Hostname: page-component-7dd5485656-k8lnt Total loading time: 0 Render date: 2025-10-31T01:14:27.881Z Has data issue: false hasContentIssue false
  • English
  • Français

Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries

Published online by Cambridge University Press:  18 December 2008

S. Lee ,
A. Tsang ,
A. M. Ruscio ,
J. M. Haro ,
D. J. Stein ,
J. Alonso ,
M. C. Angermeyer ,
E. J. Bromet ,
K. Demyttenaere  and
G. de Girolamo
...Show all authors
S. Lee*
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, PRC, USA
A. Tsang
Affiliation:
Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong, PRC, USA
A. M. Ruscio
Affiliation:
Department of Psychology, University of Pennsylvania, Philadelphia, USA
J. M. Haro
Affiliation:
Sant Joan de Deu-SSM, Barcelona, Spain
D. J. Stein
Affiliation:
University of Cape Town, UCT Department of Psychiatry, Cape Town, South Africa
J. Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del mar, CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
M. C. Angermeyer
Affiliation:
Center for Public Mental Health, Gösing a.W, Austria
E. J. Bromet
Affiliation:
SUNY Stony Brook, Stony Brook, New York, NY, USA
K. Demyttenaere
Affiliation:
University Hospital Gasthuisburg, Leuven, Belgium
G. de Girolamo
Affiliation:
Regional Health Care Agency, Emilia-Romanga Region, Italy
R. de Graaf
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
O. Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
N. Iwata
Affiliation:
Hiroshima International University, Higashi-Hiroshima, Japan
E. G. Karam
Affiliation:
Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
J.-P. Lepine
Affiliation:
Hospital Fernand Widal, Paris, France
D. Levinson
Affiliation:
Ministry of Health, Mental Health Services, Jerusalem, Israel
M. E. Medina-Mora
Affiliation:
National Institute of Psychiatry, Mexico City, Mexico
M. A. Oakley Browne
Affiliation:
Department of Rural and Indigenous Health, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
J. Posada-Villa
Affiliation:
Colegio Mayor de Cundinamarca University, Bogotá, Colombia
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, USA
*
*Address for correspondence: Professor S. Lee, Director, Hong Kong Mood Disorders Center, 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, NT, Hong Kong. (Email: singlee@cuhk.edu.hk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

A number of western studies have suggested that the 6-month duration requirement of generalized anxiety disorder (GAD) does not represent a critical threshold in terms of onset, course, or risk factors of the disorder. No study has examined the consequences of modifying the duration requirement across a wide range of correlates in both developed and developing countries.

Method

Population surveys were carried out in seven developing and 10 developed countries using the WHO Composite International Diagnostic Interview (total sample=85 052). Prevalence and correlates of GAD were compared across mutually exclusive GAD subgroups defined by different minimum duration criteria.

Results

Lifetime prevalence estimates for GAD lasting 1 month, 3 months, 6 months and 12 months were 7.5%, 5.2%, 4.1% and 3.0% for developed countries and 2.7%, 1.8%, 1.5% and 1.2% for developing countries, respectively. There was little difference between GAD of 6 months' duration and GAD of shorter durations (1–2 months, 3–5 months) in age of onset, symptom severity or persistence, co-morbidity or impairment. GAD lasting ⩾12 months was the most severe, persistently symptomatic and impaired subgroup.

Conclusions

In both developed and developing countries, the clinical profile of GAD is similar regardless of duration. The DSM-IV 6-month duration criterion excludes a large number of individuals who present with shorter generalized anxiety episodes which may be recurrent, impairing and contributory to treatment-seeking. Future iterations of the DSM and ICD should consider modifying the 6-month duration criterion so as to better capture the diversity of clinically salient anxiety presentations.

