Worry and cognitive control predict course trajectories of anxiety in older adults with late-life depression

Publication Type:

Journal Article


European Psychiatry, Volume 44, p.134-140 (2017)




Late-life depression; Late-life anxiety; Worry; Cognitive control; Heart rate variability; Negative life events


Background: Many older adults with depressive disorder manifest anxious distress. This longitudinal
study examines the predictive value of worry as a maladaptive cognitive emotion regulation strategy,
and resources necessary for successful emotion regulation (i.e., cognitive control and resting heart rate
variability [HRV]) for the course of anxiety symptoms in depressed older adults. Moreover, it examines
whether these emotion regulation variables moderate the impact of negative life events on severity of
anxiety symptoms.
Methods: Data of 378 depressed older adults (CIDI) between 60 and 93 years (of whom 144 [41%] had a
comorbid anxiety disorder) from the Netherlands Study of Depression in Older Adults (NESDO) were
used. Latent Growth Mixture Modeling was used to identify different course trajectories of six-months
BAI scores. Univariable and multivariable longitudinal associations of worry, cognitive control and HRV
with symptom course trajectories were assessed.
Results: We identified a course trajectory with low and improving symptoms (57.9%), a course trajectory
with moderate and persistent symptoms (33.5%), and a course trajectory with severe and persistent
anxiety symptoms (8.6%). Higher levels of worry and lower levels of cognitive control predicted
persistent and severe levels of anxiety symptoms independent of presence of anxiety disorder. However,
worry, cognitive control and HRV did not moderate the impact of negative life events on anxiety severity.
Conclusions: Worry may be an important and malleable risk factor for persistence of anxiety symptoms in
depressed older adults. Given the high prevalence of anxious depression in older adults, modifying worry
may constitute a viable venue for alleviating anxiety levels.