 MET.min.week−1 respectively. Post-hoc analysis demonstrated 47 % lower odds (OR: 0.53; (0.36–0.78) of GAD for 1-<200 MET.min.week1 compared to inactivity. Compared to no activity, engaging in even minimal physical activity equivalent of 10 min/day for five days/week of moderate-intensity activity (e.g., brisk walking), may lower the risk of GAD over time among older adults.

An evaluation of the feasibility and acceptability of sister circles as an anxiety intervention for pregnant Black women.

Black women and their infants face heightened health risks during pregnancy, labor, and delivery that, for many, cost them their lives. Such health risks during this critical period are linked to increased rates of anxiety among Black pregnant and postpartum women. Black women also endure racism when seeking support from mental health and healthcare providers, which further contributes to pregnancy and postpartum-related anxiety. Evidence on sister circles has demonstrated that this indigenous form of healing may provide Black pregnant and postpartum women with the support and skills needed to cope with stressors associated with mental and physical health concerns and racism. Our study aimed to evaluate the feasibility and acceptability of the Birthing Beautiful Babies Sisters Offering Support, a sister circle cognitive behavioral therapy-based stress and anxiety intervention for Black pregnant and postpartum women. Our study employed a mixed-methods framework. Descriptive analyses, paired samples t-test, and open and selective coding were conducted. We utilized the following measures: Penn State Worry Questionnaire-Abbreviated, Kessler Psychological Distress Scale, Pregnancy-Related Anxiety Scale, focus booklet, and focus group discussion. Participants reported experiencing moderate levels of worry and distress and low levels of pregnancy-related anxiety prior to the start of the Birthing Beautiful Babies Sisters Offering Support intervention. Eighty women participated in Birthing Beautiful Babies Sisters Offering Support. Eleven focus groups were conducted to assess their experience. Participants reported a perceived increase in their knowledge about panic attacks and stress and ability to manage stressors effectively. They found that all completed activities contributed to their development and application of skills. They reported they enjoyed Birthing Beautiful Babies Sisters Offering Support because of the supportive environment, openness, and emphasis on sisterhood. Participants provided helpful feedback about the structure and flow of the intervention. Limitations of the present study and future directions are discussed.

A Randomized Preference Trial Comparing Cognitive-Behavioral Therapy and Yoga for the Treatment of Late-Life Worry: Examination of Impact on Depression, Generalized Anxiety, Fatigue, Pain, Social Participation, and Physical Function.

BackgroundDepression, generalized anxiety, fatigue, diminished physical function, reduced social participation, and pain are common for many older adults and negatively impact quality of life. The purpose of the overall trial was to compare the effects of cognitive-behavioral therapy (CBT) and yoga on late-life worry, anxiety, and sleep; and examine preference and selection effects on these outcomes.ObjectiveThe present analyses compared effects of the 2 interventions on additional outcomes (depressive symptoms, generalized anxiety symptoms, fatigue, pain interference/intensity, physical function, social participation); and examined whether there are preference and selection effects for these treatments.MethodsA randomized preference trial of CBT and yoga was conducted in adults ≥60 years who scored ≥26 on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), recruited from outpatient medical clinics, mailings, and advertisements. Cognitive-behavioral therapy consisted of 10 weekly telephone sessions. Yoga consisted of 20 bi-weekly group yoga classes. Participants were randomized to(1): a randomized controlled trial (RCT) of CBT or yoga (n = 250); or (2) a preference trial in which they selected their treatment (CBT or yoga; n = 250). Outcomes were measured at baseline and post-intervention.ResultsWithin the RCT, there were significant between-group differences for both pain interference and intensity. The pain interference score improved more for the CBT group compared with the yoga group [intervention effect of (mean (95% CI) = 2.5 (.5, 4.6), P = .02]. For the pain intensity score, the intervention effect also favored CBT over yoga [.7 (.2, 1.3), P < .01]. Depressive symptoms, generalized anxiety, and fatigue showed clinically meaningful within-group changes in both groups. There were no changes in or difference between physical function or social participation for either group. No preference or selection effects were found.ConclusionBoth CBT and yoga may be useful for older adults for improving psychological symptoms and fatigue. Cognitive-behavioral therapy may offer even greater benefit than yoga for decreasing pain.

