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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
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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.


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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