Loneliness, sleep difficulties, the regular use of mood stabilizers, and aggressive challenging behavior may play a role in anxiety and depression among older adults with intellectual disabilities (ID), according to study data published in the Journal of Intellectual Disability Research. These biopsychosocial factors may be modifiable, thus presenting an opportunity to reduce anxiety and depression in this population.
The investigators abstracted data from the third wave (2016-2017) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a cohort study of adults with ID living in Ireland. Briefly, IDS-TILDA randomly selected adults from a national database, which comprises health summary data for all adults with ID in Ireland. The third wave included data for 28,388 patients aged ≥40 years with ID.
To capture demographic information, residential setting, socialization habits, physical and mental health, medication use, and sleep habits, the investigators administered face-to-face interviews. The primary outcome measure was depression and/or anxiety, measured using the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) and the Glasgow Anxiety Scale for people with a Learning Disability (GAS-LD), respectively. Pearson’s Chi-square and Fisher’s exact tests were performed to identify correlations between anxiety and depression and various biopsychosocial factors.
A total of 291 patients with ID underwent study interviews, among whom 121 (41.58%) were men. The majority of participants were 50-65 years of age (64.26%); 48.45% lived in a community group home; 44.95% were employed; and 74.57% had at least 1 chronic physical health condition. Overall, 29 participants (9.97%) met the GDS-LD criteria for depression and 44 (15.12%) met the GAS-LD criteria for anxiety. In addition, 53 patients (18.21%) met the criteria for both anxiety and depression.
Age, gender, ID severity, and residential setting were not significantly associated with anxiety or depression. However, participants who had a chronic physical health condition were significantly more likely to meet cutoff scores for anxiety alone (P =.008) and depression and/or anxiety (P =.01). Patients taking mood stabilizers were also more likely to meet the criteria for depression alone (P =.001) and depression and/or anxiety (P =.02). Similarly, patients taking anxiolytic medications, hypnotics/sedatives, and antidepressants were more likely to meet criteria for either mood disorder.
Depression and anxiety were also significantly associated with sleep difficulties, including trouble falling asleep, early waking, coughing or snoring, feeling too cold or too hot, and having a bad dream. Over half of participants (55.67%) reported lack of involvement with a club or society, whereas 26.12% reported lack of contact with family. Patients who endorsed feeling lonely were more likely to meet criteria for depression (P =.02), anxiety (P <.001), or both conditions (P <.001). Patients who reported aggressive behavior in the prior 2 months (24.4%) were significantly more likely to meet criteria for depression (P =.001).
These findings suggest that myriad factors contribute to anxiety and depression risk among patients with ID. Many of these factors are modifiable—such as loneliness and sleep difficulty—and may be promising targets for intervention. However, the study may be limited by its reliance on self-report data.
“Longitudinal studies should be implemented to provide additional and reliable knowledge on the causality and direction of associative biopsychosocial factors and mental ill health for the older ID population to better inform management strategies, prevention policies and funding of services,” the study authors concluded.
Bond L, Carroll R, Mulryan N, et al. Biopsychosocial factors associated with depression and anxiety in older adults with intellectual disability: results of the wave 3 Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing [published online March 25, 2020]. J Intellect Disabil Res. doi: 10.1111/jir.12724