A Comparison of the Factorial Structure of DSM-IV Criteria for Generalized Anxiety Disorder Between Younger and Older Adults

  • Roberto Nuevo
  • Miguel A. Ruiz
  • María Izal
  • Ignacio Montorio
  • Andrés Losada
  • María Márquez-González


The controversy concerning the validity and reliability of generalized anxiety disorder (GAD) appears to be particularly relevant in the elderly, since physical symptoms associated with GAD can readily be considered as the consequences of normal aging. This study aims to analyze the structure invariance of a questionnaire assessing the DSM-IV diagnostic criteria across samples of older adults and college students. Ninety-seven adults aged 65 or over and 130 college students completed the Worry and Anxiety Questionnaire (WAQ). The results revealed that factorial invariance could be assumed and, in addition, that scores for severity of GAD symptoms were higher in younger subjects than in older ones. The results support the applicability of DSM-IV criteria for GAD in elderly people, as the factorial structure of the WAQ was the same for this age group as for younger adults. A higher degree of GAD severity was found in the younger sample.


Diagnostic criteria GAD Anxiety disorders Worry Elderly Factor invariance 


  1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4thnth ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Arbuckle, J. L. (2003). AMOS 5.0 update to the Amos users guide. Chicago: SmallWaters Corporation.Google Scholar
  3. Arbuckle, J. L., & Wothke, W. (1999). AMOS 4.0 user’s guide. Chicago, IL: SmallWaters Corporation.Google Scholar
  4. Arbuckle, J. L., & Wothke, W. (2003). AMOS 5.0 update to the AMOS user’s guide. Chicago, IL: SmallWaters Corporation.Google Scholar
  5. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246.PubMedCrossRefGoogle Scholar
  6. Bentler, P. M. (1995). EQS: Structural equation program manual. Encino, CA: Multivariate Software.Google Scholar
  7. Brown, T. A., Barlow, D. H., & Liebowitz, M. R. (1994). The empirical basis of generalized anxiety disorder. American Journal of Psychiatry, 151, 1272–1280.PubMedGoogle Scholar
  8. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen, & J. S. Long (Eds.) Testing structural equation models (pp. 136–161). Newbury Park, CA: Sage.Google Scholar
  9. Byrne, B. M. (2001). Structural equation modelling with AMOS. Basic concepts, applications and programming. New Jersey: Lawrence Erlbaum.Google Scholar
  10. Chino, B., Mizuno, M., Nemoto, T., Yamashita, C., & Kashima, H. (2006). Relation between social functioning and neurocognitive test results using the Optional Thinking Test in schizophrenia. Psychiatry and Clinical Neurosciences, 60, 63–69.PubMedCrossRefGoogle Scholar
  11. Craske, M. G. (2003). Origins of phobias and anxiety disorders: Why more women than men?. Oxford: Elsevier.Google Scholar
  12. Del Ser, T., & Peña-Casanova, J. (1994). Objetivos y métodos de la evaluación de la demencia [Objectives and methods for the assessment of dementia]. In T. del Ser, & J. Peña-Casanova (Eds.) Evaluación neuropsicológica y funcional de la demencia [Neuropsychological and functional assessment of dementia] (pp. 1–8). Barcelona: JR Prous Editores.Google Scholar
  13. Dugas, M. J., Freeston, M. H., Provencher, M., Lachance, S., Ladouceur, R., & Gosselin, P. (2001). Le Questionnaire sur l’inquiétude et l’anxiété: validation dans des échantillons non cliniques et cliniques [The Worry and Anxiety Questionnaire: validation in nonclinical and clinical samples]. Journal de Thérapie Conportementale et Cognitive, 11, 31–36.Google Scholar
  14. Fisher, J. E., & Noll, J. P. (1996). Anxiety disorders. In L. L. Carstensen, B. A. Edelstein, & L. Dornbrand (Eds.) The practical handbook of clinical gerontology (pp. 304–323). Thousand Oaks, CA: Sage.Google Scholar
  15. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.PubMedCrossRefGoogle Scholar
  16. Flint, A. J. (1994). Epidemiology and comorbidity of anxiety disorders in the elderly. American Journal of Psychiatry, 151, 640–649.PubMedGoogle Scholar
  17. Fuentes, K., & Cox, B. J. (1997). Prevalence of anxiety disorders in elderly adults: a critical analysis. Journal of Behaviour Therapy and Experimental Psychiatry, 28, 269–279.CrossRefGoogle Scholar
  18. Heimberg, R. G., Turk, C. L., & Mennin, D. S. (2004). Preface. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.) Generalized anxiety disorder. Advances in research and practice (pp. xi–xiv). New York: Guilford Press.Google Scholar
  19. Hoelter, J. W. (1983). The analysis of covariance structures: goodness-of-fit indices. Sociological Methods & Research, 11, 325–344.CrossRefGoogle Scholar
  20. Hunt, S., Wisocki, P. A., & Yanko, J. (2003). Worry and use of coping strategies among older and younger adults. Journal of Anxiety Disorders, 17, 547–560.PubMedCrossRefGoogle Scholar
