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Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication

Published online by Cambridge University Press:  14 March 2005

RONALD C. KESSLER ,
NANCY BRANDENBURG ,
MICHAEL LANE ,
PETER ROY-BYRNE ,
PAUL D. STANG ,
DAN J. STEIN  and
HANS-ULRICH WITTCHEN
RONALD C. KESSLER
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
NANCY BRANDENBURG
Affiliation:
Pfizer, Inc., New York, NY, USA
MICHAEL LANE
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
PETER ROY-BYRNE
Affiliation:
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
PAUL D. STANG
Affiliation:
Department of Public Health, West Chester University, and Galt Associates, Blue Bell, PA, USA
DAN J. STEIN
Affiliation:
Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
HANS-ULRICH WITTCHEN
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
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Abstract

Background. The proposed revisions of the ICD and DSM diagnostic systems have led to increased interest in evaluation of diagnostic criteria. This report focuses on the DSM-IV requirement that episodes of generalized anxiety disorder (GAD) must persist for at least 6 months. Community epidemiological data are used to study the implications of changing this requirement in the range 1–12 months for estimates of prevalence, onset, course, impairment, co-morbidity, associations with parental GAD, and sociodemographic correlates.

Method. Data come from the US National Comorbidity Survey Replication (NCS-R), a US household survey carried out during 2001–2003. Version 3.0 of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used to assess DSM-IV anxiety disorders, mood disorders, substance disorders, and impulse-control disorders.

Results. Lifetime, 12-month, and 30-day prevalence estimates of DSM-IV GAD changed from 6·1%, 2·9%, and 1·8% to 4·2–12·7%, 2·2–5·5%, and 1·6–2·6% when the duration requirement was changed from 6 months to 1–12 months. Cases with episodes of 1–5 months did not differ greatly from those with episodes of [ges ]6 months in onset, persistence, impairment, co-morbidity, parental GAD, or sociodemographic correlates.

Conclusions. A large number of people suffer from a GAD-like syndrome with episodes of <6 months duration. Little basis for excluding these people from a diagnosis is found in the associations examined here.

Type
Research Article
Information
Psychological Medicine , Volume 35 , Issue 7 , July 2005 , pp. 1073 - 1082
Copyright
2005 Cambridge University Press

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Footnotes

The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government.
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