title: A trans-diagnostic review of anxiety disorder comorbidity and the impact of multiple exclusion criteria on studying clinical outcomes in anxiety disorders.
abstract: Anxiety disorders are highly comorbid with each other and with other serious mental disorders. As our field progresses, we have the opportunity to pursue treatment study designs that consider these comorbidities. In this perspective review, we first characterized the prevalence of multiple anxiety disorder comorbidity by reanalyzing national survey data, then conducted an English-language PubMed search of studies analyzing the impact of exclusion criteria on treatment outcome data. In the prevalence data, 60% of people with an anxiety disorder had one or more additional anxiety or depression diagnosis. Because our commonly applied exclusion criteria focus on a single diagnosis and do not consider a multiple comorbidity profile, the impact of the criteria may be to exclude up to 92% of anxiety disorder treatment seekers. Moreover, the findings do not suggest a consistent relationship between the number of exclusion criteria and the effect size of treatment outcomes. Thus, future studies might consider a more trans-diagnostic rationale for determining exclusion criteria, one that is generalizable to real-world settings in which multiple diagnoses commonly co-occur. The findings also encourage a more systematic reporting of rationales for the choice of-and the implications of-each exclusion criterion.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.|Department of Sierra-Pacific MIRECC, VA Palo Alto (Sierra-Pacific MIRECC), Palo Alto, CA, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Goldstein-Piekarski
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.|Department of Sierra-Pacific MIRECC, VA Palo Alto (Sierra-Pacific MIRECC), Palo Alto, CA, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Williams
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.|VA Center for Innovation to Implementation, Menlo Park, CA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Humphreys
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic
chemical_list: D014151:Anti-Anxiety Agents