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- Title
Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe.
- Authors
Ruscio, Ayelet Meron; Hallion, Lauren S.; Lim, Carmen C. W.; 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; Yanling He; Hinkov, Hristo; Chiyi Hu; de Jonge, Peter
- Abstract
<bold>Importance: </bold>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.<bold>Objective: </bold>To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact.<bold>Design, Setting, and Participants: </bold>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.<bold>Main Outcomes and Measures: </bold>The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking.<bold>Results: </bold>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%]).<bold>Conclusions and Relevance: </bold>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.
- Subjects
GENERALIZED anxiety disorder; ANXIETY disorders; CROSS-sectional method; EPIDEMIOLOGY; MENTAL health surveys; DEVELOPING countries; CLASSIFICATION of mental disorders; WORLD health; DEVELOPED countries; DISEASE prevalence
- Publication
JAMA Psychiatry, 2017, Vol 74, Issue 5, p465
- ISSN
2168-622X
- Publication type
journal article
- DOI
10.1001/jamapsychiatry.2017.0056