August 11, 2021

Association Between Spirituality and Pain Linguistic Bias in Medical Records Dementia and Medicare Experiences at EOL Effect of Home Hospice on Survival Barriers to ACP for Pediatric Patients The Power of Clinician Empathy Opioid Use Behaviors Rave Reviews Association Between Spirituality, Religiosity, Spiritual Pain, Symptom Distress, and Quality of Life Among Latin American Patients with Advanced Cancer: A Multicenter Study Background: Spirituality and religiosity can be used as integrative therapy to promote general well-being and health.1–4 What is the association between spirituality, religiosity, spiritual pain, symptom distress, coping, and quality of life among Latin American patients with advanced cancer? Design and Participants: This study determined the frequency and intensity of spirituality and religiosity and their association with physical and psychological symptoms, spiritual pain, coping, and quality of life among Latin American patients receiving palliative care for advanced cancer at three US, Guatemalan, and Chilean institutions. Patients completed validated assessments: the Faith, Importance and Influence, Community, and Address tool; Edmonton Symptom Assessment Scale-Financial/Spiritual; Penn State Worry Questionnaire-Abbreviated; Center for Epidemiologic Studies Depression Scale; Brief-coping strategies (COPE); Brief religious coping (RCOPE); and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex). Descriptive statistics, frequency tabulation, the Kruskal-Wallis test, and Spearman correlation were used. Results: Patients (N = 325) were age median 58 years (range = 19–85), 60% female, and 62% Catholic (30% Christian not Catholic). Ninety-seven percent considered themselves spiritual (intensity median = 7 [IQR = 5–10], 0–10 scale) and 89% religious (7 [5–9]). Spirituality/religiosity importance was median 10 (IQR = 8–10). The frequency and associations between spirituality/religiosity and various items were: helps to cope with illness (98%, r = 0.66), is a source of strength/comfort (99%, r = 0.73), has positive effect on physical (81%, r = 0.42) and emotional symptoms (84%, r = 0.17), and helps caregivers cope (100%, r = 0.40) (all P<0.0001). Sixty percent reported their spiritual/religious needs had not been supported by the medical team; 52% reported spiritual pain (intensity median = 6 [IQR = 5–8]). Spiritual pain was associated with pain, fatigue, depression, anxiety, worry, behavioral disengagement, FACIT-Sp-Ex score, and negative RCOPE (all P<0.05). Commentary: Latin American patients often are underserved by the palliative care and hospice community. This multicenter study surveyed 325 Latin American patients with advanced cancer subjects regarding the association of spirituality with their quality of life and symptoms. Participants considered themselves both spiritual and religious and felt these beliefs had a positive impact on their lives. On the other hand, half had spiritual pain which was associated with physical pain and other symptoms. Surprisingly, 60% of patients enrolled in specialty palliative care clinics did not feel supported by the medical team. There were no data presented evaluating the association of spiritual pain and not feeling supported, nor information about the chaplain staffing in the clinics. Bottom Line: Spiritual support is often seen as nonessential to medical care and may be cut at the first sign of institutional belt tightening. To provide better, quality care, not just hospice and palliative medicine but the rest of the medical/business/industrial complex needs to understand and embrace the bio/psycho/social/spiritual model of care. Reviewer: Gregory L. Phelps, MD MPH FAAAHPM, Alleo Health System/Hospice of Chattanooga, Chattanooga, TN Source: Delgado-Guay MO, Palma A, et al. Association between spirituality, religiosity, spiritual pain, symptom distress, and quality of life among Latin American patients with advanced cancer: a multicenter study [published online ahead of print April 12, 2021]. J Palliat Med. doi: 10.1089/jpm.2020.0776

Association between Spirituality, Religiosity, Spiritual Pain, Symptom Distress, and Quality of Life among Latin American Patients with Advanced Cancer: A Multicenter Study.

