Anxiety disorders and figural fluency: a measure of executive function

Abstract
Background
Anxiety possibly interferes with executive functioning, although most studies rely on anxiety symptoms or lack control for comorbid depression. The objective of the present study is to examine the association between executive functioning and (individual) anxiety disorders with and without controlling for depression.

Method
Generalized anxiety disorder (GAD), panic disorder with and without agoraphobia, agoraphobia, social phobia, as well as depressive disorder according to DSM-IV criteria were assessed with the Mini International Neuropsychiatric Interview in 82,360 community-dwelling people participating in the Lifelines cohort. Figural fluency as a measure of executive functioning was assessed with the Ruff Figural Fluency Test (RFTT). Linear regression analyses with the RFFT score as the dependent variable and psychiatric diagnosis as independent variables (dummies) were performed, adjusted for potential confounders. Multivariate results are presented with and without adjustment for depression.

Results
Presence of any anxiety disorder was associated with worse performance on the RFFT (B=−0.78, SE=0.32, p=.015), independent of depression. No dose-response relationship with the number of anxiety disorders was found.

Only agoraphobia and generalized anxiety disorder were significantly associated with the RFFT score in the multivariate models. Agoraphobia remained significant when further adjusted for depressive disorder (B=−1.14, SE=0.41, p<.01), while GAD did not (B=0.013, SE=0.431, p=.975).

Limitations
Executive function was tested by only one measure, namely figural fluency.

Conclusion
Agoraphobia is associated with worse executive functioning. Treatment of agoraphobia could be influenced by the executive dysfunction which clinicians should be aware of when regular treatment fails.

Key words
Anxiety disordersAgoraphobiaGeneralized anxiety disorderSocial phobiaPanic disorderCognition