Patterns and correlates of generalized anxiety disorder in community samples.
BACKGROUND
Although generalized anxiety disorder (GAD) is at least twice as prevalent as panic disorder and is among the commonly occurring mental disorders, changing diagnostic criteria have hampered the cumulation of data on patterns and correlates.


METHODS
A computer literature search was carried out for the terms generalized anxiety disorder and GAD in the MEDLINE and PsycLIT databases. Reports published in English since 1995 were reviewed to determine patterns and correlates of GAD in the general population.


RESULTS
The literature shows clearly that GAD is a commonly occurring disorder associated with serious impairment. Although the high comorbidities of GAD with other disorders in clinical samples led to speculation that the impairments associated with GAD were due to comorbid conditions, several recent studies show that pure GAD is associated with serious impairments. Considerable uncertainty remains regarding appropriate diagnostic criteria. The requirements that the anxiety be excessive and persist for 6 months are the subject of the most controversy. Recently reported community epidemiologic data show that generalized anxiety syndromes that persist for shorter time periods and that are not excessive in relation to objective stressors are as seriously impairing as syndromes that meet full criteria for GAD. It is less clear whether currently available treatments are as useful in resolving episodes of generalized anxiety that lie outside the boundaries of current ICD and DSM criteria.


CONCLUSIONS
GAD is a commonly occurring mental disorder that can seriously impair functioning. Coordinated community epidemiologic studies and treatment effectiveness studies are needed to resolve remaining uncertainties regarding the diagnostic boundaries of GAD.
Kessler
Ronald C
RC
Department of Health Care Policy, Harvard Medical School, Boston, Mass. 02115, USA. kessler@hcp.med.harvard.edu
Wittchen
Hans-Ulrich
HU
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012737:Sex Factors; D009626:Terminology as Topic; D014481:United States / Q000453:epidemiology