Age and sex‐related variability in the presentation of generalized anxiety and depression symptoms

Katherine N. Thompson, Christopher Hübel, Rosa Cheesman, Brett N. Adey, Chérie Armour, Molly R. Davies, Matthew Hotopf, Ian R. Jones, Gursharan Kalsi, Andrew M. McIntosh, Dina Monssen, Alicia J. Peel, Henry C. Rogers, Megan Skelton, Daniel J. Smith, James T.R. Walters, Gerome Breen, Thalia C. Eley*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

69 Downloads (Pure)

Abstract

Background: Generalized anxiety and depression are extremely prevalent and debilitating. There is evidence for age and sex variability in symptoms of depression, but despite comorbidity it is unclear whether this extends to anxiety symptomatology. Studies using questionnaire sum scores typically fail to address this phenotypic complexity.
Method: We conducted exploratory and confirmatory factor analyses on Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) items to identify latent factors of anxiety and depression in participants from the Genetic Links to Anxiety and Depression Study (N = 35,637; 16–93 years). We assessed age- and sex-related variability in latent factors and individual symptoms using multiple logistic regression.
Results: Four factors of mood, worry, motor, and somatic symptoms were identified (comparative fit index [CFI] = 0.99, Tucker–Lewis Index [TLI] = 0.99, root mean square error of approximation [RMSEA] = 0.07, standardized root mean square residuals [SRMR] = 0.04). Symptoms of irritability (odds ratio [OR] = 0.81) were most strongly associated with younger age, and sleep change (OR = 1.14) with older age. Males were more likely to report mood and motor symptoms (p < .001) and females to report somatic symptoms (p < .001).
Conclusion: Significant age and sex variability suggest that classic diagnostic criteria reflect the presentation most commonly seen in younger males. This study provides avenues for diagnostic adaptation and factor-specific interventions.
Original languageEnglish
Pages (from-to)1054-1065
JournalDepression and Anxiety
Volume38
Issue number10
Early online date08 Sep 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
Prof Breen has received honoraria, research or conference grants and consulting fees from Illumina, Otsuka, and COMPASS Pathfinder Ltd. Prof Hotopf is principal investigator of the RADAR‐CNS consortium, an IMI public private partnership, and as such receives research funding from Janssen, UCB, Biogen, Lundbeck and MSD. Prof McIntosh has received research support from Eli Lilly, Janssen, and the Sackler Foundation, and has also received speaker fees from Illumina and Janssen. Prof Walters has received grant funding from Takeda for work unrelated to the GLAD Study. The other authors declare that there are no conflict of interests.

Funding Information:
The authors thank the GLAD Study and NIHR BioResource volunteers for their participation, and gratefully acknowledge the NIHR BioResource centers, NHS Trusts, and staff for their contribution. The authors thank the National Institute for Health Research, NHS Blood and Transplant, and Health Data Research UK as part of the Digital Innovation Hub Programme. This study presents independent research funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. Further information can be found at http://brc.slam.nhs.uk/about/core-facilities/bioresource. The views expressed are those of the authors and not necessarily those of the NHS, NIHR, HSC R&D Division, Department of Health and Social Care. This study was supported by the National Institute of Health Research (NIHR) BioResource [RG94028, RG85445], NIHR Biomedical Research Centre [IS-BRC-1215-20018], HSC R&D Division, Public Health Agency [COM/5516/18], MRC Mental Health Data Pathfinder Award (MC_PC_17,217), and the National Centre for Mental Health funding through Health and Care Research Wales. Prof Eley and Dr Breen are part-funded by a program grant from the UK Medical Research Council (MR/V012878/1). Dr H?bel acknowledges funding from Lundbeckfonden (R276-2018-4581).

Funding Information:
The authors thank the GLAD Study and NIHR BioResource volunteers for their participation, and gratefully acknowledge the NIHR BioResource centers, NHS Trusts, and staff for their contribution. The authors thank the National Institute for Health Research, NHS Blood and Transplant, and Health Data Research UK as part of the Digital Innovation Hub Programme. This study presents independent research funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. Further information can be found at http://brc.slam.nhs.uk/about/core-facilities/bioresource . The views expressed are those of the authors and not necessarily those of the NHS, NIHR, HSC R&D Division, Department of Health and Social Care. This study was supported by the National Institute of Health Research (NIHR) BioResource [RG94028, RG85445], NIHR Biomedical Research Centre [IS‐BRC‐1215‐20018], HSC R&D Division, Public Health Agency [COM/5516/18], MRC Mental Health Data Pathfinder Award (MC_PC_17,217), and the National Centre for Mental Health funding through Health and Care Research Wales. Prof Eley and Dr Breen are part‐funded by a program grant from the UK Medical Research Council (MR/V012878/1). Dr Hübel acknowledges funding from Lundbeckfonden (R276‐2018‐4581).

Publisher Copyright:
© 2021 The Authors. Depression and Anxiety published by Wiley Periodicals LLC

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • factor analysis
  • factor scores
  • GAD-7
  • genetic links to anxiety and depression study
  • heterogeneity
  • PHQ-9

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Fingerprint

Dive into the research topics of 'Age and sex‐related variability in the presentation of generalized anxiety and depression symptoms'. Together they form a unique fingerprint.

Cite this