Skip to main content
×
Home
    • Aa
    • Aa

Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries

  • S. Lee (a1), A. Tsang (a2), A. M. Ruscio (a3), J. M. Haro (a4), D. J. Stein (a5), J. Alonso (a6), M. C. Angermeyer (a7), E. J. Bromet (a8), K. Demyttenaere (a9), G. de Girolamo (a10), R. de Graaf (a11), O. Gureje (a12), N. Iwata (a13), E. G. Karam (a14), J.-P. Lepine (a15), D. Levinson (a16), M. E. Medina-Mora (a17), M. A. Oakley Browne (a18), J. Posada-Villa (a19) and R. C. Kessler (a20)...
Abstract
Background

A number of western studies have suggested that the 6-month duration requirement of generalized anxiety disorder (GAD) does not represent a critical threshold in terms of onset, course, or risk factors of the disorder. No study has examined the consequences of modifying the duration requirement across a wide range of correlates in both developed and developing countries.

Method

Population surveys were carried out in seven developing and 10 developed countries using the WHO Composite International Diagnostic Interview (total sample=85 052). Prevalence and correlates of GAD were compared across mutually exclusive GAD subgroups defined by different minimum duration criteria.

Results

Lifetime prevalence estimates for GAD lasting 1 month, 3 months, 6 months and 12 months were 7.5%, 5.2%, 4.1% and 3.0% for developed countries and 2.7%, 1.8%, 1.5% and 1.2% for developing countries, respectively. There was little difference between GAD of 6 months' duration and GAD of shorter durations (1–2 months, 3–5 months) in age of onset, symptom severity or persistence, co-morbidity or impairment. GAD lasting ⩾12 months was the most severe, persistently symptomatic and impaired subgroup.

Conclusions

In both developed and developing countries, the clinical profile of GAD is similar regardless of duration. The DSM-IV 6-month duration criterion excludes a large number of individuals who present with shorter generalized anxiety episodes which may be recurrent, impairing and contributory to treatment-seeking. Future iterations of the DSM and ICD should consider modifying the 6-month duration criterion so as to better capture the diversity of clinically salient anxiety presentations.

Copyright
Corresponding author
*Address for correspondence: Professor S. Lee, Director, Hong Kong Mood Disorders Center, 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, NT, Hong Kong. (Email: singlee@cuhk.edu.hk)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

N Breslau , GC Davis (1985). DSM-III generalized anxiety disorder: an empirical investigation of more stringent criteria. Psychiatry Research 15, 231238.

TA Brown , PA Di Nardo , CL Lehman , LA Campbell (2001). Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders. Journal of Abnormal Psychology 110, 4958.

JP Feighner , E Robins , SB Guze , RA Woodruff Jr., G Winokur , R Munoz (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 5763.

SS Halli , K Vaninadha Rao (1992). Advanced Techniques of Population Analysis. Plenum Press: New York.

JM Haro , S Arbabzadeh-Bouchez , TS Brugha , G de Girolamo , ME Guyer , R Jin , JP Lepine , F Mazzi , B Reneses , G Vilagut , NA Sampson , RC Kessler (2006). Concordance of the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research 15, 167180.

JM Hettema , CA Prescott , KS Kendler (2001). A population-based twin study of generalized anxiety disorder in men and women. Journal of Nervous and Mental Disease 189, 413420.

KS Kendler , MC Neale , RC Kessler , AC Heath , LJ Eaves (1992). Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry 49, 267272.

KS Kendler , MC Neale , RC Kessler , AC Heath , LJ Eaves (1994). Clinical characteristics of familial generalized anxiety disorder. Anxiety 1, 186191.

RC Kessler , TB Ustun (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.

B Knauper , CF Cannell , N Schwarz , ML Bruce , RC Kessler (1999). Improving the accuracy of major depression age of onset reports in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research 8, 3948.

W Maier , M Gansicke , HJ Freyberger , M Linz , R Heun , Y Lecrubier (2000). Generalized anxiety disorder (ICD-10) in primary care from a cross-cultural perspective: a valid diagnostic entity? Acta Psychiatrica Scandinavica 101, 2936.

K Rickels , M Rynn (2001). Overview and clinical presentation of generalized anxiety disorder. Psychiatric Clinics of North America 24, 117.

AM Ruscio , WT Chiu , P Roy-Byrne , PE Stang , DJ Stein , HU Wittchen , RC Kessler (2007). Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. Journal of Anxiety Disorders 21, 662676.

T Slade , G Andrews (2001). DSM-IV and ICD-10 generalized anxiety disorder: discrepant diagnoses and associated disability. Social Psychiatry and Psychiatric Epidemiology 36, 4551.

KA Yonkers , MG Warshaw , AO Massion , MB Keller (1996). Phenomenology and course of generalised anxiety disorder. British Journal of Psychiatry 168, 308313.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords: