Journals of Gerontology: MEDICAL SCIENCES Cite journal as: J Gerontol A Biol Sci Med Sci. 2014 November;69A(S2):S61–S67 doi:10.1093/gerona/glu178
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected].
Anxiety Among Community-Dwelling U.S. Chinese Older Adults XinQi Dong,1 Ruijia Chen,1 and Melissa A. Simon2 1 Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois. Department of Obstetrics/Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Address correspondence to XinQi Dong, MD, MPH, Professor of Medicine, Nursing and Behavioral Sciences. Director, Chinese Health, Aging and Policy Program, Associate Director, Rush Institute for Healthy Aging, Rush University Medical Center, 1645 West Jackson, Suite 675, Chicago, IL 60612. Email: [email protected]
Background. This study aimed to explore the prevalence and correlates of anxiety disorders and any anxiety symptoms among community-dwelling U.S. Chinese older adults. Methods. Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person between 2011 and 2013. Results. Of 3,159 older adults surveyed, 8.5% had anxiety disorders and 65.0% reported having any anxiety symptoms. Being female, unmarried, poorer health status, lower quality of life, and worsening health over the past year were positively correlated with anxiety disorders and any anxiety symptoms. Living with fewer people and having fewer children were only correlated with any anxiety symptoms and lower income was only correlated with anxiety disorders. Conclusions. This study emphasizes that interventions for anxiety among Chinese older adults should give special attention to older women, those who are unmarried, with impaired health status, and poorer quality of life. Further longitudinal studies should be conducted to better understand risk factors and outcomes associated with anxiety among U.S. Chinese older adults. Key Words: Anxiety disorders—Anxiety symptoms—Older adults—Chinese—Psychological health. Received May 4, 2014; Accepted August 27, 2014 Decision Editor: Stephen Kritchevsky, PhD
A
nxiety is the most common mental illness among U.S. adults, with an estimated 12-month prevalence of 18.1%, of which 22.8% are severe anxiety disorders (1). Anxiety may cause significant adverse personal and societal outcomes. At the individual level, anxiety has been linked to physical disability (2), declines in cognitive function (3), and even suicidal ideation and mortality (4,5). At the societal level, anxiety may increase medical utilization and health care costs (6). According to a report on the economic burden of anxiety disorders, the cost of anxiety disorders is about $42 million per year—one third of the U.S. total mental illness bill (7). Anxiety is a major health problem in late life, yet anxiety symptoms in older adults are often undiagnosed and untreated. A study with 713 men and 1,338 women in Kentucky found that although 20% of participants aged 55 and older experienced a high level of anxiety symptoms, only 10% of them acknowledged the need to seek mental health treatment (8). Despite the magnitude of the issue among older adults, compared with other mental health issues such as depression and dementia, anxiety has received significantly less attention from researchers and the public (9,10). Additionally, the majority of studies on anxiety among older adults focused on the occurrence of disorders. Anxiety
disorders may be manifested by a combination of symptoms such as having constantly worrying thoughts or not being able to sit at ease. Given that a diagnosis of anxiety disorders may require several symptoms, participants who endorsed one or more symptoms but did not meet the criteria for anxiety disorders may be excluded from the estimate of prior studies. Such exclusion of subsyndromal presentations may lead to the underestimation of the issue of anxiety among older adults (11). It is imperative for community epidemiology surveys to depict more accurate and comprehensive pictures of the extent of anxiety among older adults. The prevalence, presentation, and expression of anxiety differ significantly by social and cultural factors. Anxiety, especially social anxiety, is common and more likely to interfere with social relationships in collectivistic cultures, where harmony is highly emphasized within family and society (12). In addition, responses to anxiety may vary by cultural and ethnic groups. The Chinese culture is distinctive in the great emphasis given to individual and family “face value,” in which respect and reputation are critical (13). Although anxiety may be regarded as personality disorders, Chinese older adults are often inclined to deny anxiety so as to protect family honor and save individual “face.” S61
Downloaded from http://biomedgerontology.oxfordjournals.org/ at Mahidol University / Library & Information Center on February 28, 2015
2
S62
Dong et al.
