Hostname: page-component-76d6cb85b7-5qg8f Total loading time: 0 Render date: 2026-07-19T07:07:03.545Z Has data issue: false hasContentIssue false
  • English
  • Français

Global prevalence of anxiety disorders: a systematic review and meta-regression

Published online by Cambridge University Press:  10 July 2012

A. J. Baxter ,
K. M. Scott ,
T. Vos  and
H. A. Whiteford
A. J. Baxter*
Affiliation:
Queensland Centre for Mental Health Research, Policy and Evaluation Group, Wacol, QLD, Australia University of Queensland, School of Population Health, Herston, QLD, Australia
K. M. Scott
Affiliation:
University of Otago, Department of Psychological Medicine, Dunedin, New Zealand
T. Vos
Affiliation:
University of Queensland, School of Population Health, Herston, QLD, Australia
H. A. Whiteford
Affiliation:
Queensland Centre for Mental Health Research, Policy and Evaluation Group, Wacol, QLD, Australia University of Queensland, School of Population Health, Herston, QLD, Australia
*
*Address for correspondence: A. J. Baxter, The University of Queensland, School of Population Health, Queensland Centre for Mental Health Research, Locked Bag 500, Sumner Park BC, Brisbane, QLD 4074, Australia. (Email: amanda_baxter@qcmhr.uq.edu.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study.

Method

A systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.

Results

The prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3% (3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures.

Conclusions

Anxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.

Keywords

Anxiety disordersepidemiologyglobal burden of diseasemental disordersprevalencepsychiatric epidemiology

Information

Type
Review Article
Information
Psychological Medicine , Volume 43 , Issue 5 , May 2013 , pp. 897 - 910
Copyright
Copyright © Cambridge University Press 2012