Objectives: The purpose of this multicenter study was to characterize the association between spirituality, religiosity, spiritual pain, symptom distress, coping, and quality of life (QOL) among Latin American advanced cancer patients. Methods: Three hundred twenty-five advanced cancer patients from palliative care clinics in Chile, Guatemala, and the United States completed validated assessments: Faith, Importance and Influence, Community, and Address (FICA) (spirituality/religiosity), Edmonton Symptom Assessment Scale-Financial/Spiritual (ESAS-FS), including spiritual pain, Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Center for Epidemiologic Studies Depression Scale (CES-D), Brief-coping strategies (COPE) and Brief religious coping (RCOPE) and RCOPE, respectively, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex). Results: Median age: 58 years (range: 19-85); 60% female; and 62% Catholic and 30% Christian, but not Catholic. Three hundred fifteen patients (97%) considered themselves spiritual and 89% religious, with median intensities of 7 (interquartile range [IQR]: 5-10) and 7 (5-9), respectively (0-10 scale, 10 = "very much"). Median importance of spirituality/religiosity was 10 (IQR: 8-10). The frequency and associations between spirituality/religiosity and various items were as follows: helps to cope with illness (98%; r = 0.66303; p < 0.0001), positive effect on physical symptoms (81%; r = 0.42067; p < 0.0001), and emotional symptoms (84%; r = 0.16577; p < 0.0001). One hundred ninety-five patients (60%) reported that their spiritual/religious needs had not been supported by the medical team. Spiritual pain was reported in 162/311 patients (52%), with median intensity of 6 (IQR: 5-8). Spiritual pain was associated with pain (p = 0.0225), depression (p < 0.0001), anxiety (p < 0.0001), worry (p < 0.001), behavioral disengagement (p = 0.0148), FACIT-Sp-Ex score (p = 0.0002), and negative RCOPE (p < 0.0001). Significance of Results: Spirituality and religiosity are frequent, intense, and rarely addressed among Latin American patients. Spirituality/religiosity was associated with positive COPE and higher QOL. Spiritual pain was also frequent and associated with physical and psychosocial distress. These patients need increased spiritual/religious support.

Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire - Abbreviated (PSWQ-A).

The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). Longitudinal assessment of GAD symptoms pre- and posttreatment. Participants were 259 older adults aged 60-86 years with a diagnosis of GAD who were assessed before and after treatment. Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.

Comparison of cognitive-behavioral therapy and yoga for the treatment of late-life worry: A randomized preference trial.

The purpose of this study was to compare the effects of cognitive-behavioral therapy (CBT) and yoga on late-life worry, anxiety, and sleep; and examine preference and selection effects on these outcomes. A randomized preference trial of CBT and yoga was conducted in community-dwelling adults 60 years or older, who scored 26 or above on the Penn State Worry Questionnaire-Abbreviated (PSWQ-A). CBT consisted of 10 weekly telephone sessions. Yoga consisted of 20 biweekly group yoga classes. The primary outcome was worry (PSWQ-A); the secondary outcomes were anxiety (PROMIS-Anxiety) and sleep (Insomnia Severity Index [ISI]). We examined both preference effects (average effect for those who received their preferred intervention [regardless of whether it was CBT or yoga] minus the average for those who did not receive their preferred intervention [regardless of the intervention])and selection effect (which addresses the question of whether there is a benefit to getting to select one intervention over the other, and measures the effect on outcomes of self-selection to a specific intervention). Five hundred older adults were randomized to the randomized trial (125 each in CBT and yoga) or the preference trial (120 chose CBT; 130 chose yoga). In the randomized trial, the intervention effect of yoga compared with CBT adjusted for baseline psychotropic medication use, gender, and race was 1.6 (-0.2, 3.3), p = .08 for the PSWQ-A. Similar results were observed with PROMIS-Anxiety (adjusted intervention effect: 0.3 [-1.5, 2.2], p = .71). Participants randomized to CBT experienced a greater reduction in the ISI compared with yoga (adjusted intervention effect: 2.4 [1.2, 3.7], p < .01]). Estimated in the combined data set (N = 500), the preference and selection effects were not significant for the PSWQ-A, PROMIS-Anxiety, and ISI. Of the 52 adverse events, only two were possibly related to the intervention. None of the 26 serious adverse events were related to the study interventions. CBT and yoga were both effective at reducing late-life worry and anxiety. However, a greater impact was seen for CBT compared with yoga for improving sleep. Neither preference nor selection effects was found.