  21. Ibáñez, I., González, M., Fernández-Valdés, A., López-Curbelo, M., Rodríguez, M., & García, C. D. (2000). El Cuestionario de Preocupación y Ansiedad: un instrumento para la evaluación del trastorno de ansiedad generalizada [The Worry and Anxiety Questionnaire: an instrument for the assessment of the generalized anxiety disorder]. Ansiedad y Estrés, 6, 203–221.Google Scholar
  22. Jorekog, K. G., & Sorbom, D. (1996). LISREL 8: User’s reference guide. Chicago: Scientific Software International.Google Scholar
  23. Lobo, A., Ezquerra, J., Gómez, F. B., Sala, J. M., & Seva, A. (1979). El mini-examen cognoscitivo. Un test sencillo y práctico para detectar alteraciones intelectuales en pacientes médicos [Cognoscitive mini-test. (a simple and practical test to detect intellectual changes in medical patients]. Actas Luso-Españolas de Neurología Psiquiátrica, 7, 189–202.Google Scholar
  24. MacCallum, R. C., Widaman, K. F., Zhang, S., & Hong, S. (1999). Sample size in factor analysis. Psychological Methods, 4, 84–99.CrossRefGoogle Scholar
  25. Montorio, I., Nuevo, R., Márquez, M., Izal, M., & Losada, A. (2003). Characterization of worry according to severity of anxiety in elderly living in the community. Aging and Mental Health, 7, 334–341.PubMedCrossRefGoogle Scholar
  26. Nuevo, R. (2005). Sensibilidad y especificidad del Cuestionario de Preocupación y Ansiedad para la detección del Trastorno de Ansiedad Generalizada en la edad avanzada [Sensitivity and specificity of the Worry and Anxiety Questionnaire for detecting generalized anxiety disorder in the old age]. Revista de Psicopatología y Psicología Clínica, 10, 135–142.Google Scholar
  27. Nuevo, R., Montorio, I., & Borkovec, T. D. (2004). A test of the role of metaworry in the prediction of worry severity in an elderly sample. Journal of Behavior Therapy and Experimental Psychiatry, 35, 209–218.PubMedCrossRefGoogle Scholar
  28. Palmer, B. W., Jeste, D. V., & Sheikh, J. I. (1997). Anxiety disorders in the elderly: DSM-IV and other barriers to diagnosis and treatment. Journal of Affective Disorders, 46, 183–190.PubMedCrossRefGoogle Scholar
  29. Piguet, O., Grayson, D. A., Broe, G. A., Tate, R. L., Bennett, H. P., Lye, T. C., et al. (2002). Normal aging and executive functions in ‘old-old’ community dwellers: poor performance is not an inevitable outcome. International Psychogeriatrics, 14, 139–159.PubMedCrossRefGoogle Scholar
  30. Ray, J. J. (1988). Lie scales and the elderly. Personality and Individual Differences, 9, 417–418.CrossRefGoogle Scholar
  31. Reise, S. P., Widaman, K. F., & Pugh, R. H. (1993). Confirmatory factor analysis and item response theory: two approaches for exploring measurement invariance. Psychological Bulletin, 114, 552–566.PubMedCrossRefGoogle Scholar
  32. Ruscio, A. M., Borkovec, T. D., & Ruscio, J. (2001). A taxometric investigation of the latent structure of worry. Journal of Abnormal Psychology, 110, 413–422.PubMedCrossRefGoogle Scholar
  33. Stanley, M. A., Diefenbach, G. J., Hopko, D. R., Novy, D., Kunik, M. E., Wilson, N., et al. (2003). The nature of generalized anxiety in older primary care patients. Journal of Psychopathology and Behavioral Assessment, 25, 273–280.CrossRefGoogle Scholar
  34. Tomarken, A. J., & Waller, N. G. (2003). Potential problems with “well fitting” models. Journal of Abnormal Psychology, 112, 578–598.PubMedCrossRefGoogle Scholar
  35. Tombaugh, T. N., McDowell, I., Kristjansson, B., & Hubley, A. M. (1996). Mini-mental state examination and the modified MMSE: psychometric comparison and normative data. Psychological Assessment, 1, 48–59.CrossRefGoogle Scholar
  36. Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922–935.PubMedGoogle Scholar
  37. Wetherell, J. L., & Gatz, M. (2005). The Beck Anxiety Inventory in older adults with generalized anxiety disorder. Journal of Psychopathology and Behavioral Assessment, 27, 17–24.CrossRefGoogle Scholar
  38. Wetherell, J. L., Le Roux, H., & Gatz, M. (2003). DSM-IV criteria for generalized anxiety disorder in older adults: distinguishing the worried from the well. Psychology and Aging, 18, 622–627.PubMedCrossRefGoogle Scholar
  39. Whitbourne, S. K. (1996). Psychological perspectives on the normal aging process. In L.L. Carstensen, B. A. Edelstein, & L. Dornbrand (Eds.)The practical handbook of clinical gerontology (pp. 3–35). Thousand Oaks, CA: Sage.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Roberto Nuevo
    • 1
    • 3
  • Miguel A. Ruiz
    • 1
  • María Izal
    • 1
  • Ignacio Montorio
    • 1
  • Andrés Losada
    • 2
  • María Márquez-González
    • 1
  1. 1.Psychology DepartmentUniversidad Autónoma de MadridMadridSpain
  2. 2.Psychology DepartmentUniversidad Rey Juan CarlosMadridSpain
  3. 3.Facultad de PsicologíaUniversidad Autónoma de MadridMadridSpain

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