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

Lee, Sing; Tsang, Adley; Ruscio, Ayelet Meron; Haro Abad, Josep Maria; Stein, Dan J.; Alonso Caballero, Jordi; Angermeyer, Matthias C.; Bromet, Evelyn J.; Demyttenaere, Koen; Girolamo, Giovanni de; de Graaf, Ron; Gureje, Oye; Iwata, Noboru; Karam, Elie G.; Lepine, Jean-Pierre; Levinson, Daphna; Medina Mora, Maria Elena; Browne, Mark Oakley; Posada Villa, José; Kessler, Ronald C.

doi:http://dx.doi.org/10.1017/S0033291708004807

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

Citation

Lee S, Tsang A, Ruscio AM, Haro JM, Stein DJ, Alonso J et al. Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries. Psychol Med. 2009 Jul;39(7):1163-76. DOI: 10.1017/S0033291708004807

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 >or=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.