Comparison of factor structure and psychometric properties of original and abbreviated version of the Penn State Worry Questionnaire in a nonclinical sample: a cross-sectional psychometric study

Background and objectives: Worry as a main symptom of generalized anxiety disorder is a chain of repetitive and uncontrollable thoughts about possible negative events in the future. The Penn State Worry Questionnaire is one of the most widely used measures for assessing pathological worry. The purpose of the present study was to investigate the psychometric properties of the abbreviated version of the Penn State Worry Questionnaire-Abbreviated (PSWQ-A) and to compare it with the original version of the Penn State Worry Questionnaire (PSWQ) in a nonclinical sample. Participants and methods: The present study is a cross-sectional psychometric study. The statistical population of this study consisted of all students studying at Zanjan University of Medical Sciences (n = 3500) from January to October 2018. A sample of 350 people was selected for the study. Research measures were the PSWQ-A, PSWQ, and the Generalized Anxiety Disorder 7-item (GAD-7) Scale. The present study was carried out after approval of Social Determinants of Health Research Center of Zanjan University of Medical Science with the project code of A-12-924-5 on October 7, 2017. The project was also approved by the Ethics Committee of Zanjan University of Medical Sciences on October 17, 2017 and the approval ID was IR.ZUMS.REC.1396.187. Results: Exploratory factor analysis, scree plot, and parallel analysis supported the single factor structure PSWQ-A. The total variance explained by the single-factor model of PSWQ-A was higher (53.1% versus 49.1%). Generally, fit indices for the PSWQ-A was better fitted than the PSWQ. Both measures had acceptable convergent validity (r=0.52 for both questionnaires) and satisfactory internal consistency (α=0.87 for both questionnaires). Conclusion: PSWQ-A has better psychometric properties compared to PSWQ, and it can be used for faster and more accurate assessment of worry in psychological studies and therapeutic settings.

Psychometric properties of worry and anxiety measures in a sample of african american and caucasian older adults

Objective: The aim of our study was to examine the psychometric properties of commonly used anxiety and worry assessment measures in a community-based, low-income sample of African American and Caucasian older adults.Method: African American and Caucasian participants from three community-based clinical trials testing treatments for late-life worry/anxiety were pooled to examine the factor structure, internal consistency reliability, and convergent, discriminant, and predictive validity of the Penn State Worry Questionnaire-Abbreviated (PSWQ-A), Generalized Anxiety Disorder-7 (GAD-7) and Geriatric Anxiety Inventory-short form (GAI-SF).Results: All three measures demonstrated an adequate fit to a one-factor structure. Internal consistency reliability was adequate for the PSWQ-A and GAD-7 in the total sample and racial subgroups but was acceptable for the GAI-SF only in the African American subgroup. The PSWQ-A and GAD-7 demonstrated good convergent, discriminant, and predictive validity. The GAI-SF has adequate convergent and divergent validity in the African American subgroup.Conclusion: Our study offers preliminary evidence for use of the PSWQ-A and GAD-7 for assessment of anxiety in a sample of low-income, predominantly African American participants. These measures may facilitate identification of anxiety symptoms, which are often overlooked in this population. More research is needed to examine the accuracy of these measures in other racial/ethnic groups.

Worry and anger are associated with latent classes of problematic smartphone use severity among college students.

