Purpose of Review
Anxiety disorders are the most prevalent mental disorders. Although prevalence estimates are lower in males than females, the disability associated with anxiety disorders has been increasing in males. This review focuses on recent research studying sex differences in anxiety disorders and associated symptoms in older adults.
Females are close to three times more likely than males to report most anxiety disorders. Heterogeneity exists in sex-specific lifetime and past-year estimates. Age-appropriate instruments such as the CIDI65+ show higher estimates than previous research. The profiles of females and males with anxiety with respect to depressive and somatization symptoms are different.
Age-appropriate standardized mental disorder instruments have been developed and may be useful to overcome the challenges of observed heterogeneity in anxiety disorders and allow for future cross-country comparisons and a better description of the epidemiology and biopsychosocial factors associated with different types of anxiety disorders in older adults.
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Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, et al. The burden of disease in older people and implications for health policy and practice. Lancet (London, England). 2015;385(9967):549–62. https://doi.org/10.1016/S0140-6736(14)61347-7.
Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897–910. https://doi.org/10.1017/s003329171200147x.
Ritchie H, Roser M. Mental health. Our World in Data 2018. https://ourworldindata.org/mental-health. Accessed 18 Aug 2020.
Smolders M, Laurant M, Verhaak P, Prins M, van Marwijk H, Penninx B, et al. Adherence to evidence-based guidelines for depression and anxiety disorders is associated with recording of the diagnosis. Gen Hosp Psychiatry. 2009;31(5):460–9. https://doi.org/10.1016/j.genhosppsych.2009.05.011.
Roberge P, Fournier L, Duhoux A, Nguyen CT, Smolders M. Mental health service use and treatment adequacy for anxiety disorders in Canada. Soc Psychiatry Psychiatr Epidemiol. 2011;46(4):321–30. https://doi.org/10.1007/s00127-010-0186-2.
Weisberg RB, Beard C, Moitra E, Dyck I, Keller MB. Adequacy of treatment received by primary care patients with anxiety disorders. Depress Anxiety. 2014;31(5):443–50. https://doi.org/10.1002/da.22209.
Alonso Caballero J, Collaborators WWMHS. Treatment gap for anxiety disorders is global: results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195–208.
Smetanin P, Stiff D, Briante C, Adair CE, Ahmad S, Khan M. The life and economic impact of major mental illnesses in Canada: 2011 to 2041. 2011.
Vasiliadis HM, Dionne PA, Preville M, Gentil L, Berbiche D, Latimer E. The excess healthcare costs associated with depression and anxiety in elderly living in the community. Am J Geriatr Psychiatry. 2013;21(6):536–48. https://doi.org/10.1016/j.jagp.2012.12.016.
Reynolds K, Pietrzak RH, El-Gabalawy R, Mackenzie CS, Sareen J. Prevalence of psychiatric disorders in US older adults: findings from a nationally representative survey. World Psychiatry. 2015;14(1):74–81.
Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–84. https://doi.org/10.1002/mpr.1359.
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004;420:21–7. https://doi.org/10.1111/j.1600-0047.2004.00327.x.
Preville M, Boyer R, Grenier S, Dube M, Voyer P, Punti R, et al. The epidemiology of psychiatric disorders in Quebec’s older adult population. Can J Psychiatr. 2008;53(12):822–32. https://doi.org/10.1177/070674370805301208.
Volkert J, Schulz H, Härter M, Wlodarczyk O, Andreas S. The prevalence of mental disorders in older people in Western countries - a meta-analysis. Ageing Res Rev. 2013;12(1):339–53. https://doi.org/10.1016/j.arr.2012.09.004.
Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17(3):327–35.
Fuentes K, Cox B. Assessment of anxiety in older adults: a community-based survey and comparison with younger adults. Behav Res Ther. 2000;38(3):297–309. https://doi.org/10.1016/s0005-7967(99)00067-4.
Scott KM, Von Korff M, Alonso J, Angermeyer M, Bromet EJ, Bruffaerts R, et al. Age patterns in the prevalence of DSM-IV depressive/anxiety disorders with and without physical co-morbidity. Psychol Med. 2008;38(11):1659–69. https://doi.org/10.1017/s0033291708003413.
Wittchen HU, Strehle J, Gerschler A, Volkert J, Dehoust MC, Sehner S, et al. Measuring symptoms and diagnosing mental disorders in the elderly community: the test-retest reliability of the CIDI65. Int J Methods Psychiatr Res. 2015;24(2):116–29. https://doi.org/10.1002/mpr.1455.
Gum AM, King-Kallimanis B, Kohn R. Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry. 2009;17(9):769–81. https://doi.org/10.1097/JGP.0b013e3181ad4f5a.
Preville M, Boyer R, Vasiliadis HM, Grenier S, Voyer P, Hudon C, et al. One-year incidence of psychiatric disorders in Quebec’s older adult population. Can J Psychiatr. 2010;55(7):449–57. https://doi.org/10.1177/070674371005500708.
Chou KL, Mackenzie CS, Liang K, Sareen J. Three-year incidence and predictors of first-onset of DSM-IV mood, anxiety, and substance use disorders in older adults: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related conditions. J Clin Psychiatry. 2011;72(2):144–55. https://doi.org/10.4088/JCP.09m05618gry.
Preville M, Boyer R, Vasiliadis HM, Grenier S, Streiner D, Cairney J, et al. Persistence and remission of psychiatric disorders in the Quebec older adult population. Can J Psychiatr. 2010;55(8):514–22. https://doi.org/10.1177/070674371005500806.
Andreescu C, Lenze EJ, Dew MA, Begley AE, Mulsant BH, Dombrovski AY, et al. Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study. Br J Psychiatry. 2007;190:344–9. https://doi.org/10.1192/bjp.bp.106.027169.
