Age differences in treatment response to a collaborative care intervention for anxiety disorders

Abstract

Background: Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults.

Aims: We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults.

Method: We examined findings for the overall sample, as well as within each diagnostic category (clinicaltrials.gov identifier: NCT00347269).

Results: The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults.

Conclusions: These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.

Conflict of interest statement

Declaration of interest

J.L.W. received research support from Forest Laboratories. M.B.S. receives or received research support from the US Department of Defense, Eli Lilly, GlaxoSmithKline, Hoffmann-La Roche, National Institutes of Health and the US Veterans Affairs Research Program; and is currently or has been a paid consultant for AstraZeneca, Avera Pharmaceuticals, BrainCells, Bristol-Myers Squibb, Comprehensive NeuroScience; Eli Lilly, Forest Laboratories, GlaxoSmithKline, Hoffmann-La Roche, Jazz Pharmaceuticals, Johnson & Johnson, Mindsite, Pfizer, Sepracor, and Transcept Pharmaceuticals. P.R.-B. receives research grant support from the National Institutes of Health; served as a paid member of advisory boards for Jazz Pharmaceuticals and Solvay Pharmaceuticals (one meeting for each); received honoraria for continuing medical education (CME)-sponsored speaking from the American Psychiatric Association, Anxiety Disorders Association of America, CME LLC, CMP Media, Current Medical Directions, Imedex, Massachusetts General Hospital Academy, and PRIMEDIA Healthcare.

Figures

Fig. 1

Anxiety symptoms in (a) younger (n = 870) and (b) older (n = 134) primary care patients with anxiety disorders receiving a collaborative care intervention (TX) or usual care (TAU). Controlled for education, number of chronic medical conditions, presence of more than one anxiety disorder and comorbid major depression. BSI, Brief Symptom Inventory.

Fig. 2

Somatic symptoms in (a) younger (n = 870) and (b) older (n = 134) primary care patients with anxiety disorders receiving a collaborative care intervention (TX) or usual care (TAU). Controlled for education, number of chronic medical conditions, presence of more than one anxiety disorder and comorbid major depression. BSI, Brief Symptom Inventory.

Fig. 3

Depressive symptoms in (a) younger (n = 870) and (b) older (n = 134) primary care patients with anxiety disorders receiving a collaborative care intervention (TX) or usual care (TAU). Controlled for education, number of chronic medical conditions, presence of more than one anxiety disorder and comorbid major depression. PHQ, Patient Health Questionnaire.

Fig. 4

Generalised anxiety disorder symptoms in (a) younger (n = 655) and (b) older (n = 100) primary care patients with generalised anxiety disorder receiving a collaborative care intervention (TX) or usual care (TAU). Controlled for education, number of chronic medical conditions, presence of more than one anxiety disorder and comorbid major depression. GADSS, Generalized Anxiety Disorder Severity Scale.

Fig. 5

Panic disorder symptoms in (a) younger (n = 428) and (b) older (n = 47) primary care patients with panic disorder receiving a collaborative care intervention (TX) or usual care (TAU). Controlled for education, number of chronic medical conditions, presence of more than one anxiety disorder and comorbid major depression. PDSS, Panic Disorder Severity Scale.

Fig. 6

Social phobia symptoms in (a) younger (n = 368) and (b) older (n = 35) primary care patients with panic disorder receiving a collaborative care intervention (TX) or usual care (TAU). Controlled for education, number of chronic medical conditions, presence of more than one anxiety disorder and comorbid major depression. SPIN, Social Phobia Inventory.

Fig. 7

Post-traumatic stress disorder (PTSD) symptoms in (a) younger (n = 150) and (b) older (n = 31) primary care patients with panic disorder receiving a collaborative care intervention (TX) or usual care (TAU). Controlled for education, number of chronic medical conditions, presence of more than one anxiety disorder and comorbid major depression. PCL, PTSD Checklist.