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Anxiety and Depressive Disorders in Older Primary Care Patients: Defining a Clinical Severity Gradient Corresponding to Differences in Health Status, Functioning, and Health Service Use

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Abstract

Anxiety and depression are common psychiatric disorders affecting older persons. To explore the relationships between these disorders and client characteristics, we examined data from the baseline phase of PRISM-E, a multisite randomized trial comparing two models of service delivery for older persons aged 65 and over identified in primary care settings with depression, anxiety, and/or at-risk drinking. Clinical characteristics, functioning and service use were compared across five diagnostic groups of study participants (n = 1,763; mean age = 73.8 ± 6.3 years, 71% male) with (1) anxiety only (n = 82), (2) minor/other depression (n = 502), (3) major depression (n = 700), (4) mixed minor/other depression and anxiety (n = 121), and (5) mixed major depression and anxiety (n = 358). Increasing functional problems and use of services were found across the five diagnostic subgroups, corresponding to a gradient of increasing severity for health status, number of medical disorders, SF-36 mental component score, suicidal or death ideation, and number of hospital stays, emergency room visits, and outpatient medical visits. Multivariate analyses controlling for site, demographic variables, and clinical characteristics confirmed the observed clinical severity gradient. Anxiety alone and anxiety comorbid with depression represent the two extremes of the severity gradient from the least to the most complicated and severe clinical presentations. Primary care clinicians identifying anxiety disorders in older persons should also screen for depression due to the relative infrequency of anxiety disorder alone and the significant clinical implications of co-occurring anxiety and depression.

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Acknowledgement

This initiative was funded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), with additional support and collaboration from the Department of Veterans Affairs (VA), the Health Resource Services Administration (HRSA), and the Centers for Medicare and Medicaid Services (CMS). PRISM-E Study investigators (in alphabetical order): C Aoyama, P Arean, S Bartels, H Chen, H Chung, M Cody, G Costantino, UNB Durai, C Estes, S Cooley, J Fitzpatrick, B Goodman, T Hadley, T Howell, I Katz, J Kirchner, D Krahn, S Levkoff, K Linkins, M Llorente, J Maxwell, K Miles, R Molokie, J McIntyre, E McDonel Herr, M Nazar, E Olsen, D Oslin, T Oxman, A Pomerantz, L Quijano, H Syropoulos, W Van Stone, P Wohlford, C Zubritsky.

Disclaimer

This article was written solely from the perspective of the authors and does not necessarily represent the official policy or position of the US Substance Abuse and Mental Health Services Administration, the US Department of Veterans Affairs, the Health Resources Services Administration, the US Department of Health and Human Services, or the federal government.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Health, Unity Health System, 2000 Winton Road South, Suite 4-303, Rochester, NY, USA

    Jack McIntyre

  2. Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA

    Karen Cheal, Chris Miller & Sue E. Levkoff

  3. New Hampshire Dartmouth Psychiatric Research Center, Lebanon, NH, USA

    Steve Bartels

  4. Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA

    U. N. Durai

  5. Center for Mental Health Services, U.S. Substance Abuse and Mental Health Services Administration, Rockville, MD, USA

    Betsy McDonel Herr

  6. Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA

    Louise Quijano

  7. Miami Veterans Affairs Medical Center, Miami, FL, USA

    Maria Llorente

  8. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    James H. Ware

  9. Lutheran Sunset Park Family Health Center Network, Brooklyn, NY, USA

    Giuseppe Costantino

  10. Department of Veterans Affairs South Central Mental Illness Research and Clinical Center, North Little Rock, AK, USA

    Joanne Kirchner

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  1. Jack McIntyre
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  2. Karen Cheal
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  3. Steve Bartels
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  4. U. N. Durai
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  5. Betsy McDonel Herr
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  6. Louise Quijano
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  7. Maria Llorente
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  8. James H. Ware
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  9. Giuseppe Costantino
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  12. Sue E. Levkoff
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Correspondence to Jack McIntyre.

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McIntyre, J., Cheal, K., Bartels, S. et al. Anxiety and Depressive Disorders in Older Primary Care Patients: Defining a Clinical Severity Gradient Corresponding to Differences in Health Status, Functioning, and Health Service Use. Ageing Int. 32, 93–107 (2008). https://doi.org/10.1007/s12126-008-9011-6

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  • DOI: https://doi.org/10.1007/s12126-008-9011-6

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