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Published Online: 1 July 2013

Late-Onset Agoraphobia: General Population Incidence and Evidence for a Clinical Subtype

Abstract

Objective

The purpose of this study was to estimate the general population incidence of late-life agoraphobia and to define its clinical characteristics and risk factors.

Method

A total of 1,968 persons ≥65 years old were randomly recruited from the electoral rolls of the district of Montpellier, France. Prevalent and incident agoraphobia diagnosed with a standardized psychiatric examination and validated by a clinical panel were assessed at baseline and over a 4-year follow-up.

Results

The 1-month baseline prevalence of agoraphobia was estimated to be 10.4%. Among persons with agoraphobia, 10.9% reported having their first episode at age 65 or above. During the 4-year follow-up, 11.2% of participants without agoraphobia at baseline had a first episode, resulting in an incidence rate of 32 per 1,000 person-years. These 132 incident late-onset cases were associated with higher incidence rates of anxiety disorders and suicidal ideation. Of the incident cases, only two were characterized by past or concurrent panic attacks, a rate that was not significantly different from that of the noncase group. The principal baseline risk factors for incident cases, derived from a multivariate model incorporating all significant risk factors, were younger age at onset (odds ratio=0.94, 95% CI=0.90–0.99), poorer visuospatial memory performance (odds ratio=1.60, 95% CI=1.02–2.49), severe depression (odds ratio=2.62, 95% CI=1.34–5.10), and trait anxiety (odds ratio=1.73, 95% CI=1.03–2.90). No significant association was found with cardiac pathologies.

Conclusions

Agoraphobia has a high prevalence in the elderly, and unlike cases in younger populations, late-onset cases are not more common in women and are not associated with panic attacks, suggesting a late-life subtype. Severe depression, trait anxiety, and poor visuospatial memory are the principal risk factors for late-onset agoraphobia.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 790 - 798
PubMed: 23820832

History

Received: 24 September 2012
Revision received: 30 November 2012
Revision received: 28 January 2013
Accepted: 4 February 2013
Published online: 1 July 2013
Published in print: July 2013

Authors

Details

Karen Ritchie, Ph.D.
From the French National Center for Health and Medical Research (INSERM), Montpellier, France; University of Montpellier; Faculty of Medicine, Imperial College, London; and Institute of Psychiatry, King’s College London.
Joanna Norton, Ph.D.
From the French National Center for Health and Medical Research (INSERM), Montpellier, France; University of Montpellier; Faculty of Medicine, Imperial College, London; and Institute of Psychiatry, King’s College London.
Anthony Mann, M.D.
From the French National Center for Health and Medical Research (INSERM), Montpellier, France; University of Montpellier; Faculty of Medicine, Imperial College, London; and Institute of Psychiatry, King’s College London.
Isabelle Carrière, Ph.D.
From the French National Center for Health and Medical Research (INSERM), Montpellier, France; University of Montpellier; Faculty of Medicine, Imperial College, London; and Institute of Psychiatry, King’s College London.
Marie-Laure Ancelin, Ph.D.
From the French National Center for Health and Medical Research (INSERM), Montpellier, France; University of Montpellier; Faculty of Medicine, Imperial College, London; and Institute of Psychiatry, King’s College London.

Notes

Address correspondence to Dr. Ritchie ([email protected]) or Dr. Norton ([email protected]).

Author Contributions

Drs. Ritchie and Norton contributed equally to this article.

Funding Information

The authors report no financial relationships with commercial interests.The ESPRIT (Enquête de Santé Psychologique–Risques, Incidence et Traitement [Survey of Psychological Health–Risk Factors, Incidence, and Treatment]) study was funded by an unconditional grant from Novartis and a grant from the National Research Agency (French National Research Agency project 07 LVIE004).

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