Methods Population and Settings Data of this study were collected from 2011 to 2013, as part of the Population Study of Chinese Elderly in Chicago (PINE). The PINE study is a community-engaged, population-based epidemiological study of U.S. Chinese older adults aged 60 and older conducted in the Greater Chicago area. The project was initiated by a synergistic community-academic collaboration among the Rush Institute for Healthy Aging, Northwestern University, and many Greater Chicago area community-based social service agencies and organizations. To ensure the study’s relevance to the well-being of the Chinese community and increase community participation, the PINE study was guided by a community-based participatory research approach. A community advisory board played a pivotal role in providing insights for our research activities. Board members were community stakeholders and residents enlisted from more than 20 civic, health, and social advocacy groups and community centers and clinics in the city and suburbs of Chicago. The board worked extensively with the investigative team to develop and test study instruments to ensure cultural sensitivity and appropriateness. Study Design and Procedure The research team implemented a targeted communitybased recruitment strategy by first engaging community
centers in the Greater Chicago area. More than 20 social service agencies, community centers, health advocacy agencies, faith-based organizations, senior apartments, and social clubs served as the basis of study recruitment sites. Community-dwelling older adults aged 60 and older who self-identified as Chinese were eligible to participate in the study. Out of 3,542 eligible older adults approached, 3,159 agreed to participate in the study, yielding a response rate of 91.9%. Details of the PINE study design are published elsewhere (18). Trained multicultural and multilingual interviewers conducted face-to-face home interviews with participants in their preferred language (English or Chinese) and dialect (eg, Cantonese, Taishanese, Mandarin, and Teochew). Based on the available data drawn from the U.S. Census 2010 and a random block census project conducted among the Chinese community in Chicago, the PINE study is representative of the Chinese aging population in the greater Chicago area (19). The study was approved by the Institutional Review Board of the Rush University Medical Center. Measurements Sociodemographics.—Basic demographic information including age (in years), years of education completed, annual personal income (0–$4,999 per year; $5,000–$9,999 per year; $10,000–14,999 per year; $15,000–$19,999 per year; or more than $20,000 per year), marital status (married, separated, divorced, or widowed), number of children, number of grandchildren, years in the community, and years in the United States were assessed in all participants. Living arrangement was categorized into four groups: (i) living alone, (ii) living with one person, (iii) living with two to three persons, or (iv) living with four or more persons. Overall health status, quality of life, and health changes over the last year.—Overall health status was measured by “In general, how would you rate your health?” on a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = very good). Quality of life was assessed by asking “In general, how would you rate your quality of life?” also on a 4-point scale ranging from 1 = poor to 4 = very good. Health changes over the last year was measured by “Compared to one year ago, how would you rate your health now?” on a 3-point scale (1 = worsened, 2 = same, 3 = improved). Anxiety.—We used the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) to assess anxiety among Chinese older adults (20). Participants were asked if they currently experienced the following symptoms: (i) felt tense or wound up, (ii) had a frightened feeling as if something awful is about to happen, (iii) had worrying thoughts, (iv) sit at ease and feel relaxed, (v) had a frightened feeling like butterflies in the stomach, (vi) had feelings of restless, or (vii) had feelings of panic. Respondents indicated answers
Downloaded from http://biomedgerontology.oxfordjournals.org/ at Mahidol University / Library & Information Center on February 28, 2015
The tendency to deny symptoms or express anxiety symptoms as somatic symptoms such as pain or fatigue may add to the complexity of detecting anxiety among Chinese older adults. Despite possibly unique cultural patterns of anxiety, the research on anxiety disorders and anxiety symptoms among Chinese older adults, regardless of their place of residence, is still in its infancy. The prevalence of anxiety cannot be fully understood without taking the immigration context into account. Language and cultural barriers experienced in a new country may increase intergenerational conflicts and breakdowns of traditional support systems (14–16). Furthermore, living in a conflict environment, financial strain, and separation from family members and relatives in the home country may predispose U.S. Chinese older adults to greater risk for anxiety. Over the past several years, the number of U.S. Chinese older adults has grown rapidly, to an estimated 540,000 people age 60 years or older in 2010 (17). The vulnerability and the growth in the population of U.S. Chinese older adults warrant a deeper understanding of their psychological well-being. The objectives of the study were to (i) understand the prevalence of anxiety disorders and anxiety symptoms among U.S. Chinese older adults and (ii) explore demographic, socioeconomic, family structure, and health-related correlates of anxiety disorders and anxiety symptoms among U.S. Chinese older adults.
