Abstract
Clinical features of older primary care patients with GAD (PC-GAD; n = 22) were examined relative to older patients with GAD recruited for two academic clinical trials (M. A. Stanley, J. G. Beck, et al., 2003; J. L. Wetherell, M. Gatz, & M. G, Craske, 2003) and to a sample of older primary care patients without psychiatric diagnoses (No Dx; n = 10). Comparisons revealed similar levels of worry, anxiety, depressive symptoms, quality of life, and functional status between the PC-GAD subsample and patients recruited for academic trials, although primary care patients were older, less well educated, and more ethnically diverse. The PC-GAD subgroup, however, reported greater symptom severity, reduced quality of life, and poorer perceived general health, mental health, and vitality than the No Dx subgroup (η2 = .23–.43). Service utilization was not different between PC-GAD and No Dx subgroups, with the exception of psychotropic medication use. The Penn State Worry Questionnaire (PSWQ) and an abbreviated version of this measure may be useful for identifying late-life GAD in primary care. Cutoff scores of 50 and 22 on the full and abbreviated versions of the PSWQ, respectively, demonstrated excellent specificity, sensitivity, and positive predictive value. Negative predictive value was less impressive, probably as a result of high base rates for GAD in this sample.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Barlow, D. H., Lerner, J. A., & Esler, J. L. (1996). Behavioral health care in primary care settings: Recognition and treatment of anxiety disorders. In R. J. Resnick & R. H. Rozensky (Eds.), Health psychology through the life span: Practice and research opportunities (pp. 133-148). Washington, DC: American Psychological Association.
Beck, J. G., Stanley, M. A., & Zebb, B. J. (1996). Characteristics of generalized anxiety disorder in older adults: A descriptive study. Behaviour Research and Therapy, 34, 225-234.
Beck, A. T., & Steer, R. (1987). Beck Depression Inventory: Manual. San Antonio, TX: The Psychiatric Corporation.
Beck, A. T., & Steer, R. A. (1990). Beck Anxiety Inventory: Manual. San Antonio, TX: The Psychological Corporation.
Beekman, A. T. F., Bremmer, M. A., Deeg, D. J. H., van Balkom, A. J. L. M., Smit, J. H., de Beurs, E., et al. (1998). Anxiety disorders in later life: A report from the longitudinal aging study Amsterdam. International Journal of Geriatric Psychiatry, 13, 717-726.
Blazer, D., George, L. K., & Hughes, D. (1991). The epidemiology of anxiety disorders: An age comparison. In C. Salzman & B. D. Lebowitz (Eds.), Anxiety in the elderly: Treatment and research (pp. 17-30). New York: Springer.
Bourland, S. L., Stanley, M. A., Synder, A. G., Novy, D. M., Beck, J. G., Averill, P. M., et al. (2000). Quality of life in older adults with generalized anxiety. Aging and Mental Health, 4, 315-323.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193-213.
Buysse, D. J., Reynolds, C. F., Monk, T. H., Hoch, C. C., Yeager, A. L., & Kupfer, D. J. (1991). Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep, 14, 331-338.
de Beurs, E., Beekman, A. T. F., van Balkom, A. J. L. M., Deeg, D. J. H., van Dyck, R., & van Tilburg, W. (1999). Consequences of anxiety in older persons: Its effect on disability, well-being and use of health services. Psychological Medicine, 29, 583-593.
Diefenbach, G. J., Hopko, D. R., Feigon, S., Stanley, M. A., Novy, D. M., Beck, J. G., et al. (2003). “Minor GAD”: Characteristics of subsyndromal GAD in older adults. Behaviour Research and Therapy, 41, 481-487.
Druss, B. G., Rohrbaugh, R. M., & Rosenheck, R. A. (1999). Depressive symptoms and health care costs in older medical patients. American Journal of Psychiatry, 156, 477-479.
First, M. B., Spitzer, R. L., Miriam, G., & Williams, J. B. W. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version. New York: Biometrics Research, New York State Psychiatric Institute.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method of grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
Frisch, M. B. (1999). Quality of life assessment/intervention and the Quality of Life Inventory (QOLI). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (2nd ed, pp. 1277-1331). Mahwah, NJ: Erlbaum.
Hopko, D. R., Stanley, M. A., Reas, D. L., Wetherell, J. L., Beck, J. G., Novy, D. M., et al. (2003). Assessing worry in older adults: Confirmatory factor analysis of the Penn State Worry Questionnaire, and psychometric properties of an abbreviated model. Psychological Assessment, 15, 173-183.
Kim, H. F., Kunik, M. E., Molinari, V., Hillman, S. L., Lalani, S., Orengo, C. A., et al. (2000). Functional impairment in COPD patients: The impact of anxiety and depression. Psychosomatics, 41, 465-471.
