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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)
  • DOI:
  • Published online: 18 December 2008

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.


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.


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.


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.

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:
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