Anxiety Among U.S. Chinese Older Adults
Data Analysis We used univariate descriptive statistics to summarize demographic, socioeconomic, family structure, and healthrelated characteristics of the PINE participants. Chi-square statistics and/or t test were used to compare these characteristics between groups with and without anxiety disorders and any anxiety symptoms. Pearson correlation coefficients and Spearman’s rank correlation were calculated to determine the relationships of the demographic, socioeconomic, family structure, and health-related variables with anxiety disorders and anxiety symptoms. All statistical analyses were undertaken using SAS, Version 9.2 (SAS Institute Inc., Cary, NC). Results Characteristics of PINE Study Participants by Any Anxiety Symptoms Of the 3,159 Chinese older adults surveyed, 58.9% were women. Approximately 8.5% of the participants had anxiety disorders. More specifically, 4.6% of the participants reported mild anxiety disorders, 2.7% had moderate anxiety disorders, and 1.1% had severe anxiety disorders. In addition, 65.0% of participants reported having any anxiety symptoms. Participant characteristics are presented in Table 1. Compared with older adults without anxiety, those with anxiety disorders were more likely to be female (74.0% vs 56.5%), widowed (32.7% vs 23.7%), with poorer health status (49.4% vs 15.9%), with poor quality of life (9.1% vs 2.6%), and with worsening health status (65.5% vs 40.3%). Similarly, compared with those without anxiety symptoms, a larger percentage of those with anxiety symptoms were female (63.2% vs 50.9%), were widowed (26.0% vs 21.2%), had 0–1 children (17.1% vs 11.7%), lived alone (22.8% vs 18.5%), had poorer health status (22.7% vs 10.8%), had fair or poor quality of life (55.5% vs 37.2%), and had worsened health status over the past year (46.6% vs 34.3%). Presence of Symptoms of Anxiety Table 2 presents the prevalence of each anxiety symptom. Feeling tense or wound up was the most common anxiety
symptom (29.7%), followed by having worrying thoughts (26.7%), feeling restless (24.0%), having frightened feeling like butterflies in the stomach (21.4%), having frightened feeling like something awful is about to happen (19.1%), sudden feelings of panic (16.5%), and inability to sit at ease and relax (12.6%). Prevalence of Symptoms of Anxiety by Self-reported Health Status Table 3 presents anxiety disorders and anxiety symptoms by health status. The prevalence of anxiety disorders and anxiety symptoms increased with poorer health status— older adults with poor health status had the highest prevalence of anxiety disorders (22.4%) and anxiety symptoms (80.5%). Similarly, the presence of anxiety disorders and symptoms was high among those whose health status worsened over the past year (disorders: 13.0%; symptoms: 72.6%). Anxiety disorders and symptoms were reported by a higher percentage of older adults with fair (disorders: 11.6%; symptoms: 74.6%) or poor quality of life (disorders: 24.7%; symptoms: 73.2%) compared with older adults with good or very good quality of life. Correlations Between Anxiety and Demographic, Socioeconomic, Family Structure, and Health-Related Variables Being female (r = .10, p < .001), lower income (r = .05, p < .01), unmarried (r = .06, p < .001), poorer health status (r = .21, p < .001), lower quality of life (r = .15, p < .001), and worsening health status (r = .14, p < .001) were positively correlated with anxiety disorders. Being female (r = .14, p < .001), unmarried (r = .07, p < .001), living with fewer people (r = .05, p < .01), having fewer children (r = .04, p < .05), poorer health status (r = .27, p < .001), lower quality of life (r = .22, p < .001), and worsening health status (r = .15, p < .001) were positively correlated with having one or more symptoms of any anxiety. Discussion The PINE study represents the first large-scale population-based epidemiological study of anxiety among community-dwelling U.S. Chinese older adults. We found that anxiety was a significant mental health issue among U.S. Chinese older adults, with 8.5% of participants reported anxiety disorders and 65.0% of participants reporting one or more symptoms. Being female, unmarried, poorer health status, lower quality of life, and worsening health over the past year were positively correlated with anxiety disorders and any anxiety symptom. Living with fewer people and having fewer children were correlated with anxiety symptoms only, whereas lower income was only correlated with anxiety disorders.