Kogan, J. N., Edelstein, B. A., & McKee, D. R. (2000). Assessment of anxiety in older adults: Current status. Journal of Anxiety Disorders, 13, 107-122.
Lenze, E. J., Rogers, J. C., Martire, L. M., Mulsant, B. H., Rollman, B. L., Dew, M. A., et al. (2001). The association of late-life depression and anxiety with physical disability: A review of the literature and prospectus for future research. American Journal of Geriatric Psychiatry, 9, 113-135.
Menza, M. A., & Rosen, R. C. (1995). Sleep in Parkinson's disease: The role of depression and anxiety. Psychosomatics, 36, 262-266.
Meyer, T., Miller, M., Metzger, R., & Borkovec, T. D. (1990). Development and validity of the Penn State Worry Scale. Behaviour Research and Therapy, 28, 487-495.
Segal, D. L., Hersen, M., Van Hasselt, V. B., Kabacoff, R. L., & Roth, L. (1993). Reliability of diagnosis in older psychiatric patients using the Structured Clinical Interview for DSM-III-R. Journal of Psychpathology and Behavioral Assessment, 15, 347-356.
Simon, G., Ormel, J., VonKorff, M., & Barlow, W. (1995). Health care costs associated with depressive and anxiety disorders in primary care. American Journal of Psychiatry, 152, 352-357.
Spitzer, R. L., Williams, J. B. W., Kroenke, K., Linzer, M., De Gruy, F. V., Hahn, S. R., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. Journal of American Medical Association, 272, 1749-1756.
Stanley, M. A., & Beck, J. G. (2000). Anxiety disorders. Clinical Psychology Review, 20, 731-754.
Stanley, M. A., Beck, J. G., Novy, D. M., Averill, P. M., Swann, A. C., Diefenbach, G. J., et al. (2003). Cognitive behavioral treatment of late-life generalized anxiety disorder. Journal of Consulting and Clinical Psychology, 71, 309-319.
Stanley, M. A., Hopko, D. R., Diefenbach, G. J., Bourland, S. L., Rodriguez, H., & Wagener, P. (2003). Treatment of generalized anxiety disorder in primary care: Treatment development and initial outcomes. American Journal of Geriatric Psychiatry, 11, 92-96.
Stanley, M. A., Roberts, R. E., Bourland, S. L., & Novy, D. M. (2001). Anxiety disorders among older primary care patients. Journal of Clinical Geropsychology, 7, 105-116.
Steer, R. A., Willman, M., Kay, P. A. J., & Beck, A. T. (1994). Differentiating elderly medical and psychiatric outpatients with the Beck Anxiety Inventory. Assessment, 1, 345-351.
Stein, M. B., Chartier, M., & Walker, J. R. (1993). Sleep in nondepressed patients with panic disorder: I. Systematic assessment of subjective sleep quality and sleep disturbance. Sleep, 16, 724-726.
Ware, J. E. (1999). SF-36 Health Survey. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment, (2nd ed., pp. 1227-1246). Mahwah, NJ: Erlbaum.
Weissman, M. M., Olfson, M., Gameroff, M. J., Feder, A., & Fuentes, M. (2001). A comparison of three scales for assessing social functioning in primary care. American Journal of Psychiatry, 158, 460-466.
Wetherell, J. L., & Areán, P. A. (1997). Psychometric evaluation of the Beck Anxiety Inventory with older medical patients. Psychological Assessment, 9, 136-144.
Wetherell, J. L., & Gatz, M. (2003). The Beck Anxiety Inventory in late-life generalized anxiety disorder. Unpublished manuscript.
Wetherell, J. L., Gatz, M., & Craske, M. G. (2003). Treatment of generalized anxiety disorder in older adults. Journal of Consulting and Clinical Psychology, 71, 31-40.
Wilson, K. A., de Beurs, E., Palmer, C. A., & Chambless, D. L. (1999). Beck Anxiety Inventory, In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment, (2nd ed., pp. 971-992). Mahwah, NJ: Erlbaum.
Author information
Authors and Affiliations
Corresponding author
Additional information
An erratum to this article can be found online at http://dx.doi.org/10.1007/s10862-011-9221-1
Rights and permissions
About this article
Cite this article
Stanley, M.A., Diefenbach, G.J., Hopko, D.R. et al. The Nature of Generalized Anxiety in Older Primary Care Patients: Preliminary Findings. Journal of Psychopathology and Behavioral Assessment 25, 273–280 (2003). https://doi.org/10.1023/A:1025903214019
Issue Date:
DOI: https://doi.org/10.1023/A:1025903214019