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Comparative Study
. 2019 Jun;36(6):499-510.
doi: 10.1002/da.22885. Epub 2019 Feb 6.

A comparison of DSM-5 and DSM-IV agoraphobia in the World Mental Health Surveys

Annelieke M Roest  1 , Ymkje Anna de Vries  1 , Carmen C W Lim  2 , Hans-Ulrich Wittchen  3   4 , Dan J Stein  5 , Tomasz Adamowski  6 , Ali Al-Hamzawi  7 , Evelyn J Bromet  8 , Maria Carmen Viana  9 , Giovanni de Girolamo  10 , Koen Demyttenaere  11 , Silvia Florescu  12 , Oye Gureje  13 , Josep Maria Haro  14 , Chiyi Hu  15 , Elie G Karam  16   17   18 , José Miguel Caldas-de-Almeida  19 , Norito Kawakami  20 , Jean Pierre Lépine  21 , Daphna Levinson  22 , Maria E Medina-Mora  23 , Fernando Navarro-Mateu  24   25   26 , Siobhan O'Neill  27 , Marina Piazza  28 , José A Posada-Villa  29 , Tim Slade  30 , Yolanda Torres  31 , Ronald C Kessler  32 , Kate M Scott  33 , Peter de Jonge  1 ; WHO World Mental Health Survey Collaborators
Affiliations
Comparative Study

A comparison of DSM-5 and DSM-IV agoraphobia in the World Mental Health Surveys

Annelieke M Roest et al. Depress Anxiety. 2019 Jun.

Abstract

Background: The Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) definition of agoraphobia (AG) as an independent diagnostic entity makes it timely to re-examine the epidemiology of AG. Study objective was to present representative data on the characteristics of individuals who meet DSM-IV criteria for AG (AG without a history of panic disorder [PD] and PD with AG) but not DSM-5 criteria, DSM-5 but not DSM-IV criteria, or both sets of criteria.

Methods: Population-based surveys from the World Mental Health Survey Initiative including adult respondents (n = 136,357) from 27 countries across the world. The Composite International Diagnostic Interview was used to assess AG and other disorders.

Results: Lifetime and 12-month prevalence estimates of DSM-5 AG (1.5% and 1.0%) were comparable to DSM-IV (1.4% and 0.9%). Of respondents meeting criteria in either system, 57.1% met criteria in both, while 24.2% met criteria for DSM-5 only and 18.8% for DSM-IV only. Severe role impairment due to AG was reported by a lower proportion of respondents who met criteria only for DSM-IV AG (30.4%) than those with both DSM-5 and DSM-IV AG (44.0%; χ 21 = 4.7; P = 0.031). The proportion of cases with any comorbidity was lower among respondents who met criteria only for DSM-IV AG (78.7%) than those who met both sets (92.9%; χ 21 = 14.5; P < 0.001).

Conclusions: This first large survey shows that, compared to the DSM-IV, the DSM-5 identifies a substantial group of new cases with AG, while the prevalence rate remains stable at 1.5%. Severity and comorbidity are higher in individuals meeting DSM-5 AG criteria compared with individuals meeting DSM-IV AG criteria only.

Keywords: agoraphobia; anxiety/anxiety disorders; cross-national; disorders; epidemiology; phobia/phobic.

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Conflict of interest statement

In the past 3 years, Dr. Stein has received research grants and/or consultancy honoraria from AMBRF/Foundation for Alcohol Research, Biocodex, Cipla, Lundbeck, National Responsible Gambling Foundation, Novartis, Servier, and Sun. Dr. Demyttenaere has served on advisory boards for Eli Lilly, Lundbeck, Johnson&Johnson, Servier, Boehringer Ingelheim, Livanova and has research grants from Eli Lilly, foundation “ga voor geluk,” Fonds voor Wetenschappelijk Onderzoek Vlaanderen.

In the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Sage Pharmaceuticals, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co‐owner of DataStat, Inc., a market research firm that carries out healthcare research. Dr. Haro reports personal fees from Roche, Lundbeck, Eli Lilly and Otsuka, outside the submitted work.

Authors Roest, de Vries, de Jonge, Wittchen, Lim, Adamowski, Carmen Viana, Florescu, Kawakami, Slade, Torres, Posada‐Villa, Lépine, Al‐Hamzawi, Levinson, de Girolamo, Karam, Elena Medina Mora, Gureje, O’Neill, Hu, Piazza, Miguel Caldas‐de‐Almeida, Navarro‐Mateu, Bromet, and Scott do not have conflict of interests to report.

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