Persistence, Impairment, Disability and Unmet Treatment of Lifetime and 12-Month Anxiety Disorders in Black Men and Women, 50 Years of Age and Older

Abstract

Objectives: To examine anxiety disorders in aging Black adults. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime/12-month prevalence of Diagnostic and Statistical Manual of Mental Disorders fourth Edition anxiety disorders in Black men and women, age 50+ ( N = 1561). Disorder-specific persistence and severity, functional impairment, and mental health service utilization were investigated using multivariate regressions. Results: Black men and women who met criteria for anxiety disorders (lifetime prevalence=12.4%/18.3% in men/women) also demonstrated persistent disorders (percent meeting criteria = 40.3%–61.2%). Those with a 12-month anxiety disorder (6.2%/10.5% of men/women) typically reported severe task interference (38.3%–85.7%). Those with any 12-month anxiety disorder, compared to those without, experienced greater impairment in days out of role, work, family burden, cognition and, in women, mobility ( p’s < .05). Only 47.0%/65.2% of Black men/women with any lifetime anxiety disorder used mental health services. Discussion: Despite low prevalence, older Blacks with anxiety disorders experience substantial mental health burden in middle age and later.

Prevalence, Severity and Burden of Post-Traumatic Stress Disorder in Black Men and Women Across the Adult Life span

“…A third possibility, discussed in other papers, involves psychological theories of successful aging (Reynolds et al, 2016) and cognitive theories on stress processing and emotional regulation in older adults (Jones et al, 2022). We do know that PTSD as well as other anxiety disorders are persistent and contribute to increased disability in older age (Jones et al, 2022), even if the disorder is not perceived to offer severe interference.…”

“…A third possibility, discussed in other papers, involves psychological theories of successful aging (Reynolds et al, 2016) and cognitive theories on stress processing and emotional regulation in older adults (Jones et al, 2022). We do know that PTSD as well as other anxiety disorders are persistent and contribute to increased disability in older age (Jones et al, 2022), even if the disorder is not perceived to offer severe interference. According to the Selective Optimization with Compensation Model (Baltes & Baltes, 1990), successful aging occurs when people selectively attend to activities and thoughts that contribute to well-being and reduced stress, and they have developed compensatory strategies that enable them to continue these pursuits even as their health and other resources decline with age.…”

“…Given the link between PTSD and employment outcomes (Stevenson et al, 2021), it may be important to develop PTSD treatment that can be delivered within the context of vocational training programs to mitigate poor economic outcomes in middle age and beyond as has been shown with anxiety disorders (Himle et al, 2019). In addition, as discussed in another paper in this issue, for older Black men and women, there is a need to implement age and culturally targeted screening measures within the primary care setting to help identify, diagnose and treat PTSD (Jones et al, 2022). Finally, our results further demonstrate the undercurrent of racial discrimination that persists throughout the life course and its relationship to PTSD prevalence and severity in Black women in particular (Sibrava et al, 2019).…”

“…Some have even speculated that PTSD may play a role in Black women’s disparities in maternal mortality and birth outcomes (Seng et al, 2011; Villarosa, 2018). Moreover, the risk of developing PTSD extends into middle and older age in Black populations (Himle et al, 2009), potentially contributing to disability and impairment in later life (Jones et al, 2022).…”

Contemporary Research on Older Black Americans, a Special Issue of Journal of Aging and Health in Honor of the Life and Legacy of James S. Jackson

“…They argue that despite older African Americans’ low prevalence rates for disorders, those who specifically have anxiety disorders experience substantial mental health burden. A second article by Jones et al (2022) involves an in-depth examination of age differences in post-traumatic stress disorder (PTSD). In addition to examining lifetime and 12-month prevalence rates of PTSD, they also examined PTSD persistence, severity, and functional impairment.…”