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Articles   |    
Late-Onset Agoraphobia: General Population Incidence and Evidence for a Clinical Subtype
Karen Ritchie, Ph.D.; Joanna Norton, Ph.D.; Anthony Mann, M.D.; Isabelle Carrière, Ph.D.; Marie-Laure Ancelin, Ph.D.
Am J Psychiatry 2013;170:790-798. doi:10.1176/appi.ajp.2013.12091235
View Author and Article Information

The authors report no financial relationships with commercial interests.

Drs. Ritchie and Norton contributed equally to this article.

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).

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.

Address correspondence to Dr. Ritchie (karen.ritchie@inserm.fr) or Dr. Norton (joanna.norton@inserm.fr).

Copyright © 2013 by the American Psychiatric Association

Received September 24, 2012; Revised November 30, 2012; Revised January 28, 2013; Accepted February 04, 2013.

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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TABLE 1.Baseline Association Between Health and Lifestyle Variables and Agoraphobia in an Elderly Cohorta
Table Footer Note

a Data are adjusted for age, sex, and education.

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TABLE 2.Incident Cases of Agoraphobia According to Baseline Variables in an Elderly Cohort
Table Footer Note

a Results are for the maximum number of participants for whom data were available (minimum number of participants included in the regression models, N=1,366).

Table Footer Note

b Odds ratios are from a mixed regression model adjusted for age and time.

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