The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review
Open accessAbstract
Background: To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources. Methods: A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations. Results: Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality. Conclusions: Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
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Anxiety disorders can be highly debilitating from even subclinical symptomatology.
“These disorders can start early in life [3], persist long after onset [4], and be highly debilitating from even subclinical symptomatology [5,6].”
From Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. (2019) · cites this paper as [5]
Subclinical general anxiety symptoms can be quite debilitating.
“Despite these limitations, there is still a need for more iACT research on people suffering from subclinical general anxiety symptoms, as they can be quite debilitating [5].”
From Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. (2019) · cites this paper as [5]
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- Authors
- Haller, H., Cramer, H., Lauche, R., Gass, F., & Dobos, G. J.
- Affiliations
- Kliniken Essen-Mitte (DE)
- Corresponding author
- Dobos, Gustav J
- Venue
- BMC Psychiatry
- Published
- 2014-05-01
- Volume
- 14
- Issue
- 1
- Pages
- 128-128
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4048364
- OpenAlex
- W2041463522
- Cited by
- 267
- References
- 79
- Citations by year
- 2026: 11 · 2025: 28 · 2024: 34 · 2023: 25 · 2022: 31 · 2021: 34 · 2020: 32 · 2019: 18 · 2018: 17 · 2017: 12 · 2016: 11 · 2015: 13 · 2014: 1
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DuEPublico (University of Duisburg-Essen) (submittedVersion, cc-by)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- 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, prevalence, disease burden, psychosocial impairment, work functioning, benzodiazepine use, primary care utilization, comorbidities, health care costs, DSM-III-R, DSM-IV, ICD-10
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Female, Humans, Male, Primary Health Care, Comorbidity, Prevalence, Cost of Illness, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders
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