E. de Beurs

Consequences of anxiety in older persons: its effect on disability, well-being and use of health services

BACKGROUND Although anxiety is quite prevalent in late life, its impact on disability, well-being, and health care utilization of older persons has not been studied. Older persons are a highly relevant age group for studying the consequences of anxiety, since their increasing numbers put an extra strain on already limited health care resources. METHODS Data of a large community-based random probability sample (N = 659) of older subjects (55-85 year) in the Netherlands were used to select three groups: subjects with a diagnosed anxiety disorder, subjects with merely anxiety symptoms and a reference group without anxiety. These groups were compared with regard to their functioning, subjective well-being, and use of health care services, while controlling for potentially confounding variables. RESULTS Anxiety was associated with increased disability and diminished well-being. Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms. Although use of health services was increased in anxiety sufferers, their use of appropriate care was generally low. CONCLUSIONS Anxiety has a clear negative impact on the functioning and well-being of older subjects. The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking. Finally, in spite of its grave consequences for the quality of life, appropriate care for anxiety is seldom received. Efforts to improve recognition, disseminate effective treatments in primary care, and referring to specialized care may have positive effects on the management of anxiety in late life.

The role of self-reported impulsivity and reward sensitivity versus neurocognitive measures of disinhibition and decision-making in the prediction of relapse in pathological gamblers.

BACKGROUND Disinhibition and decision-making skills play an important role in theories on the cause and outcome of addictive behaviors such as substance use disorders and pathological gambling. In recent studies, both disinhibition and disadvantageous decision-making strategies, as measured by neurocognitive tests, have been found to influence the course of substance use disorders. Research on factors affecting relapse in pathological gambling is scarce. METHOD This study investigated the effect of both self-reported impulsivity and reward sensitivity, and neurocognitively assessed disinhibition and decision-making under conflicting contingencies, on relapse in a group of 46 pathological gamblers. RESULTS Logistic regression analysis indicated that longer duration of the disorder and neurocognitive indicators of disinhibition (Stop Signal Reaction Time) and decision-making (Card Playing Task) were significant predictors of relapse (explaining 53% of the variance in relapse), whereas self-reported impulsivity and reward sensitivity did not significantly predict relapse. Overall classification accuracy was 76%, with a positive classification accuracy of 76% and a negative classification accuracy of 75%. CONCLUSIONS Duration of the disorder and neurocognitive measures of disinhibition and decision-making are powerful predictors of relapse in pathological gambling. The results suggest that endophenotypical neurocognitive characteristics are more promising in the prediction of relapse in pathological gambling than phenotypical personality characteristics. Neurocognitive predictors may be useful to guide treatment planning of follow-up contacts and booster sessions.

Long-term effects of childhood sexual abuse: Objective and subjective characteristics of the abuse and psychopathology in later life.

This study investigates the association between objective and subjective characteristics of childhood sexual abuse and psychopathology in later life. The sample consists of 404 Dutch female adults who had been sexually abused in their childhood or adolescence. The participants were recruited by means of articles about childhood sexual abuse in major Dutch newspapers. The characteristics and severity of the sexual abuse were assessed with the Questionnaire Unwanted Sexual Experiences in the Past (QUSEP). General psychopathology was measured with the Symptom Checklist (SCL-90), the degree of dissociation was measured with the Dissociation Questionnaire (DIS-Q). Stepwise multiple regression analyses showed a moderate association between psychopathology and objective characteristics of the abuse, such as number of different types of abusive events and the duration of the abuse. However, more strongly associated with later psychopathology were variables reflecting coping style, such as the degree of self-blame, and circumstantial factors, such as the emotional atmosphere in the family of origin and the reactions after disclosure. Whether or not the abuse was incestuous did not explain additional variance in later psychopathology.

Comorbidity of the anxiety disorders in a community-based older population in The Netherlands

Objective: The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community‐based older population, and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses.

Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam

BACKGROUND Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model. METHOD Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms. RESULTS It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of ones partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety. CONCLUSION The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.

