title: Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication.
abstract: Concerns have been raised that the DSM-IV requirements of 6-month duration, excessive worry, and three associated symptoms exclude a substantial number of people with clinically significant anxiety from a diagnosis of generalized anxiety disorder (GAD). We examined the implications of relaxing these three criteria for the estimated prevalence and predictive validity of GAD using nationally representative data from the US National Comorbidity Survey Replication. Relaxing all three criteria more than doubles the estimated prevalence of GAD. Broadly defined GAD significantly predicts the subsequent first onset of a wide range of temporally secondary disorders. The odds of secondary disorders are somewhat smaller for broadly defined than DSM-IV GAD, though few of these differences are statistically significant. Results suggest that subthreshold manifestations of GAD are significantly related to elevated risk of subsequent psychopathology. Further research is needed to determine whether broadening the current diagnostic criteria results in a more valid characterization of GAD.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, USA. ruscio@psych.upenn.edu
authors.forename: Ayelet Meron
authors.initials: AM
authors.lastname: Ruscio
authors.forename: Wai Tat
authors.initials: WT
authors.lastname: Chiu
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.forename: Paul E
authors.initials: PE
authors.lastname: Stang
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D010552:Personality Assessment; D012959:Socioeconomic Factors; D014481:United States