Cited by 46Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessChild and Adolescent Psychosocial and Emotional Development

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

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Lee, S., Tsang, A., Ruscio, A. M., Haro, J. M., Stein, D. J., Alonso, J., Angermeyer, M. C., Bromet, E. J. +12 more·2009·Psychological Medicine

Abstract

Background: 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. Method: 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. Results: 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 ⩾12 months was the most severe, persistently symptomatic and impaired subgroup. Conclusions: 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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  • Population survey evidence from developing and developed countries suggests that lifetime prevalence rates of GAD remain stable when symptoms have persisted from 1 to 3 months.

    “Population survey evidence from developing and developed countries suggests that lifetime prevalence rates of GAD remain stable when symptoms have persisted from 1 to 3 months.[70]”

    From The Classification of Anxiety and Fear-Related Disorders in the ICD-11: Review: Anxiety and Fear-Related Disorders in ICD-11 (2016) · cites this paper as [70]

    The Abstract (Results) reports different lifetime prevalence estimates at the 1-month and 3-month minimum durations: 7.5% versus 5.24% in developed countries and 2.65% versus 1.78% in developing countries. The Results (Prevalence) explicitly says estimated prevalence increases as the duration criterion is shortened, rather than remaining stable. (LLM, conf=0.90)

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  • The prevalence of GAD symptoms among the participants was higher than the 3.0% annual prevalence rate of GAD in the general population in low income countries.

    “The prevalence of GAD symptoms among the participants was higher than the 3.0% annual prevalence rate of GAD in the general population in low income countries (Lee et al. (2009).”

    From Cognitive and social predictors of generalized anxiety disorder symptoms among fresh undergraduates in Uganda (2016) · cites this paper as Lee et al. (2009)

    The Results (Prevalence) give 12-month GAD prevalence estimates of 0.7%–1.4% for developing countries, not 3.0%. They place approximately 3.0% in a different category: lifetime prevalence in developed countries with a 12-month minimum symptom duration. The paper does not compare these estimates with the citing study's participants. (LLM, conf=0.89)

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  • ICD-11 duration requirement follows evidence that individuals with GAD-like presentations lasting less than 6 months are similar to those with episodes of 6 months or more in terms of onset, persistence, impairment, comorbidity, parental GAD, and socio-demographic correlates.

    “following evidence that individuals with GAD-like presentations lasting less than 6 months are similar to those with episodes of 6 months or more in terms of onset, persistence, impairment, comorbidity, parental GAD, and socio-demographic correlates 52 .”

    From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [52]

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  1. First MB Spitzer RL Gibbon M Williams JBW 2002 Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP) Biometrics Research, NewYork State Psychiatric Institute New York

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Authors
Lee, S., Tsang, A., Ruscio, A. M., Haro, J. M., Stein, D. J., Alonso, J., Angermeyer, M. C., Bromet, E. J., Demyttenaere, K., de Girolamo, G., de Graaf, R., Gureje, O., Iwata, N., Karam, E. G., Lepine, J.-P., Levinson, D., Medina-Mora, M. E., Oakley Browne, M. A., Posada-Villa, J., & Kessler, R. C.
Affiliations
  • Chinese University of Hong Kong (HK)
  • University of Pennsylvania (US)
  • University of Cape Town (ZA)
  • Municipal Institute for Medical Research (ES)
  • Stony Brook University (US)
  • Universitair Ziekenhuis Leuven (BE)
  • University College Hospital (GB)
  • Hiroshima International University (JP)
  • Saint George Hospital (LB)
  • Israel Ministry of Health (IL)
  • Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
  • Universidad Colegio Mayor de Cundinamarca (CO)
  • Harvard University (US)
Corresponding author
Lee, S.
Venue
Psychological Medicine
Published
2008-12-18
Volume
39
Issue
7
Pages
1163-1176
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
OpenAlex
W1977579155
Cited by
46
References
37
Citations by year
2026: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2017: 7 · 2016: 3 · 2015: 2 · 2014: 4 · 2013: 3 · 2012: 4
FWCI
6.35
Type
journal article
Language
en
Open access
Locations
  • Psychological Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion, other-oa)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • eCite Digital Repository (University of Tasmania) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
Funders
  • World Health Organization
  • National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
  • National Institute of Mental Health (R13-MH-066849, R0 1-MH61905, R01‐MH070884, U01-MH-60220, R01MH061905, R01MH059575, U13MH066849, U01MH060220, R01‐MH069864)
  • National Institute on Drug Abuse (K05DA015799, R01DA016558)
  • Fogarty International Center (R03TW006481)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
generalized anxiety disorder, diagnostic criteria, DSM-IV, ICD, lifetime prevalence, developing countries, symptom severity, impairment, comorbidities, age of onset
MeSH terms
Adolescent, Adult, Aged, Anxiety Disorders, Mental Disorders, Child, Cross-Sectional Studies, Developing Countries, Female, Health Surveys, Humans, Interview, Psychological, Male, Middle Aged, Recurrence, Time Factors, World Health Organization, Comorbidity, Age of Onset, Developed Countries, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

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