Dissociative Style and Directed Forgetting

Dissociative style may correspond to an enhanced ability to avoid conscious recollection of traumatic experiences, which may, however, remain dormant in nonconscious memory. This hypothesis was tested in two “directed-forgetting” experiments with affectively neutral words (experiment 1) and sex and threat words (experiment 2) employing students high and low in dissociative style, and dissociative patients. Conscious and nonconscious memory were separated with the process dissociation procedure (Jacoby, 1991). Instruction to forget was expected to reduce conscious but to enhance nonconscious memory performance in subjects with a high dissociative ability. Results were opposite to predictions. Particularly for sex words, the instruction to forget raised the overall (conscious and nonconscious) memory performance of the patients. An alternative construction hypothesis is proposed that identifies dissociative style with enhanced skills of constructing conscious experiences.

Validation of the Dutch adaptation of the Buss-Durkee Hostility Inventory

The validity of the Dutch adaptation of the Buss-Durkee Hostility Inventory was investigated. On the basis of the ratings of the staff of a residential treatment center for adolescents with conduct disorders, two contrast groups (high versus low aggression) were formed. In all, 67 male adolescents participated in the study. The subscales of the inventory clearly discriminated between the two groups. A discriminant function analysis revealed that the inventory could correctly classify the subjects into aggressive and non-aggressive with 96% accuracy. The pattern of correlations between the inventory and an anger scale and a social desirability scale provide further support for the construct validity of the instrument.

Continuous monitoring of panic

Data on naturally occurring panic attacks were gathered through continuous self‐monitoring for 94 patients suffering from panic disorder with agoraphobia. A total of 1276 panic attacks were collected. In this article various aspects of panic attacks, including severity, duration and time of onset and situations in which panic occurs are addressed. In addition, the symptoms of panic were investigated, examining the (in)variability of attacks within each patient and the patterning of symptoms in the entire group of patients. The most important findings were as follows: attacks occurred predominantly in nonphobic situations; nocturnal panic attacks were generally more severe than attacks during the day; symptom patterns across various attacks, stemming from the same patient, were rather variable; and finally, a substantial number of the attacks (40%) did not meet the DSM‐III‐R criteria for number of symptoms.

Monitoring and blunting coping styles: The Miller behavioural style scale and its correlates, and the development of an alternative questionnaire

Abstract The present article presents two studies concerning the measurement of monitoring (information seeking under threat) and blunting (information avoidance) coping styles. Study 1 (n = 69) showed that the widely used Miller Behavioural Style Scale suffers from a number of weaknesses such as insufficient internal consistency, susceptibility to correlate with measures of anxiety and other psychopathology, poor quality of scenarios, and moderate face validity. In study 2 (n = 42), an alternative instrument is presented: the Monitoring-Blunting Questionnaire (MBQ). The MBQ has high face validity, good reliability, and is unrelated to trait anxiety. Furthermore, in a “thought experiment” some indications were found for the predictive validity of the MBQ.

Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia : A 2-year naturalistic follow-up

Two years after completion of a controlled outcome study of treatments for panic disorder with agoraphobia, patients were revisited and interviewed about their complaints. In the initial study, four treatments had been compared: (i) fluvoxamine combined with exposure; (ii) placebo medication plus exposure; (iii) psychological panic management plus exposure: and (iv) exposure alone. Comparison of the results at post‐test had revealed superior efficacy of fluvoxamine combined with exposure over the other three treatments in reducing agoraphobic avoidance. The current naturalistic follow‐up study investigated the long‐term efficacy of the treatments with regard to abatement of complaints and reduced demand for further treatment. In addition, we examined whether patients were able to taper off the study medication without a recurrence of complaints. In total, 71 of the 76 patients of the original trial (93%) were interviewed. Comparison of the mean level of psychopathology at follow‐up revealed no difference between the original treatment groups. The effect in the fluvoxamine plus exposure group was maintained, but was no longer superior, due to further improvements in the other treatment groups. Most patients received additional treatment during the follow‐up period, usually because the 12 treatment sessions in the controlled study had yielded insufficient improvement. There was a trend for patients who received the fluvoxamine plus exposure treatment to require less aftercare than those who received the other treatments. Finally, almost 50% of the patients who had received medication in the original trial were able to taper off the use of fluvoxamine without a recurrence of complaints.