Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-24T14:19:09.373Z Has data issue: false hasContentIssue false
  • English
  • Français

Anxiety: its role in the history of psychiatric epidemiology

Published online by Cambridge University Press:  22 October 2008

J. M. Murphy  and
A. H. Leighton
J. M. Murphy*
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
A. H. Leighton
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: Dr J. M. Murphy, Department of Psychiatry, Massachusetts General Hospital, 5 Longfellow Place, Room 215, Boston, MA 02114, USA. (Email: murphy.jane@mgh.harvard.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The role played by anxiety in the history of psychiatric epidemiology has not been well recognized. Such lack of understanding retarded the incremental growth of psychiatric research in general populations. It seems useful to look back on this history while deliberations are being carried out about how anxiety will be presented in DSM-V.

Method

Drawing on the literature and our own research, we examined work that was carried out during and after the Second World War by a Research Branch of the United States War Department, by the Stirling County Study, and by the Midtown Manhattan Study. The differential influences of Meyerian psychobiology and Freudian psychoanalysis are noted.

Results

The instruments developed in the early epidemiologic endeavors used questions about nervousness, palpitations, sweating, trembling, shortness of breath, upset stomach, etc. These symptoms are important features of what the clinical literature called ‘manifest’, ‘free-floating’ or ‘chronic anxiety’. A useful descriptive name is ‘autonomic anxiety’.

Conclusions

Although not focusing on specific circumstances as in Panic and Phobic disorders, a non-specific form of autonomic anxiety is a common, disabling and usually chronic disorder that received empirical verification in studies of several community populations. It is suggested that two types of general anxiety may need to be recognized, one dominated by excessive worry and feelings of stress, as in the current DSM-IV definition of Generalized Anxiety Disorder (GAD), and another emphasizing frequent unexplainable autonomic fearfulness, as in the early epidemiologic studies.

Keywords

Autonomic hyperactivitydepressionDSM-V
Type
Review Article
Information
Psychological Medicine , Volume 39 , Issue 7 , July 2009 , pp. 1055 - 1064
Copyright
Copyright © 2008 Cambridge University Press

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.)

