Anxiety sensitivity in late-life depression. Links to cognitive impairment, insomnia, and health-related quality of life

Background and aims: Anxiety sensitivity (AS)-the fear of anxiety-related sensations driven by beliefs about their harmful consequences-is a well-established transdiagnostic vulnerability factor in younger and adult populations, but it has been less studied in late-life depression. This study investigated AS in older adults with major depressive disorder. Methods: A total of 432 patients aged ≥60 years were evaluated for depressive symptoms (Montgomery-Åsberg Depression Rating Scale; Hamilton Depression Rating Scale), anxiety (Brief Symptom Inventory; Penn State Worry Questionnaire), cognition (Mini-Mental State Examination; Repeatable Battery for the Assessment of Neuropsychological Status; Delis-Kaplan Executive Function System), health-related quality of life (HRQOL: Medical Outcomes Study 36-item Short Form Health Survey; Cumulative Illness Rating Scale), and antidepressant-related side effects (Abnormal Involuntary Movement Scale; Barnes Akathisia Scale; Udvalg for Kliniske Undersøgelser scale). Anxiety Sensitivity Index was used to assess AS. Results: Patients with higher AS levels were more frequently women, had fewer education years, and exhibited greater depressive and anxiety severity, higher rates of panic disorder, poorer cognitive performance, worse physical HRQOL, and a higher burden of antidepressant side effects. Associations with insomnia were limited to the middle-of-the-night subtype. Limitations: The cross-sectional design and diagnostic constraints limit generalizability and causal inference. Conclusions: In older adults with major depression, moderate to high AS levels correlate with cognitive, clinical, and functional vulnerability. These findings support the role of anxiety sensitivity as a prognostic marker in late-life depression.