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

Ajakaiyea, O, Alib, AAG (2009). Managing post-conflict recovery in Africa: an overview. Journal of African Economies 18 (Suppl. 1), i3–i11.CrossRefGoogle Scholar
Andrews, G, Henderson, S, Hall, W (2001). Prevalence, comorbidity, disability and service utilisation: overview of the Australian National Mental Health Survey. British Journal of Psychiatry 178, 145–153.CrossRefGoogle ScholarPubMed
Antony, MM, Stein, MB (editors) (2009). Oxford Handbook of Anxiety and Related Disorders. Oxford University Press: New York.Google Scholar
Beesdo, K, Pine, DS, Lieb, R, Wittchen, H-U (2010). Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Archives of General Psychiatry 67, 47–57.CrossRefGoogle ScholarPubMed
Belsley, DA (1991). Conditioning Diagnostics: Collinearity and Weak Data in Regression. Wiley: New York.Google Scholar
Benjet, C, Borges, G, Medina-Mora, ME, Zambrano, J, Aguilar-Gaxiola, S (2009). Youth mental health in a populous city of the developing worlds: results from the Mexican Adolescent Mental Health Survey. Journal of Child Psychology and Psychiatry 50, 386–395.CrossRefGoogle Scholar
Campbell, JC (2002). Health consequences of intimate partner violence. Lancet 359, 1331–1336.CrossRefGoogle ScholarPubMed
Chen, X, Ender, P, Mitchell, M, Wells, C (2003). Regression with Stata (http://www.ats.ucla.edu/stat/stata/webbooks/reg/default.htm). Accessed 30 November 2011.Google Scholar
Cheng, ATA (2001). Case definition and culture: are people all the same? British Journal of Psychiatry 179, 1–3.CrossRefGoogle ScholarPubMed
Costello, EJ, Egger, HL, Angold, A (2005). The developmental epidemiology of anxiety disorders: phenomenology, prevalence and comorbidity. Child and Adolescent Psychaitric Clinics of North America 14, 631–648.CrossRefGoogle ScholarPubMed
Das, J, Do, Q, Friedman, J, McKenzie, D, Scott, K (2007). Mental health and poverty in developing countries: revisiting the relationship. Social Science and Medicine 65, 467–480.CrossRefGoogle ScholarPubMed
de Graaf, R, Bijl, RV, Smit, F, Vollebergh, WAM, Spijker, J (2002). Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. American Journal of Psychiatry 159, 620–629.CrossRefGoogle ScholarPubMed
de Jong, JT, Komproe, IH, van Ommeren, M, El Masri, M, Araya, M, Khaled, N, van de Put, W, Somasundaram, D (2001). Lifetime events and posttraumatic stress disorder in 4 postconflict settings. Journal of the American Medical Association 286, 555–562.CrossRefGoogle ScholarPubMed
Degenhardt, L, Whiteford, H, Hall, W, Vos, T (2009). Estimating the burden of disease attributable to illicit drug use and mental disorders: what is ‘Global Burden of Disease 2005’ and why does it matter? Addiction 104, 1466–1471.CrossRefGoogle ScholarPubMed
Eaton, WW (1995). Progress in the epidemiology of anxiety disorders. Epidemiologic Reviews 17, 32–38.CrossRefGoogle ScholarPubMed
Espié, E, Gaboulaud, V, Baubet, T, Casas, G, Mouchenik, Y, Yun, O, Grais, RF, Moro, MR (2009). Trauma-related psychological disorders among Palestinian children and adults in Gaza and West Bank, 2005–2008. International Journal of Mental Health Systems 3, 21.CrossRefGoogle ScholarPubMed
Galea, S, Ahern, J, Tracy, M, Hubbard, A, Cerda, M, Goldmann, E, Vlahov, D (2008). Longitudinal determinants of posttraumatic stress in a population-based cohort study. Epidemiology 19, 47–54.CrossRefGoogle Scholar
Gigantesco, A, Palumbo, G, Mirabella, F, Pettinelli, M, Morosini, P (2006). Prevalence of psychiatric disorders in an Italian town: low prevalence confirmed with two different interviews. Psychotherapy and Psychosomatics 75, 170–176.CrossRefGoogle Scholar
Harris, RJ, Bradburn, M, Deeks, J, Harbord, R, Altman, D, Sterne, J (2008). Metan: fixed- and random-effects meta-analysis. Stata Journal 8, 3–28.CrossRefGoogle Scholar
Hinton, DE, Parl, L, Hsia, C, Hofmann, S, Pollack, MH (2009). Anxiety disorder presentations in Asian populations: a review. CNS Neuroscience and Therapeutics 15, 295–303.CrossRefGoogle ScholarPubMed
Homer, D, Lemeshow, S (1989). Applied Logistic Regression. Wiley: New York.Google Scholar
Hovens, JG, Giltay, EJ, Wiersma, JE, Spinhoven, P, Penninx, BW, Zitman, FG (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica. Published online 23 January 2012. doi:10.1111/j.1600-0447.2011.01828.x.CrossRefGoogle ScholarPubMed
