Longitudinal patterns of anxiety from childhood to adulthood: the Great Smoky Mountains Study

Abstract

Objective: The aims of this study were 2-fold: to provide a brief introduction to the prospective longitudinal Great Smoky Mountains Study and review recent findings; and to use this sample to conduct an epidemiologic analysis of common childhood anxiety disorders.

Method: The population-based Great Smoky Mountains Study assessed 1,420 participants from 11 counties in the southeastern United States up to 11 times between ages 9 and 26 years with the structured Child and Adolescent Psychiatric Assessment and its upward extension, the Young Adult Psychiatric Assessment.

Results: The U-shaped age prevalence curve for any anxiety disorder was the product of high levels of childhood separation anxiety and adult panic, agoraphobia, and generalized anxiety. More than 1 in 5 subjects met criteria for an anxiety disorder by early adulthood. In terms of cumulative comorbidity, there was evidence of overlap between anxiety disorders, but the level of overlap was generally consistent with what is seen among other common childhood disorders. All childhood anxiety disorders were associated with adverse functioning in at least 1 young adult functional domain, with the poorest outcomes for childhood generalized anxiety and DSM-III-R overanxious disorder.

Conclusion: Clinically significant anxiety is a common mental health problem to have had by adulthood. There was little evidence to support the consolidation of anxiety disorders, and some evidence to justify reintroduction of DSM-III-R overanxious disorder. The transition to young adulthood appears to be a key period for understanding the development of common adult anxiety disorders such as panic and agoraphobia.

Keywords: anxiety; comorbidity; development; epidemiology; longitudinal.

Figure 1

Ascertainment figure for Great Smoky Mountains Study.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 2

Age-prevalence estimates for DSM anxiety disorders: A) Any DSM-IV anxiety disorder; B) Separation anxiety; C) Social phobia; D) Specific phobia; E) Generalized anxiety; F) Panic disorder; G) Agoraphobia; H) DSM-III-R overanxious disorder.

Figure 3

Associations between childhood anxiety disorder status and outcomes in young adulthood. Note: Starred bars are significantly different from the group with no childhood anxiety disorder. For health outcomes, subjects with a history of either separation anxiety (SEP) or generalized anxiety (GAD) had poor outcomes (SEP: β=0.63, SE=0.26, p=0.015; GAD: β=0.66, SE=0.17, p<0.001), but not those with a history social phobia (SOC: β=0.26, SE=0.36, p=0.47. Subjects with generalized anxiety had more financial problems in young adulthood (GAD: β=0.51, SE=0.19, p=0.006). This was not the case for those with separation anxiety or social phobia (SEP: β=0.33, SE=0.23, p=0.15; SOC: β=−0.04, SE=0.35, p=0.91). Individuals with a history of either social phobia (SOC: β=1.09, SE=0.53, p=0.042) or generalized anxiety (GAD: β=−0.47, SE=0.22, p=0.034) had poor social outcomes. Those with a history of separation anxiety (SEP: β=−0.28, SE=0.18, p=0.13 did not have significantly worse interpersonal outcomes than those with no history of childhood anxiety. Individuals with childhood overanxious disorder had poor health (β=1.24, SE=0.23, p<0.0001), financial (β=0.58, SE=0.24, p=0.017) and social outcomes (β=1.10, SE=0.27, p<0.0001).