References

Andrews, G, Stewart, G, Morris-Yates, A, Holt, P, Henderson, S (1990). Evidence for a general neurotic syndrome. British Journal of Psychiatry 157, 6–12.CrossRefGoogle ScholarPubMed
APA (1952). Diagnostic and Statistical Manual of Mental Disorders, 1st edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1980). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn. American Psychiatric Association: Washington, DC.Google Scholar
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn revised. American Psychiatric Association: Washington, DC.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Barlow, DH, Blanchard, EB, Vermilyea, JA, Vermilyea, BB, DiNardo, PA (1986). Generalized anxiety and generalized anxiety disorders: description and reconceptualization. American Journal of Psychiatry 143, 40–44.Google ScholarPubMed
Barlow, DH, Wincze, J (1998). DSM-IV and beyond: what is generalized anxiety disorder? Acta Psychiatrica Scandinavica 98, 23–29.CrossRefGoogle Scholar
Breier, A, Charney, DS, Heninger, GR (1985). The diagnostic validity of anxiety disorders and their relationship to depressive illness. American Journal of Psychiatry 142, 787–797.Google ScholarPubMed
Breslau, N, Davis, GC (1985). DSM-III generalized anxiety disorder: an empirical investigation of more stringent criteria. Psychiatric Research 145, 231–238.CrossRefGoogle Scholar
Brodman, K, Erdmann, AJ, Wolff, HG (1949). Cornell Medical Index Health Questionnaire (Manual). Cornell University Medical College: New York.Google Scholar
Brown, TA, Barlow, DH, Liebowitz, MR (1994). The empirical basis of generalized anxiety disorder. American Journal of Psychiatry 151, 1272–1280.Google ScholarPubMed
Brugha, TS (2002). The end of the beginning: a requiem for the categorization of mental disorder? Psychological Medicine 32, 1149–1154.CrossRefGoogle ScholarPubMed
Costello, CG (1970). Classification and psychopathology. In Symptoms of Psychopathology: A Handbook (ed. Costello, C. G.), pp. 1–26. John Wiley: New York.Google Scholar
Dohrenwend, BP, Shrout, PE, Egri, G, Mendelsohn, FS (1980). Nonspecific psychological distress and other dimensions of psychopathology. Archives of General Psychiatry 37, 1229–1236.CrossRefGoogle ScholarPubMed
Eaton, WW, Ritter, C (1988). Distinguishing anxiety and depression with field survey data. Psychological Medicine 18, 155–166.CrossRefGoogle ScholarPubMed
Eysenck, HJ (1947). Dimensions of Personality. Routledge & Kegan Paul: London.Google Scholar
Eysenck, HJ, Eysenck, SBG (1975). Manual of the Eysenck Personality Questionnaire. Educational and Industrial Testing Service: San Diego, CA.Google Scholar
Freud, S (1936). The Problem of Anxiety. Norton: New York.Google Scholar
Garvey, MJ, Cook, B, Noyes, R (1988). The occurrence of a prodrome of generalized anxiety in panic disorder. Comprehensive Psychiatry 29, 445–449.CrossRefGoogle ScholarPubMed
Goldberg, DP (2000). Plato versus Aristotle: categorical and dimensional models for common mental disorders. Comprehensive Psychiatry 41 (Suppl. 1), 8–13.CrossRefGoogle ScholarPubMed
Hettema, JM, Prescott, CA, Kendler, KS (2004). Genetic and environmental sources of covariation between generalized anxiety disorder and neuroticism. American Journal of Psychiatry 161, 1581–1587.CrossRefGoogle ScholarPubMed
Hoehn-Saric, R (1982). Comparison of generalized anxiety disorder with panic disorder patients. Psychopharmacological Bulletin 18, 104–108.Google ScholarPubMed
Hoehn-Saric, R (1998). Psychic and somatic anxiety: worries, somatic symptoms and physiological changes. Acta Psychiatrica Scandinavica 98 (Suppl. 393), 32–38.CrossRefGoogle Scholar
Hughes, CC, Tremblay, MA, Rapoport, RN, Leighton, AH (1960). People of Cove and Woodlot: The Stirling County Study of Psychiatric Disorder and Sociocultural Environment, Vol. III. Basic Books: New York.Google Scholar
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Faves, LJ (1992). Major depression and generalized anxiety disorder: same genes, (partly) different environments? Archives of General Psychiatry 49, 716–722.CrossRefGoogle ScholarPubMed
Kessler, RC (2002). The categorical versus dimensional assessment controversy in the sociology of mental illness. Journal of Health and Social Behavior 43, 171–188.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demier, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorders: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 289, 3095–3105.CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Klein, DF (1981). Anxiety reconceptualized. In Anxiety: New Research and Changing Concepts (ed. Klein, D. F. and Rabkin, J.), pp. 235–263. Raven Press: New York.Google Scholar
