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 >or=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.
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 >or=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.
Authors: Josep Maria Haro; Saena Arbabzadeh-Bouchez; Traolach S Brugha; Giovanni de Girolamo; Margaret E Guyer; Robert Jin; Jean Pierre Lepine; Fausto Mazzi; Blanca Reneses; Gemma Vilagut; Nancy A Sampson; Ronald C Kessler Journal: Int J Methods Psychiatr Res Date: 2006 Impact factor: 4.035
Authors: Koen Demyttenaere; Ronny Bruffaerts; Jose Posada-Villa; Isabelle Gasquet; Viviane Kovess; Jean Pierre Lepine; Matthias C Angermeyer; Sebastian Bernert; Giovanni de Girolamo; Pierluigi Morosini; Gabriella Polidori; Takehiko Kikkawa; Norito Kawakami; Yutaka Ono; Tadashi Takeshima; Hidenori Uda; Elie G Karam; John A Fayyad; Aimee N Karam; Zeina N Mneimneh; Maria Elena Medina-Mora; Guilherme Borges; Carmen Lara; Ron de Graaf; Johan Ormel; Oye Gureje; Yucun Shen; Yueqin Huang; Mingyuan Zhang; Jordi Alonso; Josep Maria Haro; Gemma Vilagut; Evelyn J Bromet; Semyon Gluzman; Charles Webb; Ronald C Kessler; Kathleen R Merikangas; James C Anthony; Michael R Von Korff; Philip S Wang; Traolach S Brugha; Sergio Aguilar-Gaxiola; Sing Lee; Steven Heeringa; Beth-Ellen Pennell; Alan M Zaslavsky; T Bedirhan Ustun; Somnath Chatterji Journal: JAMA Date: 2004-06-02 Impact factor: 56.272
Authors: Michael B First; Wolfgang Gaebel; Mario Maj; Dan J Stein; Cary S Kogan; John B Saunders; Vladimir B Poznyak; Oye Gureje; Roberto Lewis-Fernández; Andreas Maercker; Chris R Brewin; Marylene Cloitre; Angelica Claudino; Kathleen M Pike; Gillian Baird; David Skuse; Richard B Krueger; Peer Briken; Jeffrey D Burke; John E Lochman; Spencer C Evans; Douglas W Woods; Geoffrey M Reed Journal: World Psychiatry Date: 2021-02 Impact factor: 49.548
Authors: Roberto Lewis-Fernández; Devon E Hinton; Amaro J Laria; Elissa H Patterson; Stefan G Hofmann; Michelle G Craske; Dan J Stein; Anu Asnaani; Betty Liao Journal: Depress Anxiety Date: 2010-02 Impact factor: 6.505
Authors: Ayelet Meron Ruscio; Lauren S Hallion; Carmen C W Lim; Sergio Aguilar-Gaxiola; Ali Al-Hamzawi; Jordi Alonso; Laura Helena Andrade; Guilherme Borges; Evelyn J Bromet; Brendan Bunting; José Miguel Caldas de Almeida; Koen Demyttenaere; Silvia Florescu; Giovanni de Girolamo; Oye Gureje; Josep Maria Haro; Yanling He; Hristo Hinkov; Chiyi Hu; Peter de Jonge; Elie G Karam; Sing Lee; Jean-Pierre Lepine; Daphna Levinson; Zeina Mneimneh; Fernando Navarro-Mateu; José Posada-Villa; Tim Slade; Dan J Stein; Yolanda Torres; Hidenori Uda; Bogdan Wojtyniak; Ronald C Kessler; Somnath Chatterji; Kate M Scott Journal: JAMA Psychiatry Date: 2017-05-01 Impact factor: 21.596
Authors: Enrique Alvarez; Jose L Carrasco; José M Olivares; Vanessa López-Gómez; Inma Vilardaga; María Perez Journal: Clin Pract Epidemiol Ment Health Date: 2012-11-16