Keywords

Cross-nationaldiagnosisdurationepidemiologygeneralized anxiety disorder

Information

Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 7 , July 2009 , pp. 1163 - 1176
Copyright
Copyright © 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Angst, J, Gamma, A, Joseph Bienvenu, O, Eaton, WW, Ajdacic, V, Eich, D, Rössler, W (2006). Varying temporal criteria for generalized anxiety disorder: prevalence and clinical characteristics in a young age cohort. Psychological Medicine 36, 1283–1292.CrossRefGoogle Scholar
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychiatric Association: Washington, DC.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Association: Washington, DC.Google Scholar
Bienvenu, OJ, Nestadt, G, Eaton, WW (1998). Characterizing generalized anxiety: temporal and symptomatic thresholds. Journal of Nervous and Mental Disease 186, 51–56.CrossRefGoogle ScholarPubMed
Breslau, N, Davis, GC (1985). DSM-III generalized anxiety disorder: an empirical investigation of more stringent criteria. Psychiatry Research 15, 231–238.CrossRefGoogle ScholarPubMed
Brown, TA, Di Nardo, PA, Lehman, CL, Campbell, LA (2001). Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders. Journal of Abnormal Psychology 110, 49–58.CrossRefGoogle ScholarPubMed
Carter, RM, Wittchen, HU, Pfister, H, Kessler, RC (2001). One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety 13, 78–88.CrossRefGoogle Scholar
Chang, SM, Hahm, BJ, Lee, JY, Shin, MS, Jeon, HJ, Hong, JP, Lee, HB, Lee, DW, Cho, MJ (2008). Cross-national difference in the prevalence of depression caused by the diagnostic threshold. Journal of Affective Disorders 106, 159–167.CrossRefGoogle ScholarPubMed
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, de Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, C, de Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Von Korff, MR, Wang, PS, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S, WHO World Mental Health Survey Consortium (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association 291, 2581–2590.Google ScholarPubMed
Feighner, JP, Robins, E, Guze, SB, Woodruff, RA Jr., Winokur, G, Munoz, R (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 57–63.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Gureje, O, Lasebikan, VO, Kola, L, Makanjuola, VA (2006). Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. British Journal of Psychiatry 188, 465–471.CrossRefGoogle ScholarPubMed
Halli, SS, Vaninadha Rao, K (1992). Advanced Techniques of Population Analysis. Plenum Press: New York.CrossRefGoogle Scholar
Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, de Girolamo, G, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA, Kessler, RC (2006). Concordance of the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research 15, 167–180.CrossRefGoogle ScholarPubMed
Hettema, JM, Prescott, CA, Kendler, KS (2001). A population-based twin study of generalized anxiety disorder in men and women. Journal of Nervous and Mental Disease 189, 413–420.CrossRefGoogle ScholarPubMed
Heuzenroeder, L, Donnelly, M, Haby, MM, Mihalopoulos, C, Rossell, R, Carter, R, Andrews, G, Vos, T (2004). Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder. Australia and New Zealand Journal of Psychiatry 38, 602–612.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1992). Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry 49, 267–272.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1994). Clinical characteristics of familial generalized anxiety disorder. Anxiety 1, 186–191.CrossRefGoogle ScholarPubMed
Kessler, RC, Andrade, LH, Bijl, RV, Offord, DR, Demler, OV, Stein, DJ (2002). The effects of comorbidity on the onset and persistence of generalized anxiety disorder in the ICPE surveys. Psychological Medicine 32, 1213–1225.CrossRefGoogle ScholarPubMed
Kessler, RC, Brandenburg, N, Lane, M, Roy-Byrne, P, Stang, PD, Stein, DJ, Wittchen, HU (2005). Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychological Medicine 35, 1073–1082.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Knauper, B, Cannell, CF, Schwarz, N, Bruce, ML, Kessler, RC (1999). Improving the accuracy of major depression age of onset reports in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research 8, 39–48.CrossRefGoogle Scholar
Lee, S, Tsang, A, Chui, H, Kwok, K, Cheung, E (2007 a). A community epidemiological survey of generalized anxiety disorder in Hong Kong. Community Mental Health Journal 43, 305–319.CrossRefGoogle ScholarPubMed
Lee, S, Tsang, A, Zhang, MY, Huang, YQ, He, YL, Liu, ZR, Shen, YC, Kessler, RC (2007 b). Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China. Psychological Medicine 37, 61–71.CrossRefGoogle ScholarPubMed
Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehan, DV (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93–105.CrossRefGoogle ScholarPubMed
Maier, W, Gansicke, M, Freyberger, HJ, Linz, M, Heun, R, Lecrubier, Y (2000). Generalized anxiety disorder (ICD-10) in primary care from a cross-cultural perspective: a valid diagnostic entity? Acta Psychiatrica Scandinavica 101, 29–36.CrossRefGoogle ScholarPubMed
Rickels, K, Rynn, M (2001). Overview and clinical presentation of generalized anxiety disorder. Psychiatric Clinics of North America 24, 1–17.CrossRefGoogle ScholarPubMed
Ruscio, AM (2002). Delimiting the boundaries of generalized anxiety disorder: differentiating high worriers with and without GAD. Journal of Anxiety Disorders 16, 377–400.CrossRefGoogle ScholarPubMed
Ruscio, AM, Chiu, WT, Roy-Byrne, P, Stang, PE, Stein, DJ, Wittchen, HU, Kessler, RC (2007). Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. Journal of Anxiety Disorders 21, 662–676.CrossRefGoogle ScholarPubMed
Shen, YC, Zhang, MY, Huang, YQ, He, YL, Liu, ZR, Cheng, H, Tsang, A, Lee, S, Kessler, RC (2006). Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychological Medicine 36, 257–267.CrossRefGoogle ScholarPubMed
Slade, T, Andrews, G (2001). DSM-IV and ICD-10 generalized anxiety disorder: discrepant diagnoses and associated disability. Social Psychiatry and Psychiatric Epidemiology 36, 45–51.CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JBW (1984). Diagnostic issues in the DSM-III classification of the anxiety disorders. In Psychiatry Updates: The American Psychiatric Association Annual Review Volume III (ed. Grinspoon, L.), pp. 392–402. American Psychiatric Press: Washington, DC.Google Scholar
United Nations Development Programme (2004). Human Development Report 2004: Cultural Liberty in Today's Diverse World. United Nations Development Programme: New York.Google Scholar
Wang, PS, Angermeyer, MC, Borges, G, Bruffaerts, R, Tat Chiu, W, de Girolamo, G, Fayyad, J, Gureje, O, Haro, JM, Huang, Y, Kessler, RC, Kovess, V, Levinson, D, Nakane, Y, Oakley Brown, MA, Ormel, JH, Posada-Villa, J, Aguilar-Gaxiola, S, Alonso, J, Lee, S, Heeringa, S, Pennell, BE, Chatterji, S, Ustun, TB (2007). Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6, 177–185.Google ScholarPubMed
Wolter, KM (1985). Introduction to Variance Estimation. Springer-Verlag: New York.Google Scholar
WHO (1978). Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases. World Health Organization: Geneva.Google Scholar
WHO (1993). The ICD-10 Classification of Mental and Behavioural Disorders. World Health Organization: Geneva.Google Scholar
Yonkers, KA, Dyck, IR, Warshaw, M, Keller, MB (2000). Factors predicting the clinical course of generalised anxiety disorder. British Journal of Psychiatry 176, 544–549.CrossRefGoogle ScholarPubMed
Yonkers, KA, Warshaw, MG, Massion, AO, Keller, MB (1996). Phenomenology and course of generalised anxiety disorder. British Journal of Psychiatry 168, 308–313.CrossRefGoogle ScholarPubMed