Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-18T18:08:03.791Z Has data issue: false hasContentIssue false
  • English
  • Français

A longitudinal examination of psychosocial impairment across the anxiety disorders

Published online by Cambridge University Press:  13 August 2013

K. Naragon-Gainey ,
M. W. Gallagher  and
T. A. Brown
K. Naragon-Gainey*
Affiliation:
Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
M. W. Gallagher
Affiliation:
Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
T. A. Brown
Affiliation:
Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
*
* Address for correspondence: K. Naragon-Gainey, Ph.D., Department of Psychology, Park Hall, University at Buffalo, The State University of New York, Buffalo, NY 14260, USA. (Email [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Anxiety disorders are highly prevalent disorders associated with substantial psychosocial impairment, but few studies have examined impairment within specific anxiety disorders. Furthermore, it is unclear how change in different types of anxiety has an impact on change in impairment, particularly given high rates of co-morbidity. The current study assessed the temporal associations of impairment and symptoms of three common anxiety disorders in a large, diagnostically heterogeneous clinical sample.

Method

Data were collected from 606 treatment-seeking individuals at an anxiety clinic, most of whom subsequently enrolled in cognitive-behavioral therapy. Symptoms of panic, social anxiety and generalized anxiety disorder (GAD), as well as levels of impairment, were assessed three times over 2 years. In addition to examining levels of impairment across diagnostic groups, latent growth modeling was used to evaluate the longitudinal associations of anxiety symptoms and impairment.

Results

Those with a principal diagnosis of GAD reported higher levels of impairment in some domains at baseline; however, at follow-up assessments individuals with social anxiety disorder reported greater impairment than those with panic disorder. Anxiety symptoms and impairment both declined over time. Change in all three anxiety symptoms was closely associated with change in impairment, but only GAD remained a significant (positive) predictor of change in impairment after accounting for co-morbidity.

Conclusions

Impairment and all three anxiety disorders were closely associated, both cross-sectionally and longitudinally. Because change in GAD was most specifically related to change in impairment, treatment for those with multiple anxiety disorders could focus on treating GAD symptoms first or treating transdiagnostic processes.

