Shorter communication
‘Minor GAD’: Characteristics of subsyndromal GAD in older adults

https://doi.org/10.1016/S0005-7967(02)00130-4Get rights and content

Abstract

Subsyndromal emotional symptoms are common in older adults and are associated with increased disability, health care utilization, and risk for developing psychiatric disorders. The purpose of this study was to examine subsyndromal generalized anxiety disorder (GAD) in older adults. Participants included 30 older adults with diagnosable GAD, 19 with subsyndromal anxiety symptoms [minor GAD; (MGAD)], and 21 normal control volunteers (NC). Participants were assessed using the Anxiety Disorders Interview Schedule for DSM-IV and completed self-report measures of anxiety, worry, depression, and life satisfaction. Excessive worry on more days than not, difficulty controlling worry, and clinically significant distress or impairment were the diagnostic criteria endorsed by MGAD participants least often. Therefore, these criteria may be useful in distinguishing between GAD and subsyndromal GAD. Self-reported anxiety and worry also systematically differed across groups in the expected directions, with a discriminant analysis yielding good classification of the GAD and NC groups based on these measures. Categorization of MGAD participants generally was poor, with most misclassified as GAD patients. Clinical implications of these findings are discussed.

Section snippets

Participants

Clinical participants included 51 adults, ages 60–80, who were divided into those with diagnosable DSM-IV GAD (n=30) or Minor GAD (MGAD; n=21). Patients with comorbid disorders (e.g., major depression, social phobia) were excluded to eliminate these syndromes as confounds. MGAD participants were patients who endorsed some but not all DSM-IV diagnostic criteria for GAD. Control participants included 19 older adults (≥60 yr), who were free from psychiatric problems. Demographic data are presented

Clinician-rated symptoms of individuals with minor GAD

Data obtained through ADIS-IV interviews were used to examine symptom patterns among individuals with MGAD. Two post-doctoral fellows in psychology independently reviewed the written ADIS-IV protocols and coded whether participants met each diagnostic criterion for GAD. Inter-rater agreement was adequate across all diagnostic criteria (percent agreement M=0.80, range r=0.62–1.00). Consensus agreement regarding the presence of each symptom was established using the following criteria: both

Discussion

The goal of this study was to examine symptom characteristics of older adults with subsyndromal GAD. A descriptive review of the data showed that three diagnostic criteria (worry more days than not, difficulty controlling worry, and clinically significant distress/impairment) were endorsed by relatively few (<20%) of the MGAD participants. Therefore, these criteria may be the most useful in distinguishing GAD from subsyndromal GAD. In addition, participants with GAD, subsyndromal GAD, and NC

Acknowledgements

This project was sponsored in part by a grant from the National Institute of Mental Health (R01 MH53932) to the fourth author. The authors would like to express their appreciation to Dr. Andrew Shack for his help in coding the data.

References (11)

  • P.A. Parmelee et al.

    Anxiety and its association with depression among institutionalized elderly

    The American Journal of Geriatric Psychiatry

    (1993)
  • Diagnostic and statistical manual of mental disorders

    (1994)
  • A.T.F. Beekman et al.

    Anxiety disorders in later life: a report from the longitudinal aging study Amsterdam

    International Journal of Geriatric Psychiatry

    (1998)
  • S.L. Bourland et al.

    Quality of life in older adults with generalized anxiety disorder

    Aging and Mental Health

    (2000)
  • T.A. Brown et al.

    The Anxiety Disorder Interview Schedule for DSM-IV. Center for Stress and Anxiety Disorders

    (1994)
There are more references available in the full text version of this article.

Cited by (43)

  • Integrating iCBT for generalized anxiety disorder into routine clinical care: Treatment effects across the adult lifespan

    2017, Journal of Anxiety Disorders
    Citation Excerpt :

    This study examined the effects of iCBT for GAD across the adult lifespan among a large sample seeking help for their mental health problems in routine clinical care. Given that individuals experiencing subthreshold symptomatology often seek mental health services (Druss et al., 2007; Goldney, Fisher, Dal Grande, & Taylor, 2004), are more likely to have met criteria for a disorder previously; and are more likely to relapse compared to those without a sub-threshold disorder (de Beurs et al., 1999; Diefenbach et al., 2003; Jeuring, Huisman, Comijs, Stek, & Beekman, 2016; Pietrzak et al., 2013; Wetherell, Le Roux, & Gatz, 2003); this study included patients with subthreshold symptoms and a probable diagnosis of GAD. Consistent with Mewton et al. (2013), we hypothesized that patients of all ages would experience significant reductions in distress and impairment with treatment, and that age groups would not differ in the magnitude of these effects.

  • Threshold and Subthreshold Generalized Anxiety Disorder in Later Life

    2015, American Journal of Geriatric Psychiatry
    Citation Excerpt :

    Subthreshold GAD has also been found to be associated with poorer physical health, greater stress, sleep difficulty, and use of a greater number of prescription medications relative to asymptomatic controls, and these effects are partly attributable to comorbid depression.9 Despite some differences in symptom presentation between older adults with subthreshold and threshold GAD, it remains difficult to distinguish these older adult subgroups on the basis of Diagnostic and Statistical Manual of Mental Disorders (DSM) symptom presentation.6,10,11 For example, although GAD patients have been found to report a higher degree of uncontrollable worry, a greater number of symptoms, and a higher degree of disability relative to those with subthreshold GAD,6,11 these symptoms are expected to distinguish these two groups because they are integral to a GAD diagnosis.

  • Clinical Interviewing With Older Adults

    2012, Cognitive and Behavioral Practice
    Citation Excerpt :

    However, dimensional ratings can yield benefits with an older population. For example, dimensional rating schemes such as those used in the ADIS can detect subclinical syndromes that are relatively common in the elderly (e.g., Diefenbach et al., 2003), and that might be described inadequately or missed entirely by the SCID's ‘mild,’ ‘moderate,’ ‘severe’ categorical rating scheme (First et al., 2002). Although each section of the ADIS begins with closed-ended questions, dimensional information on key symptoms is also collected even if formal diagnoses are not ultimately assigned.

View all citing articles on Scopus
View full text