Downloaded from http://biomedgerontology.oxfordjournals.org/ at Mahidol University / Library & Information Center on February 28, 2015
to each item on a 4-point scale ranging from 0 (not at all) to 3 (most of the time). The item “sit at ease and feel relaxed” was positively worded and reversed code as most of the time = 0, a lot of time =1, occasionally = 2, and not at all = 3. Participants scored eight or higher were considered as having anxiety disorders. In addition, the severity of anxiety disorders was categorized into three levels according to their score: mild (8–10), moderate (11–14), and severe (15–21). The HADS-A has been tested in Chinese populations and has shown good interrater reliability (21,22). The standardized Cronbach’s alpha for the Chinese anxiety measure in the PINE study was .80.
S63
S64
Dong et al.
Table 1. Characteristics of PINE Study Participants by Any Anxiety Disorders Anxiety Disorders Any Disorders (N = 265)
χ2
Anxiety Symptom df
No Symptoms (N = 1,050)
χ2
df
p Value
231 (22.0) 226 (21.5) 201 (19.1) 178 (17.0) 124 (11.8) 90 (8.6)
447 (21.8) 403 (19.6) 399 (19.4) 371 (18.1) 259 (12.6) 175 (8.5)
2
5
.83
755 (36.8) 1,299 (63.2)
516 (49.1) 534 (50.9)
44
1
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected].
Anxiety Among Community-Dwelling U.S. Chinese Older Adults XinQi Dong,1 Ruijia Chen,1 and Melissa A. Simon2 1 Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois. Department of Obstetrics/Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Address correspondence to XinQi Dong, MD, MPH, Professor of Medicine, Nursing and Behavioral Sciences. Director, Chinese Health, Aging and Policy Program, Associate Director, Rush Institute for Healthy Aging, Rush University Medical Center, 1645 West Jackson, Suite 675, Chicago, IL 60612. Email: [email protected]
Background. This study aimed to explore the prevalence and correlates of anxiety disorders and any anxiety symptoms among community-dwelling U.S. Chinese older adults. Methods. Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person between 2011 and 2013. Results. Of 3,159 older adults surveyed, 8.5% had anxiety disorders and 65.0% reported having any anxiety symptoms. Being female, unmarried, poorer health status, lower quality of life, and worsening health over the past year were positively correlated with anxiety disorders and any anxiety symptoms. Living with fewer people and having fewer children were only correlated with any anxiety symptoms and lower income was only correlated with anxiety disorders. Conclusions. This study emphasizes that interventions for anxiety among Chinese older adults should give special attention to older women, those who are unmarried, with impaired health status, and poorer quality of life. Further longitudinal studies should be conducted to better understand risk factors and outcomes associated with anxiety among U.S. Chinese older adults. Key Words: Anxiety disorders—Anxiety symptoms—Older adults—Chinese—Psychological health. Received May 4, 2014; Accepted August 27, 2014 Decision Editor: Stephen Kritchevsky, PhD
A
nxiety is the most common mental illness among U.S. adults, with an estimated 12-month prevalence of 18.1%, of which 22.8% are severe anxiety disorders (1). Anxiety may cause significant adverse personal and societal outcomes. At the individual level, anxiety has been linked to physical disability (2), declines in cognitive function (3), and even suicidal ideation and mortality (4,5). At the societal level, anxiety may increase medical utilization and health care costs (6). According to a report on the economic burden of anxiety disorders, the cost of anxiety disorders is about $42 million per year—one third of the U.S. total mental illness bill (7). Anxiety is a major health problem in late life, yet anxiety symptoms in older adults are often undiagnosed and untreated. A study with 713 men and 1,338 women in Kentucky found that although 20% of participants aged 55 and older experienced a high level of anxiety symptoms, only 10% of them acknowledged the need to seek mental health treatment (8). Despite the magnitude of the issue among older adults, compared with other mental health issues such as depression and dementia, anxiety has received significantly less attention from researchers and the public (9,10). Additionally, the majority of studies on anxiety among older adults focused on the occurrence of disorders. Anxiety