Keywords

Anxietygeneralized anxiety disorderpanic disorderpsychosocial impairmentsocial anxiety disorder
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 8 , June 2014 , pp. 1691 - 1700
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allison, PD (2003). Missing data techniques for structural equation modeling. Journal of Abnormal Psychology 112, 545–557.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Barlow, DH, Ellard, KK, Fairholme, CP, Farchione, TJ, Boisseau, CL, Allen, LB, Ehrenreich-May, J (2011). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Client Workbook. Oxford University Press: New York.Google Scholar
Bentler, PM (1990). Comparative fit indices in structural equation models. Psychological Bulletin 28, 97–104.Google Scholar
Brown, EJ, Turovsky, J, Heimberg, RG, Juster, HR, Brown, TA, Barlow, DH (1997). Validation of the Social Interaction Anxiety Scale and the Social Phobia Scale across the anxiety disorders. Psychological Assessment 9, 21–27.Google Scholar
Brown, TA (2007). Temporal course and structural relationships among dimensions of temperament and DSM-IV anxiety and mood disorder constructs. Journal of Abnormal Psychology 116, 313–328.Google Scholar
Brown, TA, Antony, MA, Barlow, DH (1995). Diagnostic comorbidity in panic disorder: effect on treatment outcome and course of comorbid diagnoses following treatment. Journal of Consulting and Clinical Psychology 63, 408–418.Google Scholar
Brown, TA, Chorpita, BF, Barlow, DH (1998). Structural relationships among the dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology 107, 179–192.Google Scholar
Brown, TA, Di Nardo, PA, Lehman, CL, Campbell, LA (2001). Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders. Journal of Abnormal Psychology 110, 49–58.Google Scholar
Brown, TA, White, KS, Barlow, DH (2005). A psychometric reanalysis of the Albany Panic and Phobia Questionnaire. Behaviour Research and Therapy 43, 337–355.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Erlbaum: Hillsdale, NJ.Google Scholar
Di Nardo, PA, Brown, TA, Barlow, DH (1994). Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L). Oxford University Press: New York.Google Scholar
Dunn, TW, Vittengl, JR, Clark, LA, Carmody, T, Thase, ME, Jarrett, RB (2012). Changes in psychosocial functioning and depressive symptoms during acute-phase cognitive therapy for depression. Psychological Medicine 42, 317–326.Google Scholar
Hafner, RJ, Marks, IM (1976). Exposure in vivo of agoraphobics: contributions of diazepam, group exposure, and anxiety evocation. Psychological Medicine 6, 71–88.Google Scholar
Hettema, JM, Prescott, CA, Kendler, KS (2004). Genetic and environmental sources of covariation between generalized anxiety disorder and neuroticism. American Journal of Psychiatry 161, 1581–1587.CrossRefGoogle ScholarPubMed
Hu, L, Bentler, PM (1998). Cutoff criteria for fit indexes in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychological Methods 3, 424–453.Google Scholar
Hussain, A, Weisaeth, L, Heir, T (2011). Psychiatric disorders and functional impairment among natural disaster victims after exposure to a natural disaster: a population based study. Journal of Affective Disorders 128, 135–141.Google Scholar
Jöreskog, KG, Sörbom, D (1996). LISREL 8 User's Reference Guide. Scientific Software International: Uppsala, Sweden.Google Scholar
Keller, MB (2003). The lifelong course of social anxiety disorder: a clinical perspective. Acta Psychiatrica Scandinavica 108, 85–94.Google Scholar
Kessler, RC, Chiu, WT, Demler, O, Walter, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry 62, 617–627.Google Scholar
Kessler, RC, DuPont, RL, Berglund, PA, Wittchen, H-U (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. American Journal of Psychiatry 156, 1915–1923.Google Scholar
Lam, RW, Filteau, M-J, Milev, R (2011). Clinical effectiveness: the importance of psychosocial functioning outcomes. Journal of Affective Disorders 132, S9–S13.Google Scholar
Lochner, C, Mogotsi, M, du Toit, PL, Kaminer, D, Niehaus, DJ, Stein, DJ (2003). Quality of life in anxiety disorders: a comparison of obsessive–compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology 36, 255–262.Google Scholar
Markon, KE (2010). How things fall apart: understanding the nature of internalizing through its relationship with impairment. Journal of Abnormal Psychology 119, 447–458.Google Scholar
Mataix-Cols, D, Cowley, AJ, Hankinsa, M, Schneider, A, Bachofen, M, Kenwright, M, Gega, L, Cameron, R, Marks, IM (2005). Reliability and validity of the Work and Social Adjustment Scale in phobic disorders. Comprehensive Psychiatry 46, 223–228.CrossRefGoogle ScholarPubMed
Mattick, RP, Clarke, JC (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety fear. Behaviour Research and Therapy 36, 455–470.CrossRefGoogle Scholar
McKnight, PE, Kashdan, TB (2009). The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clinical Psychology Review 29, 243–259.Google Scholar
Meyer, TJ, Miller, ML, Metzger, RL, Borkovec, TD (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Thearpy 28, 487–495.Google Scholar