Johnson, PB, Malgady, R (1999). Cultural/ethnic comparisons: a research agenda. Journal of Gender, Culture, and Health 4, 171–185.CrossRefGoogle Scholar
Kadri, N, Agoub, M, El Gnaoui, S, Berrada, S, Moussaoui, D (2007). Prevalence of anxiety disorders: a population-based epidemiological study in metropolitan area of Casablanca, Morocco. Annals of General Psychiatry 6, 6.CrossRefGoogle ScholarPubMed
Kahn, RS, Wise, PH, Kennedy, BP, Kawachi, I (2000). State income inequality, household income, and maternal mental and physical health: cross sectional national survey. British Medical Journal 321, 1311–1315.CrossRefGoogle ScholarPubMed
Kapiriri, L, Norheim, OF, Heggenhougen, K (2003). Using burden of disease information for health planning in developing countries: the experience from Uganda. Social Science and Medicine 56, 2433–2441.CrossRefGoogle ScholarPubMed
Kawakami, N, Abdulghani, EA, Alonso, J, Bromet, EJ, Bruffaerts, R, Caldas-de-Almeida, JM, Chiu, WT, de Girolamo, G, de Graaf, R, Fayyad, J, Ferry, F, Florescu, S, Gureje, O, Hu, C, Lakoma, MD, LeBlanc, W, Lee, S, Levinson, D, Malhotra, S, Matschinger, H, Medina-Mora, ME, Nakamura, Y, Oakley Browne, MA, Okoliyski, M, Posada-Villa, J, Sampson, NA, Viana, MC, Kessler, RC (2012). Early-life mental disorders and adult household income in the World Mental Health Surveys. Biological Psychiatry. Published online 20 April 2012. doi:10.1016/j.biopsych.2012.03.009.CrossRefGoogle ScholarPubMed
Kessler, RC, Amminger, GP, Aguilar-Gaxiola, S, Alonso, J, Lee, S, Ustun, TB (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry 20, 359–364.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.CrossRefGoogle ScholarPubMed
Kessler, RC, Greenberg, PE (2002). The economic burden of anxiety and stress disorders. In Neuropsychopharmacology: The Fifth Generation of Progress (ed. Davis, K. L., Charney, D., Coyle, J. T. and Nemeroff, C.), pp 981–992. Lippencott, Williams and Wilkins: Philadelphia.Google Scholar
Kessler, RC, McLaughlin, KA, Koenen, KC, Petukhova, M, Hill, ED (2012). The importance of secondary trauma exposure for post-disaster mental disorder. Epidemiology and Psychiatric Sciences 21, 35–45.CrossRefGoogle ScholarPubMed
Kessler, RC, Wai, TC, Demler, O, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kruijshaar, ME, Barendregt, J, Vos, T, de Graaf, R, Spijker, J, Andrews, G (2005). Lifetime prevalence estimates of major depression: an indirect estimation method and a quantification of recall bias. European Journal of Epidemiology 20, 103–111.CrossRefGoogle Scholar
Lewis-Fernández, R, Hinton, D, Laria, A, Patterson, E, Hofmann, S, Craske, M, Stein, D, Asnaani, A, Liao, B (2010). Culture and the anxiety disorders: recommendations for DSM-V. Depression and Anxiety 27, 212–229.CrossRefGoogle ScholarPubMed
Marks, I (1986). Epidemiology of anxiety. Social Psychiatry 21, 167–171.CrossRefGoogle ScholarPubMed
Moffitt, TE, Caspi, A, Harrington, H, Milne, BJ, Melchior, M, Goldberg, D, Poulton, R (2007). Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32. Psychological Medicine 37, 441–452.CrossRefGoogle Scholar
Moffitt, TE, Caspi, A, Taylor, AJ, Kokaua, J, Milne, BJ, Polanczyk, G, Poulton, R (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine 40, 899–909.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Medicine 6, e1000097.CrossRefGoogle ScholarPubMed
Murray, CJL, King, G, Lopez, AD, Tomijima, N, Krug, EG (2002). Armed conflict as a public health problem. British Medical Journal 324, 346–349.CrossRefGoogle ScholarPubMed
Murray, CJL, Lopez, A (1996). Global Health Statistics: A Compendium of Incidence, Prevalence and Mortality Estimates for over 200 Conditions. Harvard School of Public Health on behalf of the World Health Organization and the World Bank: Cambridge, MA.Google Scholar
Murray, CJL, Lopez, AD, Black, R, Mathers, CD, Shibuya, K, Ezzati, M, Salomon, JA, Michaud, CM, Walker, N, Vos, T (2005). Global Burden of Disease 2005: call for collaborators. Lancet 370, 109–110.CrossRefGoogle Scholar
Overbeek, G, Vollebergh, W, de Graaf, R, Scholte, R, de Kemp, R, Engels, R (2006). Longitudinal associations of marital quality and marital dissolution with the incidence of DSM-III-R disorders. Journal of Family Psychology 20, 284–291.CrossRefGoogle ScholarPubMed
