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

Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, PRC.
Psychological Medicine (Impact Factor: 5.94). 07/2009; 39(7):1163-76. DOI: 10.1017/S0033291708004807
Source: PubMed


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.
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.
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.
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.

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    • "What is the evidence for these changes and what are their implications? Studies have generally supported a reduction in the minimum duration of GAD (Angst et al., 2006; Bienvenu et al., 1998; Kessler et al., 2005; Lee et al., 2009; Maier et al., 2000). There are two main reasons for this shift. "
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    • "was taken from Wave 1 and the one-month criterion was used (Kendler et al., 1992a) for the current study. The oneand six-month GAD criteria yield a sample with comparable characteristics (Breslau & Davis, 1985; Kendler et al., 1992a; Lee et al., 2009). In the current sample, 539 women (25.9% of women with non-missing data) met criterion for GAD. "
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    • "Thus, besides the general need to improve the GAD definition according to our current knowledge about this condition, developmental aspects may be more strongly considered in DSM-5. While this may generally apply to both ends of the life spectrum including the elderly, the current study focussed on the first three decades of life, and thus can contribute e in contrast to other studies (Andrews and Hobbs, 2010; Kessler et al., 2005a; Lee et al., 2009; Ruscio et al., 2007, 2005) e some preliminary recommendations for DSM-5 with regard to youth vs. young adult GAD criteria. A few specific age-related findings emerged in the current study. "
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