Klerman, GL (1976). Age and clinical depression: today's youth in the twenty-first century. Journal of Gerontology 31, 318–323.CrossRefGoogle ScholarPubMed
Klerman, GL (1990). Paradigm shifts in USA psychiatric epidemiology since World War II. Social Psychiatry and Psychiatric Epidemiology 15, 27–32.Google Scholar
Klerman, GL, Paykel, ES (1970). Depressive pattern, social background, and hospitalization. Journal of Nervous and Mental Disease 150, 466–478.CrossRefGoogle ScholarPubMed
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921–926.CrossRefGoogle ScholarPubMed
Kubarych, TS, Aggen, SH, Hettema, JM, Kendler, KS, Neale, MC (2005). Endorsement frequencies and factor structure of DSM-III-R and DSM-IV Generalized Anxiety Disorder symptoms in women: implication for future research, classification, clinical practice and comorbidity. International Journal of Methods in Psychiatric Research 14, 69–81.CrossRefGoogle ScholarPubMed
Langner, TS (1962). A twenty-two item screening score of psychiatric symptoms indicating impairment. Journal of Health and Human Behavior 3, 269–276.CrossRefGoogle ScholarPubMed
Langner, TS, Michael, ST (1963). Life Stress and Mental Health: The Midtown Manhattan Study. Free Press: New York.Google Scholar
Leavitt, HC (1946). A comparison between the Neuropsychiatric Screening Adjunct (NSA) and the Cornell Selectee Index (Form N). American Journal of Psychiatry 106, 353–357.CrossRefGoogle Scholar
Leighton, AH (1959). My Name is Legion: The Stirling County Study of Psychiatric Disorder and Sociocultural Environment, Vol. I. Basic Books: New York.Google Scholar
Leighton, DC, Harding, JS, Macklin, DB, Macmillan, AM, Leighton, AH (1963). The Character of Danger: The Stirling County Study of Psychiatric Disorder and Sociocultural Environment, Vol. III. Basic Books: New York.Google Scholar
Lewis, A (1970). The ambiguous word ‘anxiety’. International Journal of Psychiatry 9, 62–79.Google ScholarPubMed
Link, B, Dohrenwend, BP (1980). Formulation of hypotheses about the true prevalence of demoralization in the United States. In Mental Illness in the United States: Epidemiologic Estimates (ed. Dohrenwend, B. P., Dohrenwend, B. S., Gould, M. S., Link, B., Neugebauer, R. and Wunsch-Hitzig, R.), pp. 114–132. Praeger: New York.Google Scholar
Macmillan, AM (1957). The Health Opinion Survey: technique for estimating prevalence of psychoneurotic and related types of disorders in communities. Psychological Reports 3, 325–339.CrossRefGoogle Scholar
Marshall, RD, Klein, DF (1999). Diagnostic classification of anxiety disorders: historical context and implications for neurobiology. In Neurobiology of Mental Illness (ed. Charney, D. S., Nestler, E. J. and Bunney, B. S.), pp. 437–450. Oxford University Press: New York.Google Scholar
Meehl, PE, Hathaway, SR (1946). The K factor as a suppressor variable in the MMPI. Journal of Applied Psychology 30, 525–564.CrossRefGoogle Scholar
Menninger, KA (1959). Toward a unitary concept of mental illness. In A Psychiatrist's World: Selected Papers (ed. Hall, B. H.), pp. 516–528. Viking Press: New York.Google Scholar
Muncie, W (1948). Psychobiology and Psychiatry. A Textbook of Normal and Abnormal Human Behavior, 2nd edn. Mosby: St Louis.Google Scholar
Murphy, JM (1980). Continuities in community-based psychiatric epidemiology. Archives of General Psychiatry 37, 1215–1223.CrossRefGoogle ScholarPubMed
Murphy, JM, Horton, NJ, Laird, NM, Monson, RR, Sobol, AM, Leighton, AH (2004). Anxiety and depression: a 40-year perspective on relationships regarding prevalence, distribution, and comorbidity. Acta Psychiatrica Scandinavica 109, 355–375.CrossRefGoogle ScholarPubMed
Murphy, JM, Monson, RR, Laird, NM, Sobol, AM, Leighton, AH (1998). Identifying depression in a forty-year epidemiologic investigation: the Stirling County study. International Journal of Methods in Psychiatric Research 7, 89–109.CrossRefGoogle Scholar
Murphy, JM, Monson, RR, Laird, NM, Sobol, AM, Leighton, AH (2000). A forty-year perspective on the prevalence of depression from the Stirling County Study. Archives of General Psychiatry 57, 209–215.CrossRefGoogle Scholar
Murphy, JM, Monson, RR, Olivier, DC, Sobol, AM, Leighton, AH (1987). Affective disorders and mortality: a general population study. Archives of General Psychiatry 44, 473–480.CrossRefGoogle ScholarPubMed
Murphy, JM, Neff, RK, Sobol, AM, Rice, JX, Olivier, DC (1985). Computer diagnosis of depression and anxiety: the Stirling County Study. Psychological Medicine 15, 99–112.CrossRefGoogle ScholarPubMed
