One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample

Abstract

Several studies of representative populations have reported prevalence rates of DSM-III and DSM-III-R generalized anxiety disorder (GAD); however, no community study has examined the effect of the stricter DSM-IV criteria on prevalence estimates and patterns of comorbidity. Furthermore, past studies based on "lifetime" symptom assessments might have led to upper-bound 1-year and point prevalence estimates. Data is presented from a national representative sample study of 4,181 adults in Germany, 18-65 years old, who were interviewed for DSM-IV disorders with the 12-month version of the Munich-Composite International Diagnostic Interview. The prevalence rate of strictly defined, 12-month threshold DSM-IV GAD was estimated to be 1.5%; however, 3.6% of respondents presented with at least subthreshold syndromes of GAD during the past 12 months. Higher rates of worrying and GAD were found in women (worrying 10%, GAD 2.7%) and in older respondents (worrying 9.3%, TAD 2.2%). Taking into account a wider scope of diagnoses than previous studies, a high degree of comorbidity in GAD cases was confirmed: 59.1% of all 12-month GAD cases fulfilled criteria for major depression, and 55.9% fulfilled criteria for any other anxiety disorder. In conclusion, prevalence and comorbidity rates found for DSM-IV GAD are not substantially different from rates reported for DSM-III-R GAD. The minor differences in our findings compared to previous reports are more likely attributable to differences in study methodology rather than changes in diagnostic criteria for DSM-IV.

Risco de suicídio e comorbidades psiquiátricas no transtorno de ansiedade generalizada

“…A taxa de comorbidade entre TAG e outras condições psiquiátricas é bastante elevada, ocorrendo, na verdade, na maioria dos casos. Um estudo alemão, com 4.181 adultos, revelou comorbidade de 91,3% de algum transtorno psiquiátrico com o TAG 9 , resultado semelhante aos 88,1% do presente estudo; a ocorrência de comorbidade psiquiátrica foi bem menos prevalente em indivíduos sem TAG (38,4%). Pesquisa recente, com 12.665 indivíduos, demonstrou inclusive que o TAG é o transtorno mais comórbido com outros transtornos ansiosos, como o transtorno de pânico em 62,3% dos casos 21 .…”

“…A taxa de herdabilidade varia entre 14,3% e 49%, a depender dos critérios diagnósticos utilizados 8 . O TAG é um transtorno com altas taxas de comorbidade, destacando-se transtornos de humor e outros transtornos de ansiedade 9 . O paciente com TAG apresenta risco 33 vezes superior ao da população geral de apresentar transtorno depressivo maior e 20 vezes maior de apresentar transtorno de pânico 4 .…”

Broadening the definition of generalized anxiety disorder: Effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication

“…This is supported by indications that some cases falling below the GAD threshold are sufficiently similar to diagnosed cases that their inclusion may improve the validity of the diagnosis. Important similarities have previously been observed in functional impairment, socio-demographic features, family history of GAD, and other key correlates between the full GAD syndrome and GAD lasting as little as one month (Bienvenu et al, 1998;Carter et al, 2001;Hunt et al, 2002;Kendler et al, 1992;Kessler et al, 2005b;Maier et al, 2000;Wittchen et al, 2002) or involving non-excessive worry (Bienvenu et al, 1998;Ruscio et al, 2005).…”

Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS)

“…Unfortunately, we were not commissioned to include post-traumatic stress disorder and antisocial personality (as for example in the NCS) because of time and financial restrictions. Subthreshold diagnoses could be assessed as well (Carter et al 2001). Health care utilization is presented in form of the variable 'at least minimal intervention', a combination of items asking about having ever sought treatment due to psychological, mental, addictive or psychosomatic problems, or been recommended by a doctor to do so.…”