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 Jonge & 15 others Elie 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

32 Citations (Scopus)

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.
LanguageEnglish
Pages465-475
JournalJAMA Psychiatry
Volume74
Issue number5
Early online date15 Mar 2017
DOIs
Publication statusPublished - 1 May 2017

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Anxiety Disorders
Epidemiology
Health Surveys
Developed Countries
Social Class
Diagnostic and Statistical Manual of Mental Disorders
Population
Comorbidity
Mental Health
Anxiety
Public Health
Outcome Assessment (Health Care)
Surveys and Questionnaires
Interviews

Cite this

Ruscio, A. M., Hallion, L., Lim, C., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., ... 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
Ruscio, Ayelet Meron ; Hallion, Lauren ; Lim, Carmen ; Aguilar-Gaxiola, Sergio ; Al-Hamzawi, Ali ; Alonso, Jordi ; Andrade, Laura Helena ; Borges, Guilherme ; Bromet, Evelyn J ; Bunting, Brendan ; Caldas de Almeida, José Miguel ; Demyttenaere, Koen ; Florescu, Silvia ; de Girolamo, Giovanni ; Gureje, Oye ; Haro, Josep Maria ; He, Y ; Hinkov, Hirsto ; Hu, C ; de Jonge, Peter ; Karam, Elie G. ; Lee, Sing ; Lepine, Jean-Pierre ; Levinson, Daphna ; Mneimneh, Z ; Navarro-Mateu, Fernando ; Posada-Villa, Jose ; Slade, Tim ; Stein, Dan ; Torres, Yolanda ; Uda, Hidenori ; Wojtyniak, Bogdan ; Kessler, Ronald ; Chatterji, Somnath ; Scott, Kate. / Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. In: JAMA Psychiatry. 2017 ; Vol. 74, No. 5. pp. 465-475.
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title = "Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe.",
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.",
author = "Ruscio, {Ayelet Meron} and Lauren Hallion and Carmen Lim and Sergio Aguilar-Gaxiola and Ali Al-Hamzawi and Jordi Alonso and Andrade, {Laura Helena} and Guilherme Borges and Bromet, {Evelyn J} and Brendan Bunting and {Caldas de Almeida}, {Jos{\'e} Miguel} and Koen Demyttenaere and Silvia Florescu and {de Girolamo}, Giovanni and Oye Gureje and Haro, {Josep Maria} and Y He and Hirsto Hinkov and C Hu and {de Jonge}, Peter and Karam, {Elie G.} and Sing Lee and Jean-Pierre Lepine and Daphna Levinson and Z Mneimneh and Fernando Navarro-Mateu and Jose Posada-Villa and Tim Slade and Dan Stein and Yolanda Torres and Hidenori Uda and Bogdan Wojtyniak and Ronald Kessler and Somnath Chatterji and Kate Scott",
year = "2017",
month = "5",
day = "1",
doi = "10.1001/jamapsychiatry.2017.0056",
language = "English",
volume = "74",
pages = "465--475",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
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Ruscio, AM, Hallion, L, Lim, C, Aguilar-Gaxiola, S, Al-Hamzawi, A, Alonso, J, Andrade, LH, Borges, G, Bromet, EJ, Bunting, B, Caldas de Almeida, JM, Demyttenaere, K, Florescu, S, de Girolamo, G, Gureje, O, Haro, JM, He, Y, Hinkov, H, Hu, C, de Jonge, P, Karam, EG, Lee, S, Lepine, J-P, Levinson, D, Mneimneh, Z, Navarro-Mateu, F, Posada-Villa, J, Slade, T, Stein, D, Torres, Y, Uda, H, Wojtyniak, B, Kessler, R, Chatterji, S & Scott, K 2017, 'Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe.', JAMA Psychiatry, vol. 74, no. 5, pp. 465-475. https://doi.org/10.1001/jamapsychiatry.2017.0056

Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. / Ruscio, Ayelet Meron; Hallion, Lauren; Lim, Carmen; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Alonso, Jordi; Andrade, Laura Helena; Borges, Guilherme; Bromet, Evelyn J; Bunting, Brendan; Caldas de Almeida, José Miguel; Demyttenaere, Koen; Florescu, Silvia; de Girolamo, Giovanni; Gureje, Oye; Haro, Josep Maria; He, Y; Hinkov, Hirsto; Hu, C; de Jonge, Peter; Karam, Elie G.; Lee, Sing; Lepine, Jean-Pierre; Levinson, Daphna; Mneimneh, Z; Navarro-Mateu, Fernando; Posada-Villa, Jose; Slade, Tim; Stein, Dan; Torres, Yolanda ; Uda, Hidenori; Wojtyniak, Bogdan; Kessler, Ronald; Chatterji, Somnath; Scott, Kate.

In: JAMA Psychiatry, Vol. 74, No. 5, 01.05.2017, p. 465-475.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe.

AU - Ruscio, Ayelet Meron

AU - Hallion, Lauren

AU - Lim, Carmen

AU - Aguilar-Gaxiola, Sergio

AU - Al-Hamzawi, Ali

AU - Alonso, Jordi

AU - Andrade, Laura Helena

AU - Borges, Guilherme

AU - Bromet, Evelyn J

AU - Bunting, Brendan

AU - Caldas de Almeida, José Miguel

AU - Demyttenaere, Koen

AU - Florescu, Silvia

AU - de Girolamo, Giovanni

AU - Gureje, Oye

AU - Haro, Josep Maria

AU - He, Y

AU - Hinkov, Hirsto

AU - Hu, C

AU - de Jonge, Peter

AU - Karam, Elie G.

AU - Lee, Sing

AU - Lepine, Jean-Pierre

AU - Levinson, Daphna

AU - Mneimneh, Z

AU - Navarro-Mateu, Fernando

AU - Posada-Villa, Jose

AU - Slade, Tim

AU - Stein, Dan

AU - Torres, Yolanda

AU - Uda, Hidenori

AU - Wojtyniak, Bogdan

AU - Kessler, Ronald

AU - Chatterji, Somnath

AU - Scott, Kate

PY - 2017/5/1

Y1 - 2017/5/1

N2 - 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.

AB - 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.

U2 - 10.1001/jamapsychiatry.2017.0056

DO - 10.1001/jamapsychiatry.2017.0056

M3 - Article

VL - 74

SP - 465

EP - 475

JO - JAMA Psychiatry

T2 - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 5

ER -