Murphy, JM, Olivier, DC, Sobol, AM, Monson, RR, Leighton, AH (1986). Diagnosis and outcome: depression and anxiety in a general population. Psychological Medicine 16, 117–126.CrossRefGoogle ScholarPubMed
Noyes, R, Woodman, C, Garvey, MJ, Cook, BL, Suelzer, M, Clancy, J, Anderson, DJ (1992). Generalized anxiety disorder vs. panic disorder: distinguishing characteristics and patterns of comorbidity. Journal of Nervous and Mental Disease 180, 369–379.CrossRefGoogle ScholarPubMed
Phillips, DL (1966). The ‘true prevalence’ of mental illness in a New England state. Community Mental Health Journal 2, 35–40.CrossRefGoogle Scholar
Radloff, LS (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
Robins, LN, Helzer, JE, Croughan, J, Ratcliff, KS (1981). National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics and validity. Archives of General Psychiatry 38, 381–389.CrossRefGoogle ScholarPubMed
Robins, LN, Regier, DA (eds) (1991). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Free Press: New York.Google Scholar
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA, Sartorius, N, Towle, LH (1988). The Composite International Diagnostic Interview. Archives of General Psychiatry 45, 1069–1077.CrossRefGoogle ScholarPubMed
Roth, M, Argyle, N (1988). Anxiety, panic and phobic disorders: an overview. Journal of Psychiatric Research 22, 33–54.CrossRefGoogle ScholarPubMed
Roy, MA, Neale, MC, Pedersen, NL, Mathe, AA, Kendler, KS (1995). A twin study of generalized anxiety disorder and major depression. Psychological Medicine 25, 1037–1049.CrossRefGoogle ScholarPubMed
Schapira, K, Roth, M, Kerr, TA, Gurney, C (1972). The prognosis of affective disorders: the differentiation of anxiety states from depressive illnesses. British Journal of Psychiatry 121, 175–181.CrossRefGoogle ScholarPubMed
Schwab, JJ, Bell, RA, Warheit, GJ, Schwab, RB (1979). Social Order and Mental Health: The Florida Health Study. Brunner/Mazel: New York.Google Scholar
Slade, T, Watson, D (2006). The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychological Medicine 36, 1593–1600.CrossRefGoogle ScholarPubMed
Smoller, JW, Tsuang, MT (1998). Panic and phobic anxiety: defining phenotypes for genetic studies. American Journal of Psychiatry 155, 1152–1162.CrossRefGoogle ScholarPubMed
Srole, L, Langner, TS, Michael, ST, Opler, MK, Rennie, TAC (1962). Mental Health in the Metropolis: The Midtown Manhattan Study. McGraw-Hill: New York.CrossRefGoogle Scholar
Star, SA (1950). The screening of psychoneurotics in the army: technical development of tests; comparison of psychiatric diagnoses and test scores at all induction stations. In The American Soldier: Measurement and Prediction, Vol. IV (ed. Stouffer, S. A., Guttman, L., Suchman, E. A., Lazarsfeld, P. F., Star, S. A. and Clausen, J. A.), pp. 486–567. Princeton University Press: Princeton.Google Scholar
Stouffer, SA, Guttman, L, Suchman, EA, Lazarsfeld, PF, Star, SA, Clausen, JA (eds) (1950). The American Soldier: Measurement and Prediction, Vol. IV. Princeton University Press: Princeton.Google Scholar
Tousignant, M, Denis, G, Lachapelle, R (1974). Some considerations concerning the validity and use of the Health Opinion Survey. Journal of Health and Social Behavior 14, 241–252.CrossRefGoogle Scholar
Turvey, CL, Stevens, DE, Merikangas, KR (1999). The validity of the associated symptom criteria for DSM-IV generalized anxiety disorder. International Journal of Methods in Psychiatric Research 8, 129–137.CrossRefGoogle Scholar
Vollebergh, WAM, Iedema, J, deGraaf, R, Smit, F, Ormel, J (2001). The structure and stability of common mental disorders: the NEMESIS Study. Archives of General Psychiatry 58, 597–603.CrossRefGoogle ScholarPubMed
Weider, A, Mittelmann, B, Wechsler, D, Wolff, HG (1944). The Cornell Selectee Index. Journal of the American Medical Association 124, 224–228.CrossRefGoogle Scholar
Weissman, MM, Klerman, GL (1978). Epidemiology of mental disorders: emerging trends in the United States. Archives of General Psychiatry 35, 705–712.CrossRefGoogle ScholarPubMed
Winters, EE (ed.) (1951). The Collected Papers of Adolf Meyer, Vol. III: Medical Teaching. Johns Hopkins Press: Baltimore.Google Scholar
World Mental Health Survey Consortium (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association 291, 2581–2590.CrossRefGoogle Scholar
Zubin, J, Fleiss, J (1971). Current biometric approaches to depression. In Depression in the 1970s: Modern Theory and Research (ed. Fieve, R.), pp. 7–19. Excerpta Medica: Princeton.Google Scholar