title: Disability in anxiety disorders.
abstract: BACKGROUND
  This study compares disability levels between different anxiety disorders and healthy controls. We further investigate the role of anxiety arousal and avoidance behaviour in disability, and whether differences in these symptom patterns contribute to disability differences between anxiety disorders.
  
  
  METHODS
  Data were from 1826 subjects from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose anxiety disorders. The World Health Organization Disability Assessment Schedule II was used to measure disability in six domains (cognition, mobility, selfcare, social interaction, life activities, participation). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire.
  
  
  RESULTS
  All anxiety disorders were associated with higher disability. Disability was generally highest in multiple anxiety disorder (e.g. mean disability in cognition=33.7) and social anxiety disorder (mean=32.7), followed by generalized anxiety disorder (mean=27.2) and panic disorder with agoraphobia (mean=26.3), and lowest in panic disorder without agoraphobia (mean=22.1). Anxiety arousal was more associated with disability in life activities (B=8.5, p<0.001) and participation (B=9.9, p<0.001) whereas avoidance behaviour was more associated with disability in cognition (B=7.4, p<0.001) and social interaction (B=8.6, p<0.001). Different disability patterns between anxiety disorders were not completely explained by anxiety arousal and avoidance behaviour.
  
  
  CONCLUSIONS
  The cross-sectional study design precludes any causal interpretations. In order to examine the full range of comorbidity among anxiety, a greater range of anxiety disorders would have been preferable.
  
  
  CONCLUSIONS
  Disability is highest in social anxiety disorder and multiple anxiety disorder. Both anxiety arousal and avoidance behaviour are associated with higher disability levels but do not fully explain the differences across anxiety disorders.
authors.affiliation: Department of Psychiatry, Pro Persona Mental Health Care, Willy Brandtlaan 20, 6717 RR Ede, The Netherlands. Electronic address: s.hendriks@propersona.nl.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Hendriks
authors.affiliation: Department of Psychiatry, Pro Persona Mental Health Care, Radboud University Nijmegen, Nijmegen, The Netherlands; Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Spijker
authors.affiliation: VU University Medical Center, Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Carmilla M M
authors.initials: CM
authors.lastname: Licht
authors.affiliation: VU University Medical Center, Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: Department of Psychiatry, Pro Persona Mental Health Care, Willy Brandtlaan 20, 6717 RR Ede, The Netherlands.
authors.forename: Florian
authors.initials: F
authors.lastname: Hardeveld
authors.affiliation: Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: VU University Medical Center, Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, Amsterdam, The Netherlands.
authors.forename: Neeltje M
authors.initials: NM
authors.lastname: Batelaan
authors.affiliation: VU University Medical Center, Department of Psychiatry/EMGO Institute/Neuroscience Campus Amsterdam, Amsterdam, The Netherlands; University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands; Leiden University Medical Center, Department of Psychiatry, Leiden, The Netherlands.
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
mesh_terms: D000328:Adult; D000379:Agoraphobia / Q000175:diagnosis; D001007:Anxiety; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology; D001143:Arousal; D015897:Comorbidity; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016584:Panic Disorder / Q000175:diagnosis; D010698:Phobic Disorders / Q000175:diagnosis; D011795:Surveys and Questionnaires
keywords: Anxiety arousal; Anxiety disorder; Avoidance behaviour; Disability