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. 2017 May 1;74(5):465-475.
doi: 10.1001/jamapsychiatry.2017.0056.

Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe

Ayelet Meron Ruscio  1 , Lauren S Hallion  2 , Carmen C W Lim  3 , Sergio Aguilar-Gaxiola  4 , Ali Al-Hamzawi  5 , Jordi Alonso  6 , Laura Helena Andrade  7 , Guilherme Borges  8 , Evelyn J Bromet  9 , Brendan Bunting  10 , José Miguel Caldas de Almeida  11 , Koen Demyttenaere  12 , Silvia Florescu  13 , Giovanni de Girolamo  14 , Oye Gureje  15 , Josep Maria Haro  16 , Yanling He  17 , Hristo Hinkov  18 , Chiyi Hu  19 , Peter de Jonge  20 , Elie G Karam  21 , Sing Lee  22 , Jean-Pierre Lepine  23 , Daphna Levinson  24 , Zeina Mneimneh  25 , Fernando Navarro-Mateu  26 , José Posada-Villa  27 , Tim Slade  28 , Dan J Stein  29 , Yolanda Torres  30 , Hidenori Uda  31 , Bogdan Wojtyniak  32 , Ronald C Kessler  33 , Somnath Chatterji  34 , Kate M Scott  3
Affiliations

Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe

Ayelet Meron Ruscio et al. JAMA Psychiatry. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Demyttenaere reports grants from Eli Lilly, Foundation Ga voor Geluk, and the Flemish Research Fund. He has served as a consultant with Servier, Lundbeck, Lundbeck Institute, Astra Zeneca, and Naurex. Dr Stein has received research grants and/or consultancy honoraria from Abbott, Astra Zeneca, Eli Lilly and Company, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Sun, Takeda, Tikvah, and Wyeth. Dr Kessler has received support for his epidemiologic studies from Sanofi, was a consultant for Johnson & Johnson Wellness and Prevention, and served on an advisory board for the Johnson & Johnson Services Inc Lake Nona Life Project. Dr Kessler is a co-owner of Data Stat, Inc, a market research firm that carries out health care research. No other disclosures were reported.

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