Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe
Por:
Ruscio AM, Hallion LS, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Borges G, Bromet EJ, Bunting B, Caldas de Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hinkov H, Hu C, de Jonge P, Karam EG, Lee S, Lepine JP, Levinson D, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Slade T, Stein DJ, Torres Y, Uda H, Wojtyniak B, Kessler RC, Chatterji S and Scott KM
Publicada:
1 may 2017
Ahead of Print:
15 mar 2017
Resumen:
IMPORTANCE Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5.
OBJECTIVE To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact.
DESIGN, SETTING, AND PARTICIPANTS Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016.
MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking.
RESULTS Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7%(0.1%), 12-month prevalence of 1.8%(0.1%), and 30-day prevalence of 0.8%(0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6%[0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0%[0.9%]) and other anxiety (51.7%[0.9%]) disorders. Severe role impairment is common across life domains (50.6%[1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2%[1.2%]), especially those with severe role impairment (59.4%[1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0%[1.3%]).
CONCLUSIONS AND RELEVANCE The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.
Filiaciones:
Ruscio AM:
Department of Psychology, University of Pennsylvania, Philadelphia
Hallion LS:
Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
Lim CC:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
Aguilar-Gaxiola S:
Center for Reducing Health Disparities, University of California Davis Health System, Sacramento
Al-Hamzawi A:
College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq
Alonso J:
Health Services Research Unit, Institut Municipal d'Investigació Médica-Hospital del Mar Medical Research Institute, Barcelona, Spain7Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain 8CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Andrade LH:
Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
Borges G:
Calzada México Xochimilco No. 101 Delegación Tlalpan, Distrito Federal, Mexico
Bromet EJ:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
Bunting B:
School of Psychology, Ulster University, Londonderry, United Kingdom
Caldas de Almeida JM:
Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Demyttenaere K:
Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
Florescu S:
National School of Public Health, Management and Professional Development, Bucharest, Romania
de Girolamo G:
Istituto Di Ricovero e Cura a Carattere Scientifico, St John of God Clinical Research Centre, Brescia, Italy
Gureje O:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Haro JM:
Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red Salud Mental, Universitat de Barcelona, Barcelona, Spain
He Y:
Shanghai Mental Health Center, Shanghai, China
Hinkov H:
National Center for Public Health and Analyses, Sofia, Bulgaria
Hu C:
Shenzhen Institute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China
de Jonge P:
Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, the Netherlands23Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
Karam EG:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon25Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon26Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
Lee S:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Lepine JP:
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot and Paris Descartes, Paris, France
Levinson D:
Ministry of Health Israel, Mental Health Services, Jerusalem, Israel
Mneimneh Z:
Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon30Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
Navarro-Mateu F:
Unidad de Docencia, Investigación y Formación en Salud Mental, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública-Murcia, Murcia, Spain
Posada-Villa J:
Colegio Mayor de Cundinamarca University, Bogota, Colombia
Slade T:
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
Stein DJ:
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Torres Y:
Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
Uda H:
Health, Social Welfare, and Environmental Department, Kagoshima Regional Promotion Bureau, Kagoshima Prefecture, Japan
Wojtyniak B:
Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
Kessler RC:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Chatterji S:
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
Scott KM:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
Green Published, Green Accepted
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