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Review
. 2017 Apr;62(4):237-246.
doi: 10.1177/0706743716640757. Epub 2016 Jul 9.

The Age of Onset of Anxiety Disorders

Jasmijn M de Lijster  1 , Bram Dierckx  1 , Elisabeth M W J Utens  1 , Frank C Verhulst  1 , Carola Zieldorff  1 , Gwen C Dieleman  1 , Jeroen S Legerstee  1
Affiliations
Review

The Age of Onset of Anxiety Disorders

Jasmijn M de Lijster et al. Can J Psychiatry. 2017 Apr.

Abstract
in English, French

Objective: The objective was to estimate the age of onset (AOO) for all anxiety disorders and for specific subtypes. Gender differences in the AOO of anxiety disorders were examined, as were the influence of study characteristics on reported AOOs.

Methods: Seven electronic databases were searched up to October 2014, with keywords representing anxiety disorder subtypes, AOO, and study design. The inclusion criteria were studies using a general population sample that provided data on the AOO for all anxiety disorders, or specific anxiety disorders, according to DSM-III-R, DSM-IV, or ICD-10 criteria.

Results: There were 1028 titles examined, which yielded 24 studies meeting the inclusion criteria. Eight studies reported the AOO and gender. Meta-analysis found a mean AOO of all anxiety disorders of 21.3 years (95% CI 17.46 to 25.07). Separation anxiety disorder, specific phobia, and social phobia had their mean onset before the age of 15 years, whereas the AOO of agoraphobia, obsessive-compulsive disorder, posttraumatic stress disorder, panic disorder, and generalized anxiety disorder began, on average, between 21.1 and 34.9 years. Meta-analysis revealed no difference in the AOO between genders. A prospective study design and higher developmental level of the study country were associated with an earlier AOO.

Conclusions: Results from this meta-analysis indicate that anxiety disorder subtypes differ in the mean AOO, with onsets ranging from early adolescence to young adulthood. These findings suggest that prevention strategies of anxiety disorders should be directed towards factors associated with the development of anxiety disorder subtypes in the age groups with the greatest vulnerability for developing those disorders.

Objectif:: Estimer l’âge de début (ADD) de tous les troubles anxieux, et de sous-types spécifiques. Les différences selon le sexe de l’ADD des troubles anxieux ont été examinées. ainsi que l’influence des caractéristiques de l’étude sur les ADD déclarés.

Méthode:: Sept bases de données électroniques ont été recherchées jusqu’en octobre 2014, avec des mots clés représentant les sous-types des troubles anxieux, l’ADD et la méthode de l’étude. Les critères d’inclusion étaient des études utilisant un échantillon dans la population générale qui fournissait des données sur l’ADD pour tous les troubles anxieux, ou des troubles anxieux spécifiques, selon le DSM-III-R, le DSM-IV ou les critères de la CIM-10.

Résultats:: Mille vingt-huit titres ont été examinés, ce qui a produit 24 études qui satisfaisaient aux critères d’inclusion. Huit études mentionnaient l’ADD et le sexe. La méta-analyse a révélé un ADD moyen pour tous les troubles anxieux de 21,3 ans (IC à 95% 17,46 à 25,07). Le trouble d’angoisse de séparation, la phobie spécifique et la phobie sociale avaient un début moyen avant l’âge de 15 ans, alors que l’ADD de l’agoraphobie, le trouble obsessionnel-compulsif, le trouble de stress post-traumatique, le trouble panique et le trouble d’anxiété généralisée commençaient en moyenne entre 21,1 et 34,9 ans. La méta-analyse n’a révélé aucune différence de l’ADD entre les sexes. La méthode de l’étude prospective et le niveau de développement élevé du pays de l’étude étaient associés à un ADD plus précoce.

Conclusions:: Les résultats de cette méta-analyse indiquent que les sous-types de troubles anxieux ont un ADD moyen différent, les commencements s’échelonnant du début de l’adolescence au jeune âge adulte. Ces résultats suggèrent que les stratégies de prévention des troubles anxieux devraient être axées sur les facteurs associés au développement des sous-types des troubles anxieux dans les groupes d’âge présentant la plus grande vulnérabilité à développer ces troubles.

Keywords: age of onset; anxiety disorders; gender differences; general population sample; meta-analysis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of study selection process.
Figure 2.
Figure 2.
Mean age of onset estimates for anxiety disorders. Separation anxiety disorder (SAD; 4 studies; n = 388), specific phobia (SP; 11 studies; n = 7207), social phobia (SOP; 12 studies; n = 3407), agoraphobia without panic disorder (AwP; 8 studies; n = 1209), obsessive-compulsive disorder (OCD; 11 studies; n = 866), posttraumatic stress disorder (PTSD; 12 studies; n = 1459), panic disorder (PD; 11 studies; n = 3240), generalized anxiety disorder (GAD; 15 studies; n = 4422), and anxiety disorders in general (ANX; 14 studies; n = 7443). I = 93.6%–99.7% (all P < 0.0001).
Figure 3.
Figure 3.
Combined forest plot for gender difference in age of onset (years) for anxiety disorders.
See this image and copyright information in PMC

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