Wongpakaran N, Wongpakaran T, Lerttrakarnnon P, Jiraniramai S, Sirirak T, Assanangkornchai S, et al. Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings. Asian J Psychiatr. 2019;41:38–44. https://doi.org/10.1016/j.ajp.2018.10.007.
Beaunoyer E, Landreville P, Carmichael PH. Older adults’ knowledge of anxiety disorders. J Gerontol B Psychol Sci Soc Sci. 2019;74(5):806–14. https://doi.org/10.1093/geronb/gbx128.
Jalnapurkar I, Allen M, Pigott T. Sex differences in anxiety disorders: a review. J Psychiatry Depress Anxiety. 2018;4:012.
• Grenier S, Payette MC, Gunther B, Askari S, Desjardins FF, Raymond B, et al. Association of age and gender with anxiety disorders in older adults: a systematic review and meta-analysis. Int J Geriatr Psychiatry. 2019;34(3):397–407 First systematic review and meta-analysis presenting sex and age-group differences of different types of anxiety disorders, post-traumatic stress, and obsessive-compulsive disorders in older adults.
• Canuto A, Weber K, Baertschi M, Andreas S, Volkert J, Dehoust MC, et al. Anxiety disorders in old age: psychiatric comorbidities, quality of life, and prevalence according to age, gender, and country. Am J Geriatr Psychiatry. 2018;26(2):174–85. https://doi.org/10.1016/j.jagp.2017.08.015This European multi-center cross-sectional study is one of the first to use the age-appropriate CIDI65+ to assess the prevalence of anxiety disorders in older adults by gender and age group showing lower estimates in previous studies.
• Curran E, Rosato M, Ferry F, Leavey G. Prevalence and factors associated with anxiety and depression in older adults: gender differences in psychosocial indicators. J Affect Disord. 2020;267:114–22. https://doi.org/10.1016/j.jad.2020.02.018This large Irish longitudinal study showed the important prevalence of anxiety disorders in older adults and reported on the gender-specific symptom profiles of later-life anxiety.
• Boehlen FH, Herzog W, Schellberg D, Maatouk I, Schoettker B, Brenner H, et al. Gender-specific predictors of generalized anxiety disorder symptoms in older adults: results of a large population-based study. J Affect Disord. 2020;262:174–81. https://doi.org/10.1016/j.jad.2019.10.025This longitudinal German study aimed to investigate the gender-specific biopsychosocial predictors and symptoms associated with GAD severity in older adults.
Vasiliadis HM, Lamoureux-Lamarche C, Pitrou I, Berbiche D. Sex differences in type of lifetime trauma and suicidal ideation mediated by post-traumatic stress and anxio-depressive disorders in older adults. Int Psychogeriatr. 2019;32:1–11. https://doi.org/10.1017/s1041610219001893.
Lamoureux-Lamarche C, Vasiliadis HM. Lifetime traumatic events, health-related quality of life, and satisfaction with life in older adults. Qual Life Res. 2017;26(10):2683–92. https://doi.org/10.1007/s11136-017-1593-6.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
Scheffer AC, Schuurmans MJ, van Dijk N, van der Hooft T, de Rooij SE. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age Ageing. 2008;37(1):19–24. https://doi.org/10.1093/ageing/afm169.
Pohl P, Ahlgren C, Nordin E, Lundquist A, Lundin-Olsson L. Gender perspective on fear of falling using the classification of functioning as the model. Disabil Rehabil. 2015;37(3):214–22. https://doi.org/10.3109/09638288.2014.914584.
Payette MC, Bélanger C, Benyebdri F, Filiatrault J, Bherer L, Bertrand JA, et al. The association between generalized anxiety disorder, subthreshold anxiety symptoms and fear of falling among older adults: preliminary results from a pilot study. Clin Gerontol. 2017;40(3):197–206. https://doi.org/10.1080/07317115.2017.1296523.
Boehlen F, Herzog W, Schellberg D, Maatouk I, Saum K, Brenner H, et al. Gender differences in self-perceived personal resources of older adults with generalized anxiety symptoms. J Aging Sci. 2017;5.
Nilsson J, Sigström R, Östling S, Waern M, Skoog I. Changes in the expression of worries, anxiety, and generalized anxiety disorder with increasing age: a population study of 70 to 85-year-olds. Int J Geriatr Psychiatry. 2019;34(2):249–57. https://doi.org/10.1002/gps.5012.
Ferrari AJ, Norman RE, Freedman G, Baxter AJ, Pirkis JE, Harris MG, et al. The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010. PLoS One. 2014;9(4):e91936. https://doi.org/10.1371/journal.pone.0091936.
Mosier KE, Vasiliadis HM, Lepnurm M, Puchala C, Pekrul C, Tempier R. Prevalence of mental disorders and service utilization in seniors: results from the Canadian community health survey cycle 1.2. Int J Geriatr Psychiatry. 2010;25(10):960–7. https://doi.org/10.1002/gps.2434.
Kiely KM, Brady B, Byles J. Gender, mental health and ageing. Maturitas. 2019;129:76–84. https://doi.org/10.1016/j.maturitas.2019.09.004.
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This article is part of the Topical Collection on Sex and Gender Issues in Behavioral Health
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Vasiliadis, HM., Desjardins, F., Roberge, P. et al. Sex Differences in Anxiety Disorders in Older Adults. Curr Psychiatry Rep 22, 75 (2020). https://doi.org/10.1007/s11920-020-01203-x
- Anxiety disorders
- Obsessive-compulsive disorder
- Posttraumatic stress disorder
- Sex differences
- Affective symptoms
- Older adults