Age differences in treatment response to a collaborative care intervention for anxiety disorders

Julie Loebach Wetherell, Andrew J Petkus, Steven R Thorp, Murray B Stein, Denise A Chavira, Laura Campbell-Sills, Michelle G Craske, Cathy Sherbourne, Alexander Bystritsky, Greer Sullivan, Peter Roy-Byrne
British Journal of Psychiatry 2013, 203 (1): 65-72

BACKGROUND: Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults.

AIMS: We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults.

METHOD: We examined findings for the overall sample, as well as within each diagnostic category ( identifier: NCT00347269).

RESULTS: The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults.

CONCLUSIONS: These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.

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