Anxiety

• About

  People with anxiety disorders experience fear, worry or dread which; is out of proportion to the circumstances and interferes with their daily functioning

  Common symptoms of anxiety disorders are:

  • Emotional changes:
    • persistent worrying and excessive fears
    • increased irritability
  • Cognitive changes:
    • difficulty concentrating and paying attention
    • easily distracted
  • Behavioral changes:
    • avoidance of feared situations
    • social isolation or being withdrawn
    • excessive shyness
    • inability to relax
    • problems with work, social or family life
  • Physical changes:
    • poor sleep
    • somatic (body) complaints

  Onset of anxiety disorders in young people

  Anxiety disorders are the most common mental health problems experienced by young people. In Australia, anxiety disorders are estimated to affect about one in every 10 young people aged 18-24 years (1), with the rates higher among young females (14%) compared to males (8%). The most common anxiety disorders reported by young Australians are social anxiety and post-traumatic stress disorder.

  Overall, about half of people with anxiety disorders experience their first symptoms by the age of 11 years, which is significantly younger than for most other mental health problems (2). However, the typical age of onset varies between the different types of anxiety disorders: specific phobias and separation anxiety often occur at a younger age than panic disorder, generalised anxiety disorder and post-traumatic stress disorder (3).

  Risk factors

  A number of factors are known to increase the likelihood that a person will have an anxiety disorder (4). They include:

  • genetic vulnerability (for example, anxiety disorders in other family members)
  • some features of temperament, for example sensitivity to anxiety, fearfulness, behavioural inhibition or neuroticism
  • being female (5)

   

  References

  1. Australian Institute of Health and Welfare 2007. Young Australians: their health and wellbeing 2007. Cat. no. PHE 87. Canberra: AIHW. (link to

  2. Kessler, RC, Berglund, P, et al. Lifetime prevalence and age-of-onset distributions of dsm-iv disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602.

  3. Kessler, RC, Amminger, GP, et al. Age of onset of mental disorders: A review of recent literature. Curr Opin Psychiatry. 2007 Jul;20(4):359-64.

  4. Merikangas, KR. Vulnerability factors for anxiety disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2005 Oct;14(4):649-79, vii.

  5. Lewinsohn, PM, Gotlib, IH, et al. Gender differences in anxiety disorders and anxiety symptoms in adolescents. J Abnorm Psychol. 1998 Feb;107(1):109-17.

   

   

• Assessment

  Formal systems for the diagnosis of mental illness (DSM-IV Anxiety Disorders) (ICD-10; see F40-F48) define a number of different types of anxiety disorder, including:

  • panic disorder 
  • agoraphobia 
  • obsessive-compulsive disorder (OCD) 
  • social anxiety 
  • specific phobias 
  • generalized anxiety disorder 
  • post-traumatic stress disorder (PTSD) 
  • acute stress disorder 
  • mixed anxiety and depressive disorder.

  Assessment Tools
  To decide whether a young person may be experiencing an anxiety disorder, an assessment is required.  A comprehensive assessment involves asking questions about a range of aspects of a person life including their:

  • Home and Environment; 
  • Education and Employment; 
  • Activities; 
  • Drug and Alcohol use; 
  • Relationships and Sexuality; 
  • Conduct Difficulties and Risk-Taking; 
  • Anxiety and Eating; 
  • Depression and Suicide; 
  • Psychosis and Mania

  See the headspace assessment for more details.

• Treatment

  Early detection and treatment of anxiety disorders can reduce their adverse effects. Early intervention is particularly important as these disorders often become apparent at critical stages of development in childhood, adolescence and early adulthood.

  The management plan developed for a young person with anxiety will be dependent upon a range of factors including:

  • the severity of symptoms
  • health services available, both in terms of actual services to refer to and the skills and experiences of workers involved
  • other presenting health issues
  • support network available, including family and friends, or school supports
  • the young persons' preference for a particular treatment approach

  The foundation for any helping relationship is establishing a therapeutic alliance, openly discussing the problem, and having a collaborative approach.  Other helpful strategies that can be introduced within this helping relationship include skill development around problem solving, stress management, activity planning, and psychoeducation. A range of simple, self-help techniques for managing anxiety disorders has also been shown to be effective (1).

