The current study examined the naturalistic course of generalized anxiety disorder (GAD) in a sample of 113 primary care patients across a 2-year period. Initial diagnoses were established using structured clinical interviews according to DSM-IV diagnostic criteria. Results indicated that the majority of patients meeting DSM-IV diagnostic criteria for GAD were still symptomatic to some degree after 2 years of follow-up. Rates of full and partial recovery from GAD, however, were found to be higher than those reported for previous studies of GAD in psychiatric patients. Diagnostic comorbidity, severity of psychosocial impairment, and gender were found to be significantly associated with achieving full or partial recovery from GAD. Psychiatric treatment was not found to be associated with time to full or partial recovery from GAD symptoms, likely due to a treatment-biasing effect. These results underscore that GAD is a chronic and persistent illness in primary care patients.
KeywordsGAD; psychiatric treatment; GAD course; anxiety; primary careGeneralized anxiety disorder (GAD) is a highly prevalent mental illness with 1-year and lifetime prevalence rates in the general population at 3.1% and 5.1%, respectively . As many researchers have noted (e.g., Culpepper, 2002), GAD represents a particular problem in the primary care field, where GAD patients are frequently encountered but often unrecognized (Fifer et al., 1994; Niesenson et al., 1998;Wittchen et al., 2002). Anxiety disorder patients in general, and GAD patients in particular, are also among the highest utilizers of medical services (Greenberg et al., 1999;Katon et al., 1990;Rice and Miller, 1998;Roy-Byrne and Katon, 1997). Thus, studying GAD specifically within the primary care population is particularly timely and relevant. Despite the prevalence of GAD, few studies have examined the illness's natural course. Most of the data currently available on the course of GAD are retrospective and have come from epidemiological studies (e.g., Kessler et al., 1999;Wittchen et al., 1994) and/or from short-term follow-ups of patients involved in treatment studies (e.g., Mancusco et al., 1993;Rickels and Schweizer, 1993). One of the only naturalistic, prospective studies of the course of GAD conducted to date found low rates of recovery from GAD among psychiatric outpatients, with high rates of subsequent recurrence among those who do recover (Yonkers et al., 1996(Yonkers et al., , 2000. This same study identified better psychosocial functioning in general, and in specific functioning domains (e.g., relationships with spouse, and life satisfaction, etc.) as significant predictors of GAD recovery.While the results of the studies by Yonkers et al. (1996Yonkers et al. ( , 2000 provide important insights into the naturalistic course of GAD, several aspects of that study's sample need to be considered when interpreting the course findings. First, recruiting the GAD sample from psychiatric treatment settings may represent a significant departure from the typical GAD pat...