The Roles of Social Support and Self-Efficacy in Physical Health’s Impact on Depressive and Anxiety Symptoms in Older Adults

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.     

Memory performance in older adults: Experimental evidence for the indirect effect of memory self-efficacy on processing efficiency through worry

This research examined the mediating role of worry in the relationship between memory self-efficacy (MSE) and processing efficiency during episodic memory performance in older adults. We conducted an experimental study in which we manipulated older adults’ MSE using a false feedback paradigm. The memory task was adapted to provide an indicator of performance effectiveness (recall score) and an indicator of processing efficiency (ratio of recall score to number of encoding trials needed). We measured participants’ worry and emotionality before task completion. The causal impact of MSE condition (high vs. low MSE) on processing efficiency was significantly mediated through worry, with lower MSE leading to increased worry, which predicted impaired processing efficiency. This study provides the first experimental evidence for the mediating effect of worry on the causal impact of MSE on processing efficiency in older adults when they perform challenging memory tasks. We discuss implications for the clinical diagnosis of cognitive impairment and for age-related disengagement from everyday cognitive activities.     

Differential relationships of somatic and cognitive anxiety with measures of processing speed in older adults

Research suggests a reciprocal relationship between late-life anxiety and cognition, particularly attention and executive functions. Whereas evidence supports a conceptual distinction between cognitive and somatic dimensions of anxiety, their differential relationship with cognitive outcomes has not been examined, particularly on tests of attention/executive functions that rely on processing speed. Study goals were threefold: (a) to describe levels of overall, cognitive, and somatic anxiety in a sample of older adults without dementia, (b) to determine if overall anxiety is associated with performance on select measures of attention/executive functions that rely on processing speed, and (c) to determine if a differential relationship exists between cognitive and somatic anxiety and cognitive performance. Participants were 368 community-dwelling older adults. Results showed that elevated levels of somatic, but not cognitive anxiety were associated with poorer performance across measures. Findings suggest that the nature of anxiety symptoms may have important implications for cognitive performance in older adults.     

Cognitive Vulnerability to Emotional Symptoms: Reconsidering the Role of Worry and Rumination

The present study explored the pathways whereby cognitive variables (worry, rumination) may explain the relation between neuroticism and emotional symptoms in a community sample of adults (N?=?499). All participants completed a battery of questionnaires including measures of neuroticism, worry, rumination, anxiety and depression. Multiple mediation and moderated mediation analyses were used. Worry was a common pathway explaining the effect of neuroticism on both anxiety and depressive symptoms. The brooding subtype of rumination significantly mediated the relation between neuroticism and anxiety symptoms, but the reflection subtype did not have a mediating effect. Although worry by itself mediated the association between neuroticism and anxiety symptoms, it required a certain level of brooding to exert its mediating effect on the relation between neuroticism and depressive symptoms. The results are discussed in light of previous research and recent developments in treatment. Clinical implications and suggestions for future research are also discussed.     

The Conceptualization of Anxiety: An Exploratory Study of Japanese American Older Adults

Few empirical studies exist on the mental health of Japanese American older adults. This study focused on how Japanese American older adults conceptualize anxiety. Participants were presented with a checklist, which included anxiety and depression symptoms identified in a previous qualitative study conducted by the authors, as well as symptoms from Generalized Anxiety Disorder in the Statistical Manual of Mental Disorders, Fourth Edition (DSM-IVrpar;. They were asked to imagine a Japanese American older adult who was experiencing anxiety and check off the symptoms he/she would be experiencing. Results indicated that these Japanese American participants conceptualized anxiety by using more depressive symptoms than anxiety symptoms. In addition, contrary to previous research and speculation about how Asian Americans experience psychological distress, participants also checked a larger number of cognitive symptoms as opposed to somatic symptoms. The present data suggest that Japanese American older adults conceptualize anxiety differently from the traditional psychiatric conceptualization of anxiety. Thus, clinicians and researchers should not generalize symptoms of psychological distress developed and researched on nonminority older adults to ethnic minority adults, and should consider such ethnic group differences in their assessment and treatment methods for ethnic minority adults.     

The relationship between Big-5 personality traits and cognitive ability in older adults – a review

It is well established that fundamental aspects of cognition such as memory and speed of processing tend to decline with age; however, there is substantial between-individual variability in levels of cognitive performance in older adulthood and in rates of change in cognitive abilities over time. Recent years have seen an increasing number of studies concerned with examining personality characteristics as possible predictors of some of this variability in cognitive aging. The purpose of this article is to review the literature, and identify patterns of findings regarding the relationships between personality (focusing on the Big-5) and cognitive ability across nonclinical populations of older adults. Possible mechanisms underlying associations of personality characteristics with cognition are reviewed, and assessed in the context of the current literature. Some relatively consistent relationships are identified, including positive associations between openness and cognitive ability, and associations of conscientiousness with slower rates of cognitive decline. However, the relationships between several personality traits and cognitive abilities in older adults remain unclear. We suggest some approaches to research design and analysis that may help increase our understanding of how personality differences may contribute to cognitive aging.     