Phillips, MR, Zhang, J, Shi, Q, Song, Z, Ding, Z, Pang, S, Li, X, Zhang, Y, Wang, Z (2009). Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet 373, 2041–2053.CrossRefGoogle Scholar
Pirkola, S, Isometsä, E, Survisaari, J, Aro, H, Joukamaa, M, Pöikolainen, K, Koshinen, S, Aromaa, A, Loennqvist, J (2005). DSM-IV mood-anxiety and alchohol disorders and their cormorbity in the Finnish general population. Results from the Health 2000 Study. Social Psychiatry and Psychiatric Epidemiology 40, 1–10.CrossRefGoogle Scholar
Prina, AM, Ferri, CP, Guerra, M, Brayne, C, Prince, M (2011). Prevalence of anxiety and its correlates among older adults in Latin America, India and China: cross-cultural study. British Journal of Psychiatry 199, 485–491.CrossRefGoogle ScholarPubMed
Regier, DA, Rae, DS, Narrow, WE, Kaelber, CT, Schatzberg, AF (1998). Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry 173 (Suppl. 34), 24–28.CrossRefGoogle Scholar
Somers, JM, Goldner, EM, Waraich, P, Hsu, L (2006). Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Canadian Journal of Psychiatry 51, 100–113.CrossRefGoogle ScholarPubMed
Steel, Z, Chey, T, Silove, D, Marnane, C, Bryant, RA, van Ommeren, M (2009 a). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. Journal of the American Medical Association 302, 537–549.CrossRefGoogle ScholarPubMed
Steel, Z, Silove, D, Giao, NM, Phan, TT, Chey, T, Whelan, A, Bauman, A, Bryant, RA (2009 b). International and indigenous diagnoses of mental disorder among Vietnamese living in Vietnam and Australia. British Journal of Psychiatry 194, 326–333.CrossRefGoogle ScholarPubMed
Stein, DJ, Williams, SL, Jackson, PB, Seedat, S, Myer, L, Herman, A, Williams, DR (2009). Perpetration of gross human rights violations in South Africa: association with psychiatric disorders. South African Medical Journal 99, 390–395.Google ScholarPubMed
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, Moher, D, Becker, BJ, Sipe, TA, Thacker, SB (2000). Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. Journal of the American Medical Association 283, 2008–2012.CrossRefGoogle ScholarPubMed
Tanios, CY, Abou-Saleh, MT, Karam, AN, Salamoun, MM, Mneimneh, ZN, Karam, EG (2009). The epidemiology of anxiety disorders in the Arab world: a review. Journal of Anxiety Disorders 23, 409–419.CrossRefGoogle ScholarPubMed
Thompson, SG, Sharp, SJ (1999). Explaining heterogeneity in meta-analysis: a comparison of methods. Statistics in Medicine 18, 2693–2708.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
United Nations Development Programme (2010). The Real Wealth of Nations: Pathways to Human Development. Human Development Report 2010. Palgrave Macmillan: New York.Google Scholar
Ventevogel, P, De Vries, G, Scholte, WF, Shinwari, NR, Faiz, H, Nassery, R, van den Brink, W, Olff, M (2007). Properties of the Hopkins Symptom Checklist-25 (HSCL-25) and the Self-reporting Questionnaire (SRQ-20) as screening instruments used in primary care in Afghanistan. Social Psychiatry and Psychiatric Epidemiology 42, 328–335.CrossRefGoogle ScholarPubMed
Vorcaro, CMR, Rocha, FL, Uchoa, E, Lima-Costa, MF (2004). The burden of social phobia in a Brazilian community and its relationship with socioeconomic circumstances, health status and use of health services: The Bambui study. International Journal of Social Psychiatry 50, 216–226.CrossRefGoogle Scholar
Weiller, E, Bisserbe, JC, Maier, E (1998). Prevalence and recognition of anxiety syndromes in five European primary care settings. A report from the WHO study on Psychological Problems in General Health Care. British Journal of Psychiatry Supplement 34, 18–23.CrossRefGoogle Scholar
Weissman, MM (1988). The epidemiology of anxiety disorders: rates, risks and familial patterns. Journal of Psychiatric Research 22 (Suppl. 1), 99–114.CrossRefGoogle ScholarPubMed
World Health Organization (2000). Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bulletin of the World Health Organization 78, 413–426.Google Scholar
World Mental Health Survey Consortium (2008). Unpublished data provided by the World Mental Health Survey (WMHS) Consortium, December 2008 (http://www.hcp.med.harvard.edu/wmh/). Accessed June 2008.Google Scholar
Supplementary material: File

Baxter supplementary material

Baxter supplementary material

Download Baxter supplementary material(File)
File 857.6 KB