disorders may be manifested by a combination of symptoms such as having constantly worrying thoughts or not being able to sit at ease. Given that a diagnosis of anxiety disorders may require several symptoms, participants who endorsed one or more symptoms but did not meet the criteria for anxiety disorders may be excluded from the estimate of prior studies. Such exclusion of subsyndromal presentations may lead to the underestimation of the issue of anxiety among older adults (11). It is imperative for community epidemiology surveys to depict more accurate and comprehensive pictures of the extent of anxiety among older adults. The prevalence, presentation, and expression of anxiety differ significantly by social and cultural factors. Anxiety, especially social anxiety, is common and more likely to interfere with social relationships in collectivistic cultures, where harmony is highly emphasized within family and society (12). In addition, responses to anxiety may vary by cultural and ethnic groups. The Chinese culture is distinctive in the great emphasis given to individual and family “face value,” in which respect and reputation are critical (13). Although anxiety may be regarded as personality disorders, Chinese older adults are often inclined to deny anxiety so as to protect family honor and save individual “face.” S61
Downloaded from http://biomedgerontology.oxfordjournals.org/ at Mahidol University / Library & Information Center on February 28, 2015
2
S62
Dong et al.
Methods Population and Settings Data of this study were collected from 2011 to 2013, as part of the Population Study of Chinese Elderly in Chicago (PINE). The PINE study is a community-engaged, population-based epidemiological study of U.S. Chinese older adults aged 60 and older conducted in the Greater Chicago area. The project was initiated by a synergistic community-academic collaboration among the Rush Institute for Healthy Aging, Northwestern University, and many Greater Chicago area community-based social service agencies and organizations. To ensure the study’s relevance to the well-being of the Chinese community and increase community participation, the PINE study was guided by a community-based participatory research approach. A community advisory board played a pivotal role in providing insights for our research activities. Board members were community stakeholders and residents enlisted from more than 20 civic, health, and social advocacy groups and community centers and clinics in the city and suburbs of Chicago. The board worked extensively with the investigative team to develop and test study instruments to ensure cultural sensitivity and appropriateness. Study Design and Procedure The research team implemented a targeted communitybased recruitment strategy by first engaging community
centers in the Greater Chicago area. More than 20 social service agencies, community centers, health advocacy agencies, faith-based organizations, senior apartments, and social clubs served as the basis of study recruitment sites. Community-dwelling older adults aged 60 and older who self-identified as Chinese were eligible to participate in the study. Out of 3,542 eligible older adults approached, 3,159 agreed to participate in the study, yielding a response rate of 91.9%. Details of the PINE study design are published elsewhere (18). Trained multicultural and multilingual interviewers conducted face-to-face home interviews with participants in their preferred language (English or Chinese) and dialect (eg, Cantonese, Taishanese, Mandarin, and Teochew). Based on the available data drawn from the U.S. Census 2010 and a random block census project conducted among the Chinese community in Chicago, the PINE study is representative of the Chinese aging population in the greater Chicago area (19). The study was approved by the Institutional Review Board of the Rush University Medical Center. Measurements Sociodemographics.