Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe.

Ayelet Meron Ruscio, Lauren Hallion, Carmen 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, Y He, Hirsto Hinkov, C Hu, Peter de JongeElie G. Karam, Sing Lee, Jean-Pierre Lepine, Daphna Levinson, Z Mneimneh, Fernando Navarro-Mateu, Jose Posada-Villa, Tim Slade, Dan Stein, Yolanda Torres, Hidenori Uda, Bogdan Wojtyniak, Ronald Kessler, Somnath Chatterji, Kate Scott

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE:
Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5.

OBJECTIVE:
To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact.

DESIGN, SETTING, AND PARTICIPANTS:
Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016.

MAIN OUTCOMES AND MEASURES:
The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking.

RESULTS:
Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]).

CONCLUSIONS AND RELEVANCE:
The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.
Original languageEnglish
Pages (from-to)465-475
JournalJAMA Psychiatry
Volume74
Issue number5
Early online date15 Mar 2017
DOIs
Publication statusPublished - 1 May 2017

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    Ruscio, A. M., Hallion, L., Lim, C., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L. H., Borges, G., Bromet, E. J., Bunting, B., Caldas de Almeida, J. M., Demyttenaere, K., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hinkov, H., Hu, C., ... Scott, K. (2017). Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. JAMA Psychiatry, 74(5), 465-475. https://doi.org/10.1001/jamapsychiatry.2017.0056