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Cited by 143Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentMental Health Treatment and Access

Pediatric-onset and adult-onset separation anxiety disorder across countries in the World Mental Health Survey

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Silove, Derrick, Alonso, Jordi, Bromet, Evelyn, Gruber, Mike, Sampson, Nancy, Scott, Kate, Andrade, Laura, Benjet, Corina +14 more·2015·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2015.14091185PMC PMC5116912
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Abstract

OBJECTIVE: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. METHOD: The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. RESULTS: Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. CONCLUSIONS: Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment.

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  • Recent epidemiological data from 18 countries suggest that separation anxiety disorder is common, significantly impairing, predictive of adult emotional disorders when onset is during childhood, and, conversely, predicted by childhood emotional disorder when onset occurs in adulthood.

    “Recent epidemiological data from 18 countries suggest that separation anxiety disorder is common, significantly impairing, predictive of adult emotional disorders when onset is during childhood, and, conversely, predicted by childhood emotional disorder when onset occurs in adulthood.[88]”

    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 [88]

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Authors
Silove, D., Alonso, J., Bromet, E., Gruber, M., Sampson, N., Scott, K., Andrade, L., Benjet, C., Caldas de Almeida, J. M., De Girolamo, G., de Jonge, P., Demyttenaere, K., Fiestas, F., Florescu, S., Gureje, O., He, Y., Karam, E., Lepine, J.-P., Murphy, S., Villa-Posada, J., Zarkov, Z., & Kessler, R. C.
Affiliations
  • Universitat Pompeu Fabra (ES)
  • From the Psychiatry Research and Teaching Unit and Ingham Institute, School of Psychiatry, University of New South Wales, Randwick, NSW, Australia; IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University (UPF) and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, N.Y..; Department of Health Care Policy, Harvard Medical School, Boston; Department of Psychological Medicine,...
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2015-07-01
Volume
172
Issue
7
Pages
647-656
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2015.14091185
PMC
PMC5116912
OpenAlex
W2161443491
Cited by
143
References
35
Citations by year
2026: 6 · 2025: 14 · 2024: 13 · 2023: 16 · 2022: 6 · 2021: 11 · 2020: 20 · 2019: 15 · 2018: 9 · 2017: 19 · 2016: 11 · 2015: 2
FWCI
20.65
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
  • PubMed Central (acceptedVersion)
  • RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders
  • National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
  • National Institute of Mental Health (R13-MH-066849, R01‐MH070884, 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 › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
separation anxiety disorder, age of onset, prevalence, comorbidities, internalizing disorders, externalizing disorders, childhood adversity, lifetime trauma, role impairment, DSM-5, cross-national comparison
MeSH terms
Adolescent, Adult, Anxiety, Separation, Child, Child, Preschool, Cross-Sectional Studies, Cross-Cultural Comparison, Female, Health Surveys, Humans, Internal-External Control, Male, Risk Factors, Socioeconomic Factors, Statistics as Topic, Global Health, Comorbidity, Age of Onset, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

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