DSM-IV criteria for generalized anxiety disorder in older adults: distinguishing the worried from the well

This study compared 36 older adults with generalized anxiety disorder (GAD), 22 older adults with subsyndromal anxiety symptoms, and 32 normal controls on criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) for GAD. GAD patients reported more frequent and uncontrollable worry, somewhat different worry content, higher prevalence of most associated symptoms, and more distress or impairment than the subsyndromal group or normal controls. Individuals with subsyndromal anxiety reported more excessive, frequent, and uncontrollable worry than asymptomatic individuals, along with more sleep disturbance, fatigue, and distress or impairment. Results indicate that the key features of late-life GAD are distress and impairment, frequency and uncontrollability of worry, muscle tension, and sleep disturbance and that clinicians treating older adults with GAD should monitor and treat residual symptoms.     

A longitudinal investigation of perceived control and cognitive performance in young, midlife and older adults

Longitudinal associations between generalized control beliefs (one's perceived capacity to influence events) and cognitive test performance were examined in a population-based sample of young, midlife and older adults. Participants provided measures of perceived control, self-assessed health, education and depression and anxiety symptoms, and completed cognitive tests at two assessments, 4 years apart. For each age group, baseline (between-person) control was positively related to performance on tests of memory (immediate recall and digits backwards), speed (Symbol Digit Modalities Test and choice reaction time) and verbal intelligence (Spot-the-Word). Interaction effects indicated stronger associations of between-person control beliefs with indices of speed for the older age group relative to the younger groups. Within-person changes in control were not significantly associated with changes in cognitive test performance over the study interval. Implications of the findings for self-efficacy based interventions designed to promote cognitive functioning are discussed.     

The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression

Previous studies of neuropsychological performance in borderline personality disorder (BPD) have exhibited mixed results. The high rate of co-occurring major depressive disorder (MDD) in BPD makes it difficult to specify whether neuropsychological deficits in BPD predominantly reflect co-occurring MDD or unique aspects of their psychopathology. To address this issue, 22 participants with borderline personality disorder and concurrent major depressive disorder (BPD-MDD) and 33 participants with MDD and no concurrent personality disorder were compared on a neuropsychological battery that assessed seven domains of performance: general intellectual functioning, motor skill, psychomotor speed, attention, memory, working memory, and executive function. Neuropsychological performance did not differ between BPD-MDD and MDD. However, BPD-MDD participants reported higher levels of anger, anxiety, and of overall emotional distress compared to MDD. When levels of anxiety were controlled, BPD-MDD participants exhibited superior general intellectual performance, psychomotor speed, and attention. Deficits found in previous BPD samples may reflect their susceptibility to co-occurring MDD. The impact of anxiety on neuropsychological performance in BPD, though, indicates a need for future experimental studies of the effects of mood on cognitive function to determine whether mood dysregulation, rather than core depressive symptoms, underlie cognition impairments in BPD.     

Worry and rumination: differential associations with anxious and depressive symptoms and coping behavior

Worry and rumination are closely allied cognitive processes that impact on the experience of anxious and depressive symptoms. Using a prospective design, this study examined overlapping and distinct features of worry and rumination in relation to symptoms and coping behavior in a nonclinical sample of Singaporean college students. Worry and rumination were highly correlated, but they retained distinct components that predicted anxious and depressive symptoms differentially within and across time. Specifically, worry was uniquely associated with anxious and depressive symptoms whereas rumination was uniquely related to depression. In comparison to rumination, worry emerged as the dominant cognitive vulnerability factor that predicted increments in symptoms over time. With regards to coping behavior, low perceived coping effectiveness partially mediated the relation between worry and increases in anxiety and depression. Conversely, rumination uniquely predicted higher disengagement from problems, which resulted in further exacerbation of depressive mood. These results demonstrated not only the distinct features of worry and rumination on coping behavior, but also the different coping pathways by which they differentially impact on subsequent symptoms.     

