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The association of comorbid depression and anxiety symptoms with disability onset in older adults

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Dong, Liming, Freedman, Vicki A., Mendes de Leon, Carlos F.·2020·Psychosomatic Medicine
DOI 10.1097/psy.0000000000000763PMC PMC7007837
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Abstract

Objective: Despite the high prevalence of late-life depression and anxiety at threshold and subthreshold levels, their joint role in the disablement process remains unclear. This study aims to examine the association of comorbid occurring depression and anxiety across the full spectrum of symptom severity with disability onset in older adults. Methods: The study included 3663 participants from the 2011 National Health and Aging Trends Study, who reported no limitations in self-care and mobility activities at baseline. Disability onset was defined as a report of receiving help from another person in any of the activities for 3 consecutive months. Depression and anxiety symptoms were measured using the four-item Patient Health Questionnaire, grouped into low, mild, and moderate/severe symptom groups. Cox proportional hazards models were used to estimate relative risks for disability onset over a 5-year period by depression/anxiety symptom groups. Results: A total of 1047 participants developed disability (24.6%; 6.0 per 1000 person-months). At baseline, one-fifth of the sample reported symptoms that were mild ( n = 579 [14.9%]; 31.6% with disability onset) or moderate/severe ( n = 156 [4.2%]; 38.1% with disability onset). After adjustment for sociodemographics, there was a dose-response relationship between depression/anxiety symptom groups and disability onset (mild versus low: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.20–1.70; moderate/severe versus low: HR = 1.94, 95% CI = 1.45–2.59). The increased risk remained significant after adjustment for health status variables for the mild symptom group (HR = 1.26, 95% CI = 1.07–1.49), but not for the moderate/severe symptom group (HR = 1.30, 95% CI = 0.94–1.79), possibly reflecting lower statistical power. Conclusions: Findings suggest that the full spectrum of depression and anxiety symptoms are associated with increased risk for disability in late life. Their role in the disablement process warrants further investigation.

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  1. [15]Freedman VA. The demography of late-life disability In: Majmundar MK, Hayward MD, editors. Future directions for the demography of aging: Proceedings of a workshop. Washington (DC): National Academies Press; 2018. 29989766
  2. [33]Lenze EJ, Rogers JC, Martire LM, Mulsant BH, Rollman BL, Dew MA, Schulz R, Reynolds CF. The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. The American Journal of Geriatric Psychiatry. 2001; 9: 113– 35. 11316616

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Authors
Dong, L., Freedman, V. A., & Mendes de Leon, C. F.
Affiliations
University of Michigan (US)
Corresponding author
Dong, Liming
ORCID
Venue
Psychosomatic Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-11-01
Volume
82
Issue
2
Pages
158-164
ISSN
  • 0033-3174 (ISSN-L)
  • 1534-7796
DOI
10.1097/psy.0000000000000763
PMC
PMC7007837
OpenAlex
W2985555563
Cited by
80
References
40
Citations by year
2026: 11 · 2025: 15 · 2024: 12 · 2023: 18 · 2022: 12 · 2021: 8 · 2020: 3 · 2018: 1
FWCI
5.29
Type
journal article
Language
en
Open access
Locations
  • Psychosomatic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Aging (U01AG032947)
  • National Institute on Minority Health and Health Disparities (P60MD002249)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
depression, anxiety, comorbidities, disability onset, older adults, geriatric depression, subthreshold symptoms, symptom severity, disability risk
MeSH terms
Aged, Aged, 80 and over, Aging, Anxiety, Anxiety Disorders, Depression, Depressive Disorder, Female, Persons with Disabilities, Medicare, Humans, Longitudinal Studies, Male, Risk, United States, Comorbidity

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