The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation.
Journal: Psychological medicine
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Affiliated Institutions:
Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, CA, USA.
Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla, CA, USA.
Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, South Africa.
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
College of Medicine, University of Al-Qadisiya, Diwaniya governorate, Iraq.
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.
Brain and Mind Institute and Medical College East Africa, the Aga Khan University, Nairobi, Kenya.
National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico.
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA.
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium.
School of Psychology, Ulster University, Coleraine, UK.
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal.
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands.
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.
Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
Faculty of Applied Studies, University of Lower Silesia, Wroclaw, Poland.
Institut de Psychologie, EA , Université Paris Cité, Paris, France.
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru.
Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia.
Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia.
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia.
Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil.
National Institute of Health Services Management, Bucharest, Romania.
Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria.
Abstract summary
Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not 'excessive' relative to the context. We carried out the first large-scale, cross-national study to explore the implications of removing this excessiveness requirement.Data come from the World Health Organization World Mental Health Survey Initiative. A total of 133 614 adults from 12 surveys in Low- or Middle-Income Countries (LMICs) and 16 surveys in High-Income Countries (HICs) were assessed with the Composite International Diagnostic Interview. Non-excessive worriers meeting all other criteria for GAD were compared to respondents meeting all criteria for GAD, and to respondents without GAD, on clinically-relevant correlates.Removing the excessiveness requirement increases the global lifetime prevalence of GAD from 2.6% to 4.0%, with larger increases in LMICs than HICs. Non-excessive and excessive GAD cases worry about many of the same things, although non-excessive cases worry more about health/welfare of loved ones, and less about personal or non-specific concerns, than excessive cases. Non-excessive cases closely resemble excessive cases in socio-demographic characteristics, family history of GAD, and risk of temporally secondary comorbidity and suicidality. Although non-excessive cases are less severe on average, they report impairment comparable to excessive cases and often seek treatment for GAD symptoms.Individuals with non-excessive worry who meet all other criteria for GAD are clinically significant cases. Eliminating the excessiveness requirement would lead to a more defensible GAD diagnosis.
Authors & Co-authors:
Ruscio Ayelet Meron AM
Rassaby Madeleine M
Stein Murray B MB
Stein Dan J DJ
Aguilar-Gaxiola Sergio S
Al-Hamzawi Ali A
Alonso Jordi J
Atwoli Lukoye L
Borges Guilherme G
Bromet Evelyn J EJ
Bruffaerts Ronny R
Bunting Brendan B
Cardoso Graça G
Chardoul Stephanie S
de Girolamo Giovanni G
de Jonge Peter P
Gureje Oye O
Haro Josep Maria JM
Karam Elie G EG
Karam Aimee A
Kiejna Andrzej A
Kovess-Masfety Viviane V
Lee Sue S
Navarro-Mateu Fernando F
Nishi Daisuke D
Piazza Marina M
Posada-Villa José J
Sampson Nancy A NA
Scott Kate M KM
Slade Tim T
Stagnaro Juan Carlos JC
Torres Yolanda Y
Viana Maria Carmen MC
Vladescu Cristian C
Zarkov Zahari Z
Kessler Ronald C RC
Study Outcome
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