The interplay of trait worry and trait anxiety in determining episodic retrieval: The role of cognitive control

Worrying is a key concept in describing the complex relationship between anxiety and cognitive control. On the one hand, cognitive control processes might underlie the specific tendency to engage in worrying (i.e., trait worry), conceptualized as a future-oriented mental problem-solving activity. On the other hand, the general tendency to experience the signs and symptoms of anxiety (i.e., trait anxiety) is suggested to impair cognitive control because worrisome thoughts interfere with task-relevant processing. Based on these opposing tendencies, we predicted that the effect of the two related constructs, trait anxiety and trait worry, might cancel out one another. In statistics, such instances have been termed suppressor situations. In four experiments, we found evidence for such a suppressor situation: When their shared variance was controlled, trait worry was positively whereas trait anxiety was negatively related to performance in a memory task requiring strategic, effortful retrieval. We also showed that these opposing effects are related to temporal context reinstatement. Our results suggest that trait worry and trait anxiety possess unique sources of variance, which differently relate to performance in memory tasks requiring cognitive control.     

Assessing worry in older adults: confirmatory factor analysis of the Penn State Worry Questionnaire and psychometric properties of an abbreviated model

The assessment of worry among older adults typically has involved measures designed with younger cohorts. Because of special concerns in assessing older adults, modifications to existing instruments may be necessary. Addressing equivocal factor analytic data on the Penn State Worry Questionnaire (PSWQ) among younger adults, the authors conducted confirmatory factor analyses to evaluate the generalizability of previous models to older adults with generalized anxiety disorder. Data fit poorly with established single- and two-factor models. The single-factor model was modified, resulting in the elimination of 8 items, strong fit indices, high internal consistency, adequate test-retest reliability, and good convergent and divergent validity. Further psychometric work is required to assess whether the revised model is a more parsimonious method to assess late-life anxiety.     

A Longitudinal Investigation of Perceived Control and Cognitive Performance in Young,Midlife and Older Adults

ABSTRACT

Longitudinal associations between generalized control beliefs (one's perceived capacity to influence events) and cognitive test performance were examined in a population-based sample of young, midlife and older adults. Participants provided measures of perceived control, self-assessed health, education and depression and anxiety symptoms, and completed cognitive tests at two assessments, 4 years apart. For each age group, baseline (between-person) control was positively related to performance on tests of memory (immediate recall and digits backwards), speed (Symbol Digit Modalities Test and choice reaction time) and verbal intelligence (Spot-the-Word). Interaction effects indicated stronger associations of between-person control beliefs with indices of speed for the older age group relative to the younger groups. Within-person changes in control were not significantly associated with changes in cognitive test performance over the study interval. Implications of the findings for self-efficacy based interventions designed to promote cognitive functioning are discussed.     

'Minor GAD': characteristics of subsyndromal GAD in older adults

Subsyndromal emotional symptoms are common in older adults and are associated with increased disability, health care utilization, and risk for developing psychiatric disorders. The purpose of this study was to examine subsyndromal generalized anxiety disorder (GAD) in older adults. Participants included 30 older adults with diagnosable GAD, 19 with subsyndromal anxiety symptoms [minor GAD; (MGAD)], and 21 normal control volunteers (NC). Participants were assessed using the Anxiety Disorders Interview Schedule for DSM-IV and completed self-report measures of anxiety, worry, depression, and life satisfaction. Excessive worry on more days than not, difficulty controlling worry, and clinically significant distress or impairment were the diagnostic criteria endorsed by MGAD participants least often. Therefore, these criteria may be useful in distinguishing between GAD and subsyndromal GAD. Self-reported anxiety and worry also systematically differed across groups in the expected directions, with a discriminant analysis yielding good classification of the GAD and NC groups based on these measures. Categorization of MGAD participants generally was poor, with most misclassified as GAD patients. Clinical implications of these findings are discussed.     

Intolerance of uncertainty,causal uncertainty,causal importance,self-concept clarity and their relations to generalized anxiety disorder

Although numerous studies have provided support for the notion that intolerance of uncertainty plays a key role in pathological worry (the hallmark feature of generalized anxiety disorder (GAD)), other uncertainty-related constructs may also have relevance for the understanding of individuals who engage in pathological worry. Three constructs from the social cognition literature, causal uncertainty, causal importance, and self-concept clarity, were examined in the present study to assess the degree to which these explain unique variance in GAD, over and above intolerance of uncertainty. N = 235 participants completed self-report measures of trait worry, GAD symptoms, and uncertainty-relevant constructs. A subgroup was subsequently classified as low in GAD symptoms (n = 69) or high in GAD symptoms (n = 54) based on validated cut scores on measures of trait worry and GAD symptoms. In logistic regressions, only elevated intolerance of uncertainty and lower self-concept clarity emerged as unique correlates of high (vs. low) GAD symptoms. The possible role of self-concept uncertainty in GAD and the utility of integrating social cognition theories and constructs into clinical research on intolerance of uncertainty are discussed.     

Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults

Anxiety and depression are commonly comorbid in older adults and are associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments. However, little research has examined the effectiveness of psychological programs to treat comorbid anxiety and depression in older adults. Sixty-two community dwelling adults aged over 60 years with comorbid anxiety and depression were randomly allocated to group cognitive behavioural therapy or a waitlist condition and were assessed immediately following and three months after treatment. After controlling for cognitive ability at pre-treatment, cognitive behaviour therapy resulted in significantly greater reductions, than waitlist, on symptoms of anxiety and depression based on a semi-structured diagnostic interview rated by clinicians unaware of treatment condition. Significant time by treatment interactions were also found for self-report measures of anxiety and depression and these gains were maintained at the three month follow up period. In contrast no significant differences were found between groups on measures of worry and well-being. In conclusion, group cognitive behavioural therapy is efficacious in reducing comorbid anxiety and depression in geriatric populations and gains maintain for at least three months.     

Rumination, worry, cognitive avoidance, and behavioral avoidance: examination of temporal effects

Recently, cross-sectional research has demonstrated that depressive rumination is significantly associated with the tendency to engage in cognitive and behavioral avoidance. This evidence suggests that rumination may be the result of attempts to avoid personally threatening thoughts, in a manner suggested by multiple contemporary theories of worry. This investigation examined the temporal relationship among daily levels of cognitive avoidance, behavioral avoidance, rumination, worry, and negative affect. Seventy-eight adolescents completed baseline questionnaires and then electronically completed daily measures of rumination, worry, behavioral avoidance, and cognitive avoidance, as well as sad and anxious affect for 7 days. Lagged-effect multilevel models indicated that increases in daily sadness were predicted by greater daily rumination and cognitive avoidance. Increases in daily anxiety were predicted by greater daily rumination, worry, and both cognitive and behavioral avoidance. Further, both daily rumination and worry were positively predicted by daily cognitive, but not behavioral, avoidance. Mediation analyses suggested that rumination mediated the effect of cognitive avoidance on both sadness and anxiety. Also, worry mediated the effect of cognitive avoidance on anxiety. Implications for models of avoidance, rumination, and worry are discussed.     

The Emotional Experience Associated with Worrying in Adolescents

Among adults, both normal and pathological worrying has been found to be associated with a unique emotional syndrome involving irritability, restlessness, low frustration tolerance and difficulty relaxing. This emotional state is empirically distinguishable from anxiety and depression, and is reliably assessed by the Stress scale of the Depression Anxiety Stress Scales (DASS). The association between worry and ‘stress’ may have important implications for a better theoretical understanding of worrying in adults. Among youth, however, the emotional experience associated with worrying has not yet been clearly described. The present study aimed to explore whether a distinct, adult-like ‘stress’ syndrome can be assessed in adolescents via self-report, and whether, as in adults, stress has a specific association with worrying. A simplified version of the DASS was created to maximize its comprehension by adolescents. A group of 340 12–18-year-olds completed the simplified DASS and a self-report measure of worry. Factor analyses revealed a three-factor structure underlying the simplified DASS, similar to the original adult version. Further analyses showed that worry had a unique association with Stress, over and above its association with Depression and Anxiety. Adolescents who worry more excessively and uncontrollably also reported higher levels of irritability, restlessness and difficulty relaxing, while the autonomic arousal symptoms of anxiety had consistently low associations with worrying, especially in older adolescents. Results indicate that the proposed cognitive avoidance function of worrying may be present by adolescence.     

Applicability of a cognitive model of worry to children and adolescents

BackgroundIntolerance of uncertainly (IU), cognitive avoidance (CA) and positive beliefs about worry (PB) independently predict worry frequency in older adolescents and adults, and when targeted together in treatment produce significant reductions in both worry and anxiety in this age range. The present study addresses a gap in the literature by testing whether a cognitive model of excessive worry and anxiety incorporating these process variables is applicable to children and adolescents.MethodPrimary and secondary school students (n = 515; aged 7–19 years) completed modified self-report measures of worry frequency, anxiety, IU, CA and PB and a path analysis undertaken to test whether IU was a higher order variable for CA and PB and whether the relationship between IU/CA/PB and anxiety was mediated by worry frequency.ResultsSignificant (bivariate) correlations were observed between the measures of IU, PB, CA, worry and anxiety across the age range. However separate path models had to be fitted for children (aged 7–12 years) and adolescents (aged 13–19) with PB being dropped from the child model. CA was related to anxiety only through worry in children while IU showed direct paths to worry and anxiety in both children and adolescents.ConclusionsCognitive models of persistent worry in adults and older adolescents may, with some modification, have applicability to children. Further testing and refinement of these cognitive models of worry may lead to improvements in existing treatments for anxious youth.