Anxiety Among Community-Dwelling U.S. Chinese Older Adults

Anxiety is the most common mental illness among U.S. adults, with an estimated 12-month prevalence of 18.1%, of which 22.8% are severe anxiety disorders (1). Anxiety may cause significant adverse personal and societal outcomes. At the individual level, anxiety has been linked to physical disability (2), declines in cognitive function (3), and even suicidal ideation and mortality (4,5). At the societal level, anxiety may increase medical utilization and health care costs (6). According to a report on the economic burden of anxiety disorders, the cost of anxiety disorders is about $42 million per year—one third of the U.S. total mental illness bill (7). Anxiety is a major health problem in late life, yet anxiety symptoms in older adults are often undiagnosed and untreated. A study with 713 men and 1,338 women in Kentucky found that although 20% of participants aged 55 and older experienced a high level of anxiety symptoms, only 10% of them acknowledged the need to seek mental health treatment (8). Despite the magnitude of the issue among older adults, compared with other mental health issues such as depression and dementia, anxiety has received significantly less attention from researchers and the public (9,10). Additionally, the majority of studies on anxiety among older adults focused on the occurrence of disorders. Anxiety disorders may be manifested by a combination of symptoms such as having constantly worrying thoughts or not being able to sit at ease. Given that a diagnosis of anxiety disorders may require several symptoms, participants who endorsed one or more symptoms but did not meet the criteria for anxiety disorders may be excluded from the estimate of prior studies. Such exclusion of subsyndromal presentations may lead to the underestimation of the issue of anxiety among older adults (11). It is imperative for community epidemiology surveys to depict more accurate and comprehensive pictures of the extent of anxiety among older adults. The prevalence, presentation, and expression of anxiety differ significantly by social and cultural factors. Anxiety, especially social anxiety, is common and more likely to interfere with social relationships in collectivistic cultures, where harmony is highly emphasized within family and society (12). In addition, responses to anxiety may vary by cultural and ethnic groups. The Chinese culture is distinctive in the great emphasis given to individual and family “face value,” in which respect and reputation are critical (13). Although anxiety may be regarded as personality disorders, Chinese older adults are often inclined to deny anxiety so as to protect family honor and save individual “face.” The tendency to deny symptoms or express anxiety symptoms as somatic symptoms such as pain or fatigue may add to the complexity of detecting anxiety among Chinese older adults. Despite possibly unique cultural patterns of anxiety, the research on anxiety disorders and anxiety symptoms among Chinese older adults, regardless of their place of residence, is still in its infancy. The prevalence of anxiety cannot be fully understood without taking the immigration context into account. Language and cultural barriers experienced in a new country may increase intergenerational conflicts and breakdowns of traditional support systems (14–16). Furthermore, living in a conflict environment, financial strain, and separation from family members and relatives in the home country may predispose U.S. Chinese older adults to greater risk for anxiety. Over the past several years, the number of U.S. Chinese older adults has grown rapidly, to an estimated 540,000 people age 60 years or older in 2010 (17). The vulnerability and the growth in the population of U.S. Chinese older adults warrant a deeper understanding of their psychological well-being. The objectives of the study were to (i) understand the prevalence of anxiety disorders and anxiety symptoms among U.S. Chinese older adults and (ii) explore demographic, socioeconomic, family structure, and health-related correlates of anxiety disorders and anxiety symptoms among U.S. Chinese older adults.