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

Published online by Cambridge University Press:  18 December 2008

S. Lee ,
A. Tsang ,
A. M. Ruscio ,
J. M. Haro ,
D. J. Stein ,
J. Alonso ,
M. C. Angermeyer ,
E. J. Bromet ,
K. Demyttenaere  and
G. de Girolamo
...Show all authors
S. Lee*
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, PRC, USA
A. Tsang
Affiliation:
Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong, PRC, USA
A. M. Ruscio
Affiliation:
Department of Psychology, University of Pennsylvania, Philadelphia, USA
J. M. Haro
Affiliation:
Sant Joan de Deu-SSM, Barcelona, Spain
D. J. Stein
Affiliation:
University of Cape Town, UCT Department of Psychiatry, Cape Town, South Africa
J. Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del mar, CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
M. C. Angermeyer
Affiliation:
Center for Public Mental Health, Gösing a.W, Austria
E. J. Bromet
Affiliation:
SUNY Stony Brook, Stony Brook, New York, NY, USA
K. Demyttenaere
Affiliation:
University Hospital Gasthuisburg, Leuven, Belgium
G. de Girolamo
Affiliation:
Regional Health Care Agency, Emilia-Romanga Region, Italy
R. de Graaf
Affiliation:
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
O. Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
N. Iwata
Affiliation:
Hiroshima International University, Higashi-Hiroshima, Japan
E. G. Karam
Affiliation:
Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), St. George Hospital University Medical Center, Beirut, Lebanon
J.-P. Lepine
Affiliation:
Hospital Fernand Widal, Paris, France
D. Levinson
Affiliation:
Ministry of Health, Mental Health Services, Jerusalem, Israel
M. E. Medina-Mora
Affiliation:
National Institute of Psychiatry, Mexico City, Mexico
M. A. Oakley Browne
Affiliation:
Department of Rural and Indigenous Health, School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
J. Posada-Villa
Affiliation:
Colegio Mayor de Cundinamarca University, Bogotá, Colombia
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, USA
*
*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: [email protected])
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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.

Keywords

Cross-nationaldiagnosisdurationepidemiologygeneralized anxiety disorder
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 7 , July 2009 , pp. 1163 - 1176
Copyright
Copyright © 2008 Cambridge University Press

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