Problematic smartphone use (PSU) is associated with depression and anxiety symptom severity throughout the literature. However, many important psychopathology constructs have not been examined for associations with PSU severity. Worry and anger are two psychopathology constructs receiving little empirical scrutiny in relation to PSU, but theoretically should demonstrate significant relationships. Furthermore, few studies have used person-centered analyses, such as mixture modeling, to analyze possible latent subgroups of individuals based on PSU symptom ratings. We conducted a web survey of 300 American college students, using the Smartphone Addiction Scale-Short Version, Penn State Worry Questionnaire-Abbreviated Version, and Dimensions of Anger Reactions-5 Scale. Conducting mixture modeling using latent profile analysis, we found most support for a three-class model of latent groups of individuals based on their PSU item ratings. Adjusting for age and sex, worry and anger scores were significantly higher in the more severe PSU classes. Results are discussed in the context of uses and gratifications theory, as well as compensatory internet use theory, in terms of individual differences explaining excessive technology use. Limitations include the non-clinical nature of the sample. Worry and anger may be helpful constructs in understanding the phenomenology of PSU, and psychological interventions for worry and anger may offset PSU.

Predictors of Outcomes for Older Adults Participating in Calmer Life, a Culturally Tailored Intervention for Anxiety

ABSTRACTObjective: Determine predictors of reduced worry and anxiety for older adults participating in the pilot phase of Calmer Life, a modular, personalized cognitive-behavioral treatment for worry.Methods: Underserved adults (N = 54) over age 50 participated. Therapists were either experts (Ph.D. or Master’s) or nonexpert providers (case managers, community health workers, and bachelor’s level). Participants completed the Penn State Worry Questionnaire—Abbreviated (PSWQ-A) and the Geriatric Anxiety Inventory—Short Form (GAI-SF) before treatment and at 3 months.Results: Demographic and clinical variables were individually entered into separate regression equations, controlling for pretreatment scores, to determine their associations with post-treatment 1) PSWQ-A and 2) GAI-SF scores. Only younger age and African American race were significant (p < .05) univariate predictors of higher post-treatment PSWQ-A scores. African American race was also a significant predictor of higher post-treatment GAI-SF scores.Conclusions: African American participants had higher post-treatment PSWQ-A and GAI-SF scores than White and Hispanic participants. Younger age was also associated with more severe PSWQ-A post-treatment scores.Clinical Implications: Younger participants may experience additional stressors (e.g., caregiving, working) compared with older participants. Smaller decreases in anxiety in African Americans point to the need for continued focus and additional modification of interventions.

Psychometric properties of a brief version of the Penn State Worry Questionnaire in African Americans and European Americans.

The reliable and valid assessment of chronic worry in African Americans is vital when attempting to draw cross-cultural comparisons between African Americans and other ethnic groups. As such, the current study examined the psychometric properties of a brief version of a gold standard assessment of chronic worry, specifically the Penn State Worry Questionnaire-Abbreviated (PSWQ-A; Hopko et al., 2003) in a college sample of African Americans (n = 100) and European Americans (n = 121). Results indicated that the PSWQ-A total score has good internal consistency and convergent validity with another measure of anxiety, but less than favorable discriminant validity with a measure of depression in African American and European American students. Also, the 1-factor solution for the 8-item PSWQ-A had excellent model fit in our full sample and was partially invariant between ethnic groups. Collectively, the present study provides evidence that the PSWQ-A is a psychometrically sound option for assessing chronic worry and suggests that this brief measure may enhance the time efficiency and clinical utility of research and clinical assessments in ethnically diverse samples. (PsycINFO Database Record

Barriers to Mental Health Treatment in Rural Older Adults.

The purpose of this study was to identify the barriers to seeking mental health treatment experienced by rural older adults. We also examined if barriers differed by age and worry severity. Participants were 478 rural older adults responding to a flyer for a psychotherapy intervention study. Interested participants were screened by telephone, and barriers to mental health treatment were assessed. Participants completed a demographic questionnaire and the Penn State Worry Questionnaire-Abbreviated. The most commonly reported barrier to treatment was the personal belief that "I should not need help." Other commonly reported barriers included practical barriers (cost, not knowing where to go, distance), mistrust of mental health providers, not thinking treatment would help, stigma, and not wanting to talk with a stranger about private matters. Multivariable analyses indicated that worry severity and younger age were associated with reporting more barriers. Multiple barriers interfere with older adults seeking treatment for anxiety and depression. Older age is associated with fewer barriers, suggesting that the oldest old may have found strategies for overcoming these barriers. Young-old adults may benefit from interventions addressing personal beliefs about mental health and alternative methods of service delivery.

Examining the latent structure of worry and generalized anxiety in a clinical sample

Generalized anxiety disorder (GAD) is characterized by “pathological” worry, suggesting that GAD worriers differ qualitatively from non-GAD worriers. However, results from taxometric studies of worry in undergraduate and community samples have been mixed and to date, no studies have utilized clinical samples. The current study examined the latent structure of worry and GAD symptoms in a diagnostically heterogeneous clinical sample. Indicators were selected from the Penn State Worry Questionnaire-Abbreviated (n=1175) and the GAD-7 (n=638) and submitted to three taxometric procedures: MAXCOV, MAMBAC, and L-Mode. Results from all three procedures suggested that both worry and generalized anxiety are best conceptualized as dimensional constructs. Findings also indicated that ongoing conceptualization, assessment, and treatment of worry and GAD may be hampered by the application of a categorical framework.

Alcohol use, anxiety, and insomnia in older adults with generalized anxiety disorder.

To examine alcohol consumption among older primary care patients with generalized anxiety disorder (GAD); its relationship to demographic variables, insomnia, worry, and anxiety; and its moderating role on the anxiety-insomnia relationship. We expected alcohol use to be similar to previous reports, correlate with higher anxiety and insomnia, and worsen the anxiety-insomnia relationship. Baseline data from a randomized controlled trial. Michael E. DeBakey VA Medical Center and Baylor College of Medicine. 223 patients, 60 years and older, with GAD. Frequency of alcohol use, insomnia (Insomnia Severity Index), worry (Penn State Worry Questionnaire - Abbreviated, Generalized Anxiety Disorder Severity Scale), and anxiety (State-Trait Anxiety Inventory - Trait subscale, Structured Interview Guide for the Hamilton Anxiety Rating Scale [SIGH-A]). Most patients endorsed alcohol use, but frequency was low. Presence and frequency were greater than in previous reports of primary care samples. Alcohol use was associated with higher education, female gender, less severe insomnia, and lower worry (Generalized Anxiety Disorder Severity Scale) and anxiety (State-Trait Anxiety Inventory-Trait subscale; SIGH-A). Whites reportedmore drinks/week than African-Americans. More drinks/week were associated with higher education and lower anxiety (SIGH-A). Weaker relationships between worry/anxiety and insomnia occurred for those drinking. Drink frequency moderated the positive association between the Penn State Worry Questionnaire-Abbreviated and insomnia, which was lower with higher frequency of drinking. Older adults with GAD use alcohol at an increased rate, but mild to moderate drinkers do not experience sleep difficulties. A modest amount of alcohol may minimize the association between anxiety/worry and insomnia among this group.

The Peaceful Mind Program: A Pilot Test of a Cognitive–Behavioral Therapy–Based Intervention for Anxious Patients with Dementia

To assess feasibility and to conduct a preliminary evaluation of outcomes following Peaceful Mind, a cognitive-behavioral therapy-based intervention for anxiety in dementia, relative to usual care. Pilot randomized controlled trial including assessments at baseline and 3 and 6 months. Houston, TX. Thirty-two outpatients diagnosed with mild (47%) or moderate (53%) dementia receiving care through outpatient clinics at the Veterans Affairs medical center, Baylor College of Medicine, Harris County Hospital District, and community day centers for dementia, and their collaterals, who spent at least 8 hours a week with them. Peaceful Mind included up to 12 weekly in-home sessions (mean: 8.7, SD: 2.27) during the initial 3 months and up to eight brief telephone sessions (mean: 5.4, SD: 3.17) during months 3-6, involving self-monitoring for anxiety, deep breathing, and optional skills (coping self-statements, behavioral activation, and sleep management). Patients learned skills, and collaterals served as coaches. In usual care, patients received diagnostic feedback, and providers were informed of inclusion status. Neuropsychiatric Inventory-Anxiety subscale, Rating Anxiety in Dementia scale, Penn State Worry Questionnaire-Abbreviated, Geriatric Anxiety Inventory, Geriatric Depression Scale, Quality of Life in Alzheimer disease, Patient Health Questionnaire, and Client Satisfaction Questionnaire. Feasibility was demonstrated with regard to recruitment, attrition, and treatment characteristics. At 3 months, clinicians rated patients receiving Peaceful Mind as less anxious, and patients rated themselves as having higher quality of life; collaterals reported less distress related to loved ones' anxiety. Although significant positive effects were not noted in other outcomes or at 6-month follow-up, the pilot nature of the trial prohibits conclusions about efficacy. Results support that Peaceful Mind is ready for future comparative clinical trials.