—Basic demographic information including age (in years), years of education completed, annual personal income (0–$4,999 per year; $5,000–$9,999 per year; $10,000–14,999 per year; $15,000–$19,999 per year; or more than $20,000 per year), marital status (married, separated, divorced, or widowed), number of children, number of grandchildren, years in the community, and years in the United States were assessed in all participants. Living arrangement was categorized into four groups: (i) living alone, (ii) living with one person, (iii) living with two to three persons, or (iv) living with four or more persons. Overall health status, quality of life, and health changes over the last year.—Overall health status was measured by “In general, how would you rate your health?” on a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = very good). Quality of life was assessed by asking “In general, how would you rate your quality of life?” also on a 4-point scale ranging from 1 = poor to 4 = very good. Health changes over the last year was measured by “Compared to one year ago, how would you rate your health now?” on a 3-point scale (1 = worsened, 2 = same, 3 = improved). Anxiety.—We used the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) to assess anxiety among Chinese older adults (20). Participants were asked if they currently experienced the following symptoms: (i) felt tense or wound up, (ii) had a frightened feeling as if something awful is about to happen, (iii) had worrying thoughts, (iv) sit at ease and feel relaxed, (v) had a frightened feeling like butterflies in the stomach, (vi) had feelings of restless, or (vii) had feelings of panic. Respondents indicated answers
Downloaded from http://biomedgerontology.oxfordjournals.org/ at Mahidol University / Library & Information Center on February 28, 2015
The tendency to deny symptoms or express anxiety symptoms as somatic symptoms such as pain or fatigue may add to the complexity of detecting anxiety among Chinese older adults. Despite possibly unique cultural patterns of anxiety, the research on anxiety disorders and anxiety symptoms among Chinese older adults, regardless of their place of residence, is still in its infancy. The prevalence of anxiety cannot be fully understood without taking the immigration context into account. Language and cultural barriers experienced in a new country may increase intergenerational conflicts and breakdowns of traditional support systems (14–16). Furthermore, living in a conflict environment, financial strain, and separation from family members and relatives in the home country may predispose U.S. Chinese older adults to greater risk for anxiety. Over the past several years, the number of U.S. Chinese older adults has grown rapidly, to an estimated 540,000 people age 60 years or older in 2010 (17). The vulnerability and the growth in the population of U.S. Chinese older adults warrant a deeper understanding of their psychological well-being. The objectives of the study were to (i) understand the prevalence of anxiety disorders and anxiety symptoms among U.S. Chinese older adults and (ii) explore demographic, socioeconomic, family structure, and health-related correlates of anxiety disorders and anxiety symptoms among U.S. Chinese older adults.
Anxiety Among U.S. Chinese Older Adults
Data Analysis We used univariate descriptive statistics to summarize demographic, socioeconomic, family structure, and healthrelated characteristics of the PINE participants. Chi-square statistics and/or t test were used to compare these characteristics between groups with and without anxiety disorders and any anxiety symptoms. Pearson correlation coefficients and Spearman’s rank correlation were calculated to determine the relationships of the demographic, socioeconomic, family structure, and health-related variables with anxiety disorders and anxiety symptoms. All statistical analyses were undertaken using SAS, Version 9.2 (SAS Institute Inc., Cary, NC). Results Characteristics of PINE Study Participants by Any Anxiety Symptoms Of the 3,159 Chinese older adults surveyed, 58.9% were women. Approximately 8.5% of the participants had anxiety disorders. More specifically, 4.6% of the participants reported mild anxiety disorders, 2.7% had moderate anxiety disorders, and 1.1% had severe anxiety disorders. In addition, 65.0% of participants reported having any anxiety symptoms. Participant characteristics are presented in Table 1. Compared with older adults without anxiety, those with anxiety disorders were more likely to be female (74.0% vs 56.5%), widowed (32.7% vs 23.7%), with poorer health status (49.4% vs 15.9%), with poor quality of life (9.1% vs 2.6%), and with worsening health status (65.5% vs 40.3%). Similarly, compared with those without anxiety symptoms, a larger percentage of those with anxiety symptoms were female (63.2% vs 50.9%), were widowed (26.0% vs 21.2%), had 0–1 children (17.1% vs 11.7%), lived alone (22.8% vs 18.5%), had poorer health status (22.7% vs 10.8%), had fair or poor quality of life (55.5% vs 37.2%), and had worsened health status over the past year (46.6% vs 34.3%). Presence of Symptoms of Anxiety Table 2 presents the prevalence of each anxiety symptom. Feeling tense or wound up was the most common anxiety
