Department of Psychiatry and EMGO(+), Institute for Health and Care Research, VU University Medical Center, and GGZ inGeest, Amsterdam, The Netherlands.
Department of Psychology, Boston University, Boston, MA, USA; Department of Psychology, University of Haifa, Mount Carmel, Haifa, Israel.
J Anxiety Disord. 2017 Aug;50:47-51. doi: 10.1016/j.janxdis.2017.05.003. Epub 2017 May 10.
Age of onset is a marker of clinically relevant subtypes in various medical and psychiatric disorders. Past research has also reported that age of onset in generalized anxiety disorder (GAD) is clinically significant; but, in research to date, arbitrary cut-off ages have been used. In the present study, admixture analysis was used to determine the best fitting model for age of onset distribution in GAD. Data were derived from 459 adults with a diagnosis of GAD who took part in the Netherlands Study of Depression and Anxiety (NESDA). Associations between age of onset subtypes, identified by admixture analysis, and sociodemographic, clinical, and vulnerability factors were examined using univariate tests and multivariate logistic regression analyses. Two age of onset distributions were identified: an early-onset group (24 years of age and younger) and a late-onset group (greater than 24 years of age). Multivariate analysis revealed that early-onset GAD was associated with female gender (OR 2.1 (95%CI 1.4-3.2)), higher education (OR 1.1 (95%CI 1.0-1.2)), and higher neuroticism (OR 1.4 (95%CI 1.1-1.7)), while late-onset GAD was associated with physical illnesses (OR 1.3 (95%CI 1.1-1.7)). Study limitations include the possibility of recall bias given that age of onset was assessed retrospectively, and an inability to detect a possible very-late-onset GAD subtype. Collectively, the results of the study indicate that GAD is characterized by a bimodal age of onset distribution with an objectively determined early cut-off at 24 years of age. Early-onset GAD is associated with unique factors that may contribute to its aetiology; but, it does not constitute a more severe subtype compared to late-onset GAD. Future research should use 24 years of age as the cut-off for early-onset GAD to when examining the clinical relevance of age of onset for treatment efficacy and illness course.
发病年龄是多种医学和精神障碍中具有临床意义的亚型标志物。过去的研究还报告称，广泛性焦虑症（GAD）的发病年龄具有临床意义；但是，迄今为止的研究中，使用了任意的截止年龄。在本研究中，混合分析用于确定 GAD 发病年龄分布的最佳拟合模型。数据来自参加荷兰抑郁和焦虑研究（NESDA）的 459 名 GAD 成年患者。使用单变量检验和多变量逻辑回归分析，研究了混合分析确定的发病年龄亚型与社会人口统计学、临床和易感性因素之间的关联。确定了两种发病年龄分布：早期发病组（24 岁及以下）和晚期发病组（24 岁以上）。多变量分析显示，早发性 GAD 与女性（OR 2.1（95%CI 1.4-3.2））、较高的教育程度（OR 1.1（95%CI 1.0-1.2））和较高的神经质（OR 1.4（95%CI 1.1-1.7））相关，而晚发性 GAD 与身体疾病（OR 1.3（95%CI 1.1-1.7））相关。研究局限性包括由于发病年龄是回顾性评估的，因此可能存在回忆偏倚，并且无法检测到可能的很晚发病的 GAD 亚型。总的来说，研究结果表明，GAD 的发病年龄分布呈双峰模式，客观确定的 24 岁为早期截止点。早发性 GAD 与独特的因素相关，这些因素可能与其病因有关；但是，与晚发性 GAD 相比，它并不构成更严重的亚型。未来的研究应该使用 24 岁作为早发性 GAD 的截止年龄，以检查发病年龄对治疗效果和疾病进程的临床意义。