Moritz, S, Rufer, M, Fricke, S, Karow, A, Morfeld, M, Jelinek, L, Jacobsen, D (2005). Quality of life in obsessive–compulsive disorder before and after treatment. Comprehensive Psychiatry 46, 453–459.Google Scholar
Mundt, JC, Marks, IM, Shear, KM, Greist, JH (2002). The Work and Social Adjustment Scale: a simple measure of impairment in functioning. British Journal of Psychiatry 180, 461–464.Google Scholar
Muthén, LK, Muthén, BO (1998–2010). Mplus 6.0. Muthén and Muthén: Los Angeles.Google Scholar
Olatunji, BO, Cisler, JM, Tolin, DF (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clinical Psychology Review 27, 572–581.Google Scholar
Olfson, M, Broadhead, WE, Weissman, MM, Leon, AC, Farber, L, Hoven, C, Kathol, R (1996). Subthreshold psychiatric symptoms in a primary care group practice. Archives of General Psychiatry 53, 880–886.Google Scholar
Pollack, MH, Otto, MW, Worthington, JJ, Manfro, GG, Wolkow, R (1998). Sertraline in the treatment of panic disorder: a flexible-dose multicenter trial. Archives of General Psychiatry 55, 1010–1016.Google Scholar
Ramsawh, HJ, Raffa, SD, Orlando Edelen, M, Rende, R, Keller, MB (2009). Anxiety in middle adulthood: effects of age and time on the 14 year course of panic disorder, social phobia, and generalized anxiety disorder. Psychological Medicine 39, 615–624.Google Scholar
Rapee, RM, Craske, MG, Barlow, DH (1994/1995). Assessment instrument for panic disorder that includes fear of sensation-producing activities: The Albany Panic and Phobia Questionnaire. Anxiety 1, 114–122.CrossRefGoogle ScholarPubMed
Raykov, T (2005). Analysis of longitudinal studies with missing data using covariance structure modeling with full-information maximum likelihood. Structural Equation Modeling 12, 493–505.Google Scholar
Ro, E, Clark, LA (2009). Psychosocial functioning in the context of diagnosis: assessment and theoretical issues. Psychological Assessment 21, 313–324.Google Scholar
Rodriguez, BF, Bruce, SE, Pagano, ME, Keller, MB (2005). Relationships among psychosocial functioning, diagnostic comorbidity, and the recurrence of generalized anxiety disorder, panic disorder, and major depression. Journal of Anxiety Disorders 19, 752–766.CrossRefGoogle ScholarPubMed
Ruscio, AM, Brown, TA, Chiu, WT, Sareen, J, Stein, MB, Kessler, RC (2007). Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication. Psychological Medicine 38, 15–28.CrossRefGoogle ScholarPubMed
Safren, SA, Heimberg, RG, Brown, EG, Holle, C (1997). Quality of life in patients with social phobia. Depression and Anxiety 4, 126–133.Google Scholar
Seeley, JR, Kosty, DB, Farmer, RF, Lewinsohn, PM (2011). The modeling of internalizing disorders on the basis of patterns of lifetime comorbidity: associations with psychosocial functioning and psychiatric disorders among first-degree relatives. Journal of Abnormal Psychology 120, 308–321.CrossRefGoogle ScholarPubMed
Sherbourne, C, Wells, KB, Merideth, LS, Jackson, CA, Camp, P (1996). Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Archives of General Psychiatry 53, 889–894.Google Scholar
Sherbourne, CD, Sullivan, G, Craske, MG, Roy-Byrne, P, Golinelli, D, Rose, RD, Chavira, DA, Bystritsky, A, Stein, MB (2010). Functioning and disability levels in primary care outpatients with one or more anxiety disorders. Psychological Medicine 40, 2059–2068.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JBW, Lowe, B (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine 166, 1092–1097.CrossRefGoogle ScholarPubMed
Steiger, JH (1990). Structural model evaluation and modification: an interval estimation approach. Multivariate Behavioral Research 25, 173–180.Google Scholar
Stein, MB, Kean, YM (2000). Disability and quality of life in social phobia: epidemiologic findings. American Journal of Psychiatry 157, 1606–1613.CrossRefGoogle ScholarPubMed
Stein, MB, Roy-Byrne, PP, Craske, MG, Bystritsky, A, Sullivan, G, Pyne, JM, Katon, W, Sherbourne, CD (2005). Functional impact and health utility of anxiety disorders in primary care outpatients. Medical Care 43, 1164–1170.Google Scholar
Stout, RL, Dolan, R, Dyck, I, Eisen, J, Keller, MB (2001). Course of social functioning after remission from panic disorder. Comprehensive Psychiatry 42, 441–447.Google Scholar
Tucker, LR, Lewis, C (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38, 1–10.Google Scholar
Watson, D, Gamez, W, Simms, LJ (2005). Basic dimensions of temperament and their relation to anxiety and depression: a symptom-based perspective. Journal of Research in Personality 39, 45–66.Google Scholar
Weinstock, LM, Whisman, MA (2006). Neuroticism as a common feature of the depressive and anxiety disorders: a test of the revised integrative hierarchical model in a national sample. Journal of Abnormal Psychology 115, 68–74.Google Scholar
Zimmerman, M, McGlinchey, JB, Posternak, MA, Friedman, M, Attiullah, N, Boerescu, D (2006). How should remission from depression be defined? The depressed patient's perspective. American Journal of Psychiatry 163, 148–150.Google Scholar