Generalized anxiety disorder in older adults: Examining the relation between clinician severity ratings and patient self-report measures

Generalized anxiety disorder (GAD) is the most prevalent of the chronic anx iety disorders for older adults. Although a variety of self-report measures are beginning to be utilized to assess anxiety and related symptoms in old er adults, there is a paucity of data regarding the convergence of self-rep ort measures with clinician ratings of symptom severity. This situation is problematic in that interpretability of assessment data is limited as is ou r broader understanding of the construct of GAD in an older adult populatio n. To address these issues, we examined convergence across assessment modal ities among 64 older adults who met diagnostic criteria for GAD. In additio n to two Anxiety Disorders Interview. Schedule for DSM-IV (ADIS-IV) intervi ews conducted by independent raters, participants completed four self-repor t measures (Penn State Worry Questionnaire [PSWQ], Worry Scale [WS], State- Trait Anxiety Inventory [STAI], Beck Depression Inventory [BDI]) as part of a more extensive pretreatment assessment battery. Results revealed signifi cant correlations between clinician-rated GAD severity and the BDI, STAI, a nd PSWQ. Regression analyses indicated that the BDI (r(2) = .15) and the PS WQ (r(2) = .07) were particularly useful predictors of clinician-rated GAD severity. A comorbid mood disorder, however; was identified as an important mediator of these relations. Specifically, presence of coexistent depressi on accounted for 17% of the variance in clinician severity ratings (CSR; P < .01), with individuals diagnosed with a comorbid mood disorder receiving higher clinician severity ratings. The only self-report measure that accoun ted for additional significant variance was the PSWQ (7%). The study highli ghts the need to address coexistent psychological conditions when examining convergence between assessment modalities, and expands upon the relatively neglected area of anxiety assessment in older individuals. Specifically,, the BDI and the PSWQ are identified as particularly useful screening instru ments that may be helpful in conceptualizing GAD severity within an older a dult population. (C) 2000 Wiley-Liss, Inc.