Skip to main content

Sex Differences in Anxiety Disorders in Older Adults

Abstract

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.

Recent Findings

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.

Summary

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.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.

    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.

    Article  Google Scholar 

  2. 2.

    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.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Ritchie H, Roser M. Mental health. Our World in Data 2018. https://ourworldindata.org/mental-health. Accessed 18 Aug 2020.

  4. 4.

    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.

    Article  PubMed  Google Scholar 

  5. 5.

    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.

    Article  PubMed  Google Scholar 

  6. 6.

    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.

    Article  PubMed  Google Scholar 

  7. 7.

    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.

    Article  Google Scholar 

  8. 8.

    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.

  9. 9.

    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.

    Article  PubMed  Google Scholar 

  10. 10.

    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.

    Article  Google Scholar 

  11. 11.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    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.

    Article  Google Scholar 

  13. 13.

    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.

    Article  Google Scholar 

  14. 14.

    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.

    Article  PubMed  Google Scholar 

  15. 15.

    Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015;17(3):327–35.

    Article  Google Scholar 

  16. 16.

    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.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    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.

    Article  PubMed  Google Scholar 

  19. 19.

    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.

    Article  PubMed  Google Scholar 

  20. 20.

    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.

    Article  Google Scholar 

  21. 21.

    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.

    Article  PubMed  Google Scholar 

  22. 22.

    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.

    Article  Google Scholar 

  23. 23.

    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.

    Article  PubMed  Google Scholar 

  24. 24.

    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.

    Article  PubMed  Google Scholar 

  25. 25.

    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.

    Article  PubMed  Google Scholar 

  26. 26.

    Jalnapurkar I, Allen M, Pigott T. Sex differences in anxiety disorders: a review. J Psychiatry Depress Anxiety. 2018;4:012.

    Google Scholar 

  27. 27.

    • 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.

    Article  Google Scholar 

  28. 28.

    • 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.

    Article  PubMed  Google Scholar 

  29. 29.

    • 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.

    Article  PubMed  Google Scholar 

  30. 30.

    • 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.

    Article  PubMed  Google Scholar 

  31. 31.

    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.

    Article  Google Scholar 

  32. 32.

    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.

    Article  PubMed  Google Scholar 

  33. 33.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.

  34. 34.

    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.

    Article  PubMed  Google Scholar 

  35. 35.

    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.

    Article  PubMed  Google Scholar 

  36. 36.

    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.

    Article  PubMed  Google Scholar 

  37. 37.

    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.

  38. 38.

    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.

    Article  PubMed  Google Scholar 

  39. 39.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  40. 40.

    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.

    Article  PubMed  Google Scholar 

  41. 41.

    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.

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Helen-Maria Vasiliadis.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sex and Gender Issues in Behavioral Health

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Anxiety disorders
  • Obsessive-compulsive disorder
  • Posttraumatic stress disorder
  • Sex differences
  • Affective symptoms
  • Older adults