Increased mortality risk in men for anxiety disorders
Nov 2, 2004 - 3:25:38 PM

For men, but not for women, there is an increased mortality risk for anxiety disorders, according to a study from the Netherlands published in the November issue of the British Journal of Psychiatry.

Although the increased mortality risk for depression is well established, there are inconsistent reports as to whether people with anxiety disorders are at higher risk.

This study set out to determine whether anxiety disorders predict mortality in older men and women in the community.

Data were collected from the Longitudinal Ageing Study Amsterdam, which charts changes in well-being and autonomy among older people. This uses a large, community-based random sample of 3107 older men and women aged between 55 and 85, with a follow-up period of 7.5 years.

Anxiety disorders were assessed in a two-stage screening study. Stage one used a scale for measuring anxiety and depression. In stage two a diagnostic interview was held two to eight weeks after the first assessment with everyone who screened positive, and an equally large random sample of participants who screened negative.

659 people were interviewed (average age 70.6 years), of whom 332 were 'screen positives', and 327 'screen negatives'. In the study sample 17% were found to have an anxiety disorder. Older men with diagnosed anxiety disorders had an 87% higher risk of mortality than women over seven years of follow-up.

The associations between anxiety and mortality in men remained after taking into account depression, activity, smoking, drinking, body mass index, age, psychiatric treatment, functional limitations and chronic diseases, including heart disease and stroke. In women with anxiety disorders, no association was found with subsequent mortality.

The authors of the study comment that a possible explanation for the gender difference is that men have more cardiovascular disorders, the course of which could be affected more strongly by anxiety.

A psychological explanation could be that men are less capable of dealing with feelings of anxiety and hopelessness than women. Women are more inclined to discuss such feelings with others, are more open to accepting support, and may therefore be better able to cope with feelings of anxiety.

Further, men are less likely than women to report feelings of anxiety. If they do, their condition may be worse than that of their female counterparts, which can have a greater impact on their physical health and may lead to earlier death. Suicide did not explain the excess mortality among men.

A major implication of these findings is that it is important to treat anxiety in older people. In order to increase the number of treated patients, better recognition of anxiety, and patient empowerment, are key issues.

The next step for research should be to look into the causes of death associated with anxiety, and to explore further sociopsychological and pathophysiological differences between men and women.

Reference: Van Hout H P J, AartjaanT F B, De Beurs E et al (2004) Anxiety and the risk of death in older men and women. British Journal of Psychiatry, 185, 399-404.

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