  Research has shown that talking therapies such as cognitive behavioural therapy (CBT) and exposure therapy are effective in reducing anxiety symptoms in children and adolescents (1). Medication, specifically SSRI antidepressants, have also been shown to be effective for most types of anxiety disorders (2), however their use in young people is cautioned given the possible increase in the risk of suicidal ideation and suicidal behaviour that is associated with SSRI use in children and adolescents (2). There is little evidence about the efficacy of other medications (especially anti-anxiety drugs such as benzodiazepines) for anxiety disorders in this age group (3).

  The evidence map provides reference details for studies of prevention and treatment interventions for anxiety in young people. 

   

  References
  1. Reavley, NJ, Cvetkovski, S, et al. Help-seeking for substance use, anxiety and affective disorders among young people: Results from the 2007 australian national survey of mental health and wellbeing. Aust N Z J Psychiatry. 2010 Aug;44(8):729-35.

  2. Hetrick, S, Merry, S, et al. Selective serotonin reuptake inhibitors (ssris) for depressive disorders in children and adolescents. Cochrane Database Syst Rev. 2007(3):CD004851.

  3. Scott, RW, Mughelli, K, et al. An overview of controlled studies of anxiety disorders treatment in children and adolescents. J Natl Med Assoc. 2005 Jan;97(1):13-24.

• Guidelines

  The following authoritative guidelines provide evidence-based information about the practical treatment of anxiety disorders:

  Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia (2003) Royal Australian and New Zealand College of Psychiatrists 

  Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. (2007) Australian Centre for Posttraumatic Mental Health (NHMRC approved).

  Anxiety: management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. (2011) NICE clinical guideline 113.  United Kingdom

  Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. (2005) NICE clinical guideline 31.  United Kingdom

  Post-traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care. (2005) NICE clinical guideline 26. United Kingdom

  Practice guideline for the treatment of patients with panic disorder, second edition. (2009) American Psychiatric Association. United States of America   

  Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. (2007) American Academy of Child and Adolescent Psychiatry - Medical Specialty Society. 

• More info

  The following selected articles and web sites provide more information about anxiety disorders and anxiety intervention research.   

  Reavley, NJ, Allen NB, Jorm, AF, Morgan AJ, Purcell R.  A Guide to What Works for Anxiety Disorders. beyondblue: Melbourne, 2010.

  Australian Bureau of Statistics. 2007 National Survey of Mental Health and Wellbeing: Summary of Results. (Document 4326.0). Canberra: ABS; 2008.

  Masi GC et al. Pharmacological treatment options for panic disorder in children and adolescents. Expert Opinion on Pharmacotherapy 2006; 7: 545-554.

  Ipser JC et al. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2009; Issue 3; Art no. CD005170.

  James, A, Soler, A, et al. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2005(4):CD004690.

  Herbert JD et al. Cognitive behavior therapy for generalized social anxiety disorder in adolescents: A randomized controlled trial. Journal of Anxiety Disorders 2009; 23:167-177

  Stewart RE, Chambless DL. Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology 2009: 77:595-606.

  Hunot V et al. Psychological therapies for generalised anxiety disorder. Cochrane Database of Systematic Reviews 2007; Issue 1; Art no. CD001848.

  Last CG et al. Cognitive-behavioral treatment of school phobia. Journal of the American Academy of Child and Adolescent Psychiatry 1998; 37:404-411.

  Hirai M, Clum GA. A meta-analytic study of self-help interventions for anxiety problems. Behavior Therapy 2006; 37:99-111.

  Cuijpers P et al. Computer-aided psychotherapy for anxiety disorders: A meta-analytic review. Cognitive Behaviour Therapy 2009;38: 66-82.

  Sites

  Australian Centre for Post Traumatic Mental Health