symptom (29.7%), followed by having worrying thoughts (26.7%), feeling restless (24.0%), having frightened feeling like butterflies in the stomach (21.4%), having frightened feeling like something awful is about to happen (19.1%), sudden feelings of panic (16.5%), and inability to sit at ease and relax (12.6%). Prevalence of Symptoms of Anxiety by Self-reported Health Status Table 3 presents anxiety disorders and anxiety symptoms by health status. The prevalence of anxiety disorders and anxiety symptoms increased with poorer health status— older adults with poor health status had the highest prevalence of anxiety disorders (22.4%) and anxiety symptoms (80.5%). Similarly, the presence of anxiety disorders and symptoms was high among those whose health status worsened over the past year (disorders: 13.0%; symptoms: 72.6%). Anxiety disorders and symptoms were reported by a higher percentage of older adults with fair (disorders: 11.6%; symptoms: 74.6%) or poor quality of life (disorders: 24.7%; symptoms: 73.2%) compared with older adults with good or very good quality of life. Correlations Between Anxiety and Demographic, Socioeconomic, Family Structure, and Health-Related Variables Being female (r = .10, p < .001), lower income (r = .05, p < .01), unmarried (r = .06, p < .001), poorer health status (r = .21, p < .001), lower quality of life (r = .15, p < .001), and worsening health status (r = .14, p < .001) were positively correlated with anxiety disorders. Being female (r = .14, p < .001), unmarried (r = .07, p < .001), living with fewer people (r = .05, p < .01), having fewer children (r = .04, p < .05), poorer health status (r = .27, p < .001), lower quality of life (r = .22, p < .001), and worsening health status (r = .15, p < .001) were positively correlated with having one or more symptoms of any anxiety. Discussion The PINE study represents the first large-scale population-based epidemiological study of anxiety among community-dwelling U.S. Chinese older adults. We found that anxiety was a significant mental health issue among U.S. Chinese older adults, with 8.5% of participants reported anxiety disorders and 65.0% of participants reporting one or more symptoms. Being female, unmarried, poorer health status, lower quality of life, and worsening health over the past year were positively correlated with anxiety disorders and any anxiety symptom. Living with fewer people and having fewer children were correlated with anxiety symptoms only, whereas lower income was only correlated with anxiety disorders.
Downloaded from http://biomedgerontology.oxfordjournals.org/ at Mahidol University / Library & Information Center on February 28, 2015
to each item on a 4-point scale ranging from 0 (not at all) to 3 (most of the time). The item “sit at ease and feel relaxed” was positively worded and reversed code as most of the time = 0, a lot of time =1, occasionally = 2, and not at all = 3. Participants scored eight or higher were considered as having anxiety disorders. In addition, the severity of anxiety disorders was categorized into three levels according to their score: mild (8–10), moderate (11–14), and severe (15–21). The HADS-A has been tested in Chinese populations and has shown good interrater reliability (21,22). The standardized Cronbach’s alpha for the Chinese anxiety measure in the PINE study was .80.
S63
S64
Dong et al.
Table 1. Characteristics of PINE Study Participants by Any Anxiety Disorders Anxiety Disorders Any Disorders (N = 265)
χ2
Anxiety Symptom df
No Symptoms (N = 1,050)
χ2
df
p Value
231 (22.0) 226 (21.5) 201 (19.1) 178 (17.0) 124 (11.8) 90 (8.6)
447 (21.8) 403 (19.6) 399 (19.4) 371 (18.1) 259 (12.6) 175 (8.5)
2
5
.83
755 (36.8) 1,299 (63.2)
516 (49.1) 534 (50.9)
44
1
