Risks of Mortality in the Elderly with Anxiety Comorbid with Physical Illness

老年焦慮症併身體疾患之致死風險

張維紘(Wei-Hung Chang)；李怡慧(I-Hui Lee)；陳薇曾(Wei-Tseng Chen)；陳柏熹(Po-See Chen)；楊延光(Yen-Kuang Yang)；陳高欽(Kao-Chin Chen)

老年人 ； 焦慮症 ； 身體疾患 ； 致死風險 ； elderly ； anxiety disorder ； physical illnesses ； mortality risks

台灣精神醫學

30卷1期（2016 / 03 / 01）

63 - 72+IV

英文

目的：焦慮症可能會增加老年人的身體共病風險，但致死率的結果並不一致。我們的研究探討是否(A)焦慮症會增加老年人致死率(B)不同身體疾病的致死率差別。方法：使用全民健康保險研究資料庫，追蹤2000至2008共8年，分析了共247位60歲以上有焦慮症的老年人，以及987位沒有焦慮症的控制組，和焦慮症有關的部份身體疾患也一併分析，以比較兩組間的致死率風險比值。結果：有焦慮症老人的致死率會顯著增加(HR = 2.05, 95% CI= 1.32 - 3.21, p ＜ 0.01)。除此之外，逐步迴歸模型顯示對老年人來說鬱血性心衰竭是最重要的致死率預測因子(p ＜ 0.001)。中風(p ＜ 0.01)、心律不整(p ＜ 0.05)、和胃潰瘍 (p ＜ 0.05)也會顯著影響致死率。對有焦慮症的老年人來說，鬱血性心衰竭更是唯一的致死率預測因子(p＜ 0.001)。結論：許多身體疾患會增加老年人病人的致死率。除此之外，心血管相關疾病可能為老年焦慮症致死率的危險因子。

Objectives: Anxiety disorders may increase the risks of physical comorbidities in the elderly, but the results of mortality rates are inconsistent. In this study, we intended to explore (A) whether anxiety disorders increase the risks of mortality in the elderly, and (B) whether the mortality risks could be different in different physical illnesses. Methods: We included subjects aged over 60 years using the National Health Insurance Research Database (NHIRD). We included 247 subjects with anxiety disorders (generalized anxiety disorders, panic disorders, phobic disorders) and 987 control subjects without anxiety disorders in an eight-year longitudinal follow-up using the database analysis from 2000 to 2008. Certain specifi c physical illnesses related to anxiety disorders were analyzed. The hazard ratios (HRs) were calculated for the mortality risks between two groups. Results: The mortality risks of subjects with anxiety disorders and with physical comorbidities increased signifi cantly (HR = 3.29, 95% confi dence interval = 1.92 - 5.62, p ＜ 0.001). Furthermore, congestive heart failure (CHF) (HR = 2.84, 95% CI =1.73 - 4.66, p ＜ 0.001) was the most signifi cant predictive factor for mortality risks. Cerebrovascular disease (HR = 1.86, 95% CI = 1.19 - 2.93, p ＜ 0.01), cardiac arrhythmia (HR = 1.7, 95% CI = 1.01 - 2.86, p ＜ 0.05), and peptic ulcers (HR = 1.56, 95% CI = 1.07 - 2.28, p ＜ 0.01) also signifi cantly infl uenced the mortality risks. Additionally, CHF (HR = 6.63, 95% CI = 22.97 - 14.79, p ＜ 0.001) was the only predictive factor for mortality risks in the elderly with anxiety disorders. Conclusions: Several physical illnesses could enhance mortality risks in the elderly. Cardiovascular related illnesses could be the mediators of anxiety disorders in the elderly to increase mortality risks.

