Anxiety disorders are the most common class of mental health conditions in the United States. Substantial gaps exist in the literature with respect to the clinical course of anxiety disorders in particular groups of individuals who are continually increasing in prevalence in the U.S. population, particularly African American and Hispanic individuals, and individuals entering older age. Specifically, despite the increasing and substantial number of African American, Hispanic, and older adults in the population, there are no published data on the clinical course of anxiety disorders in these groups of individuals that have been collected using a prospective, short-interval interview, longitudinal, naturalistic design. In this application we propose two timely and needed studies within the Harvard/Brown Anxiety Research Program (HARP) to address these fundamental gaps in our understanding of the course of anxiety disorders in these understudied populations. First, we propose to expand our newly recruited and prospectively studied sample of African Americans and Hispanics with anxiety disorders to a total of 175 African Americans and 175 Hispanics, and to recruit a contemporaneous sample of 175 non-Hispanic Caucasians, comparable on socioeconomic indicators to the African American and Hispanic samples. The recruitment and prospective, short-interval follow-up of these individuals over the next 5 years will provide the first comprehensive description of the prospective naturalistic course of psychopathology and psychosocial outcomes associated with DSM-IV anxiety disorders and related culture-bound syndromes and symptoms in African American, Hispanic, and non-Hispanic Caucasian subjects that are comparable on socioeconomic indicators (AIM 1), as well as examination of predictors of course within each of these three ethnic groups (AIM 2). We will then conduct the first prospective longitudinal test of potential ethnic minority disparities in the course of anxiety disorders (AIM 3) along with the first examination of potential demographic, clinical, environmental stressor, and socio-cultural predictors of ethnic minority disparities in course (AIM 4). Second, we propose to continue observation of members of the original HARP cohort who have been studied for 15 years as they enter older adulthood (all 247 subjects who will reach or exceed the age of 61 during the proposed grant period) to provide new knowledge about the developmental changes that take place in the clinical course of anxiety disorders during the transition to older adulthood (AIMS 5 and 6). We will test the suggestion in the literature, based on epidemiological data, that the course of anxiety disorders improves during the transition to older adulthood;explore the extent to which indicators of declining physical and social wellness may be predictive of worsening course of anxiety disorders as subjects make the transition to older adulthood;and test the hypothesis that those individuals who have had an especially pernicious course of anxiety are at increased risk for age-related cognitive impairment. Taken together, this proposal will provide substantial new clinical knowledge about the course of anxiety disorders in understudied individuals in the population.
Despite the increasing numbers of both ethnic minorities and individuals entering older age in the United States, there is a dearth of substantial clinical knowledge about the course of anxiety disorders in these groups, including factors which place them at substantial risk for deleterious health consequences. This project will provide necessary in-depth prospective longitudinal study of the course of anxiety disorders in these groups, and holds promise for providing insight into the factors associated with the medical, psychological, and economic consequences of anxiety disorders in ethnic minorities and aging populations.
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