Concordance of self- and proxy-rated worry and anxiety symptoms in older adults with dementia

We compared the psychometric performance of two validated self-report anxiety symptom measures when rated by people with dementia versus collaterals (as proxies). Forty-one participants with mild-to-moderate dementia and their respective collaterals completed the Geriatric Anxiety Inventory, the Penn State Worry Questionnaire-Abbreviated, and a structured diagnostic interview. We used descriptive and nonparametric statistics to compare scores according to respondent characteristics. Receiver operating characteristic (ROC) curves were calculated to establish the predictive validity of each instrument by rater type against a clinical diagnosis of an anxiety disorder. Participant and collateral ratings performed comparably for both instruments. However, collaterals tended to give more severe symptom ratings, and the best-performing cut-off scores were higher for collaterals. Our findings suggest that people with mild-to-moderate dementia can give reliable self-reports of anxiety symptoms, with validity comparable to reports obtained from collaterals. Scores obtained from multiple informants should be interpreted in context.

Characteristics of Generalized Anxiety Disorder in Patients With Dementia

Overlap of cognitive and anxiety symptoms (i.e., difficulty concentrating, fatigue, restlessness) contributes to inconsistent, complicated assessment of generalized anxiety disorder (GAD) in persons with dementia. Anxious dementia patients completed a psychiatric interview, the Penn State Worry Questionnaire-Abbreviated, and the Rating for Anxiety in Dementia scale. Analyses to describe the 43 patients with and without GAD included the Wilcoxon Mann-Whitney two-sample test, Fisher's exact test. Predictors of GAD diagnosis were identified using logistic regression. Those with GAD were more likely to be male, have less severe dementia and endorsed more worry, and anxiety compared to patients without GAD. Gender, muscle tension and fatigue differentiated those with GAD from those without GAD. Although this study is limited by a small sample, it describes clinical characteristics of GAD in dementia, highlighting the importance of muscle tension and fatigue in recognizing GAD in persons with dementia.

Comparison of Self-report Measures for Identifying Late-life Generalized Anxiety in Primary Care

This study evaluated the Penn State Worry Questionnaire, Penn State Worry Questionnaire-Abbreviated, and the Generalized Anxiety Disorder Questionnaire-IV for identifying generalized anxiety disorder in older medical patients. Participants were 191 of 281 patients screened for a clinical trial evaluating cognitive-behavior treatment, n = 110 with generalized anxiety disorder, 81 without. Participants completed the Penn State Worry Questionnaire and Generalized Anxiety Disorder Questionnaire-IV at pretreatment. Kappa coefficients estimated agreement with the Structured Clinical Interview for Diagnosis. Receiver operating characteristic curves compared sensitivity and specificity of self-report measures. The Penn State Worry Questionnaire (cutoff = 50) provided the strongest prediction of generalized anxiety disorder (sensitivity, 76%; specificity, 73%; 75% correctly classified; kappa = .49. Item 2 of the Generalized Anxiety Disorder Questionnaire-IV demonstrated comparable accuracy. The Penn State Worry Questionnaire, Generalized Anxiety Disorder Questionnaire-IV, and briefer versions of these measures may be useful in identifying late-life generalized anxiety disorder in medical settings.