1. Alhurani, AS,Dekker, RL,Abed, MA(2015).The association of co-morbid symptoms of depression and anxiety with all-cause mortality and cardiac rehospitalization in patients with heart failure.Psychosomatics,56,371-380.
2. Arnold, IA,de Waal, MW,Eekhof, JA,Assendelft, WJ,Spinhoven, P,van Hemert, AM(2009).Medically unexplained physical symptoms in primary care: a controlled study on the effectiveness of cognitive-behavioral treatment by the family physician.Psychosomatics,50,515-524.
3. Astrom, M(1996).Generalized anxiety disorder in stroke patients: a 3-year longitudinal study.Stroke,27,270-275.
4. Bhugra, D(ed),Tse, S(ed),Ng, R(ed),Takei, N(ed)(2015).Routledge Handbook of Psychiatry in Asia.London:Routledge.
5. Chang, WH,Chen, WT,Lee, IH,Chen, PS,Yang, YK,Chen, KC.Coexisting anxiety disorders would alter the associations with physical disorders in the elderly - a Taiwan cross-sectional nationwide study.Psychiatry Clin Neurosci
6. Chen, J,Normand, SL,Wang, Y,Krumholz, HM(2011).National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008.JAMA,306,1669-1678.
7. Christensen, S,Riis, A,Norgaard, M,Sorensen, HT,Thomsen, RW(2007).Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study.BMC Geriatr,7,8.
8. Clinch, D,Banerjee, AK,Ostick, G(1984).Absence of abdominal pain in elderly patients with peptic ulcer.Age Ageing,13,120-123.
9. Coryell, W,Noyes, R, Jr.,House, JD(1986).Mortality among outpatients with anxiety disorders.Am J Psychiatry,143,508-510.
10. Covinsky, KE,Cenzer, IS,Yaffe, K,O’Brien, S,Blazer, DG(2014).Dysphoria and anhedonia as risk factors for disability or death in older persons: implications for the assessment of geriatric depression.Am J Geriatr Psychiatry,22,606-613.
11. de Beurs, E,Beekman, AT,van Balkom, AJ,Deeg, DJ,van Dyck, R,van Tilburg, W(1999).Consequences of anxiety in older persons: its effect on disability, well-being and use of health services.Psychol Med,29,583-593.
12. Doyle, F,Conroy, R,McGee, H(2012).Differential predictive value of depressive versus anxiety symptoms in the prediction of 8-year mortality after acute coronary syndrome.Psychosom Med,74,711-716.
13. Flint, AJ(1994).Epidemiology and comorbidity of anxiety disorders in the elderly.Am J Psychiatry,151,640-649.
14. Griffin, MR,Piper, JM,Daugherty, JR,Snowden, M,Ray, WA(1991).Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons.Ann Intern Med,114,257-263.
15. Ho, KK,Anderson, KM,Kannel, WB,Grossman, W,Levy, D(1993).Survival after the onset of congestive heart failure in Framingham Heart Study subjects.Circulation,88,107-115.
16. Huang, JQ,Sridhar, S,Hunt, RH(2002).Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis.Lancet,359,14-22.
17. Hunink, MG,Goldman, L,Tosteson, AN(1997).The recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment.JAMA,277,535-542.
18. Lien, HM,Chou, SY,Liu, JT(2008).Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.J Health Econ,27,1208-1223.
19. MacMahon, KM,Lip, GY(2002).Psychological factors in heart failure: a review of the literature.Arch Intern Med,162,509-516.
20. Moran, AE,Forouzanfar, MH,Roth, GA(2014).Temporal trends in ischemic heart disease mortality in 21 world regions, 1980 to 2010: the Global Burden of Disease 2010 study.Circulation,129,1483-1492.
21. Phillips, AC,Batty, GD,Gale, CR(2009).Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study.Psychosom Med,71,395-403.
22. Roest, AM,Martens, EJ,Denollet, J,de Jonge, P(2010).Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis.Psychosom Med,72,563-569.
23. Russ, TC,Stamatakis, E,Hamer, M,Starr, JM,Kivimaki, M,Batty, GD(2012).Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies.BMJ,345,e4933.
24. Sareen, J,Cox, BJ,Clara, I,Asmundson, GJ(2005).The relationship between anxiety disorders and physical disorders in the U.S. National Comorbidity Survey.Depress Anxiety,21,193-202.
25. Schoepf, D,Heun, R(2015).Anxiety disorders and physical comorbidity: increased prevalence but reduced relevance of specific risk factors for hospital-based mortality during a 12.5-year observation period in general hospital admissions.Eur Arch Psychiatry Clin Neurosci,265,387-398.
26. Schuurmans, J,van Balkom, A(2011).Late-life anxiety disorders: a review.Curr Psychiatry Rep,13,267-273.
27. Tsuchihashi-Makaya, M,Kato, N,Chishaki, A,Takeshita, A,Tsutsui, H(2009).Anxiety and poor social support are independently associated with adverse outcomes in patients with mild heart failure.Circ J,73,280-287.
28. van der Wal, MH,Jaarsma, T(2008).Adherence in heart failure in the elderly: problem and possible solutions.Int J Cardiol,125,203-208.
29. Versteeg, H,Hoogwegt, MT,Hansen, TB,Pedersen, SS,Zwisler, AD,Thygesen, LC(2013).Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease.J Psychosom Res,75,518-525.
30. Vos, T,Flaxman, AD,Naghavi, M(2012).Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet,380,2163-2196.
31. Wetherell, JL,Unutzer, J(2003).Adherence to treatment for geriatric depression and anxiety.CNS Spectr,8,48-59.

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