Predictors of persistence of anxiety disorders across the lifespan: a systematic review

Abstract

Despite the substantial disease burden of anxiety disorders, physicians have a poor understanding of factors that predict their typical persistent course. This systematic review of predictors of persistent anxiety disorders covered 48 studies with 29 690 patients diagnosed with an anxiety disorder that were published in PubMed, PsycINFO, and Web of Science between Jan 1, 1980 (introduction of DSM-III), and Dec 1, 2019. We also compared predictors between children, adolescents, adults, and older adults (ie, ≥55 years). A persistent course was primarily predicted by clinical and psychological characteristics, including having panic attacks, co-occurring personality disorders, treatment seeking, poor clinical status after treatment, higher severity and longer duration of avoidance behaviour, low extraversion, higher anxiety sensitivity, and higher behavioural inhibition. Unlike disorder onset, sociodemographic characteristics did not predict persistence. Our results outline a profile of patients with specific clinical and psychological characteristics who are particularly vulnerable to anxiety disorder persistence. Clinically, these patients probably deserve additional or more intensive treatment to prevent development of chronicity.

Anxiety disorders and age-related changes in physiology

“…Anxiety disorders are leading contributors to the global disease burden, highly prevalent across the lifespan and across nations, and associated with substantially increased morbidity and early mortality. [1][2][3][4] A population-based study from Denmark reported that individuals with anxiety disorders had a 39% higher risk of premature death than the general population. 5 This excess mortality does not result only from unnatural causes of death such as suicide, but also from increased rates of dementia, cardiovascular disease and other illnesses.…”

A high-throughput test of anxiety for zebrafish (Danio rerio) larvae: the larval diving response (LDR)

“…Anxiety exists either as a state (fear or nervousness, typically associated with a negative effect) or as a trait, in which anxiety proneness is stable across the lifespan (Hovenkamp-Hermelink et al, 2021). The emergence of anxiety traits can occur from as young as 6 years old, and can lead to an increased risk of developing subsequent substance misuse, disruptive behaviors and even suicidal behaviors (Asselmann et al, 2018).…”

Anxiety disorders and age-related changes in physiology

“…Anxiety disorders are leading contributors to the global disease burden, highly prevalent across the lifespan and across nations, and associated with substantially increased morbidity and early mortality. [1][2][3][4] A population-based study from Denmark reported that individuals with anxiety disorders had a 39% higher risk of premature death due to natural causes than the general population. 5 The excess mortality observed in anxiety disorders does not result only from unnatural causes of death such as suicide, but also from increased rates of dementia, [6][7][8] cardiovascular events 9 and other medical illnesses.…”

“…Given that a dose-response relationship between anxiety disorder severity and differences in physiology has been reported before, 18 we also examined chronic and/or severe anxiety disorders. Finally, depression has been associated with age-related changes in physiology 26 and is highly comorbid with anxiety disorders, [2][3][4]18 hence we also examined physiological differences between individuals with anxiety disorders without comorbid depression and healthy controls.…”

“…Anxiety disorders are leading contributors to the global disease burden, highly prevalent across the lifespan and across nations, and associated with substantially increased morbidity and early mortality (1)(2)(3)(4). A population-based study from Denmark reported that individuals with anxiety disorders had a 39% higher risk of premature death than the general population (5).…”