Abstract
This chapter presents an overview of the descriptive epidemiology of anxiety disorders based on recently completed surveys of the general population. The overall prevalence of anxiety disorders is shown to be quite high, but with considerable variation from the most prevalent (specific phobias) to the least prevalent (agoraphobia without a history of panic disorder) disorders. Age-of-onset (AOO) of anxiety disorders is typically in childhood or adolescence and the course is often chronic-recurrent. Anxiety disorders are highly comorbid with each other and with other mental disorders. Because of their early AOO, they are often the temporally primary disorders in comorbid profiles, raising the question whether early interventions to treat anxiety disorders might have a positive effect on the onset, persistence, or severity of secondary disorders such as mood and substance use disorders. This possibility has not yet been extensively explored but warrants further study given the high societal costs of anxiety disorders.
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References
Andlin-Sobocki P, Jönsson B, Wittchen H-U, Olesen J (2005) Cost of disorders of the brain in Europe. Eur J Neurol 12(Suppl 1):1–27
Andlin-Sobocki P, Wittchen H-U (2005) Cost of anxiety disorders in Europe. Eur Neurol 12(Suppl 1):39–44
Andrews G, Slade T (2002) Agoraphobia without a history of panic disorder may be part of the panic disorder syndrome. J Nerv Ment Dis 190:624–630
Beesdo K, Bittner A, Pine DS, Stein MB, Höfler M, Lieb R, Wittchen H-U (2007) Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry 64:903–912
Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BA, Grados MA, Nestadt G (2000) The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry 48:287–293
Bruce ML, Leaf PJ, Rozal GP, Florio L, Hoff RA (1994) Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study. Am J Psychiatry 151:716–721
Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, Shea MT, Keller MB (2005) Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 162:1179–1187
Brugha TS, Jenkins R, Taub N, Meltzer H, Bebbington PE (2001) A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Psychol Med 31:1001–1013
Christiana JM, Gilman SE, Guardino M, Mickelson K, Morselli PL, Olfson M, Kessler RC (2000) Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: an international survey of members of mental health patient advocate groups. Psychol Med 30:693–703
Cox BJ, Clara IP, Enns MW (2002) Posttraumatic stress disorder and the structure of common mental disorders. Depress Anxiety 15:168–171
Diener ML, Kim D-Y (2004) Maternal and child predictors of preschool children's social competence. J Appl Dev Psychol 25:3–24
Fehm L, Pelissolo A, Furmark T, Wittchen HU (2005) Size and burden of social phobia in Europe. Eur Neuropsychopharmacol 15:453–462
Goldsmith T, Shapiro MA, Phillips KA, McElroy SL (1998) Conceptual foundations of obsessive-compulsive spectrum disorders. In: Swinson RP, Anthony MM, Rachman S, Richter MA (eds) Obsessive-compulsive disorder: theory, research, and treatment. Guilford, New York, pp 397–425
Goodwin RD, Faravelli C, Rosi S, Cosci F, Truglia E, de Graaf R, Wittchen HU (2005) The epidemiology of panic disorder and agoraphobia in Europe. Eur Neuropsychopharmacol 15:435–443
Grant BF, Hasin DS, Stinson FS, Dawson DA, Goldstein RB, Smith S, Huang B, Saha TD (2006) The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 67:363–374
Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ (1999) The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 60:427–435
Gureje O, Lasebikan VO, Kola L, Makanjuola VA (2006) Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. Br J Psychiatry 188:465–471
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lépine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC (2006) Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 15:167–180
Kendall PC, Kessler RC (2002) The impact of childhood psychopathology interventions on subsequent substance abuse: policy implications, comments, and recommendations. J Consult Clin Psychol 70:1303–1306
Kendler KS, Prescott CA, Myers J, Neale MC (2003) The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry 60:929–937
Kessler RC (1995) Epidemiology of psychiatric comorbidity. In: Tsuang MT, Tohen M, Zahner GEP (eds) Textbook in Psychiatric Epidemiology. Wiley, New York, pp 179–197
Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Üstün TB (2007a) Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 20:359–364
Kessler RC, Angermeyer M, Anthony JC, DEG R, Demyttenaere K, Gasquet I, DEG G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Üstün TB (2007b) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6:168–176
Kessler RC, Brandenburg N, Lane M, Roy-Byrne P, Stang PD, Stein DJ, Wittchen HU (2005a) Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychol Med 35:1073–1082
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005b) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627
Kessler RC, Merikangas KR (2004) The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res 13:60–68
Kessler RC, Üstün TB (2008) The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. Cambridge University Press, New York
Klein DF, Gorman JM (1987) A model of panic and agoraphobic development. Acta Psychiatr Scand Suppl 335:87–95
Knight DC, Nguyen HT, Bandettini PA (2005) The role of the human amygdala in the production of conditioned fear responses. Neuroimage 26:1193–1200
Kringlen E, Torgersen S, Cramer V (2001) A Norwegian psychiatric epidemiological study. Am J Psychiatry 158:1091–1098
Lépine JP (2002) The epidemiology of anxiety disorders: prevalence and societal costs. J Clin Psychiatry 63(Suppl 14):4–8
Lieb R (2005) Anxiety disorders: clinical presentation and epidemiology. Handb Exp Pharmacol 169:405–432
Lieb R, Becker E, Altamura C (2005) The epidemiology of generalized anxiety disorder in Europe. Eur Neuropsychopharmacol 15:445–452
Marciniak M, Lage MJ, Landbloom RP, Dunayevich E, Bowman L (2004) Medical and productivity costs of anxiety disorders: case control study. Depress Anxiety 19:112–120
Neziroglu F, Henricksen J, Yaryura-Tobias JA (2006) Psychotherapy of obsessive-compulsive disorder and spectrum: established facts and advances, 1995–2005. Psychiatr Clin North Am 29:585–604
Olfson M, Guardino M, Struening E, Schneier FR, Hellman F, Klein DF (2000) Barriers to the treatment of social anxiety. Am J Psychiatry 157:521–527
Patel A, Knapp M, Henderson J, Baldwin D (2002) The economic consequences of social phobia. J Affect Disord 68:221–233
Richter MA, Summerfeldt LJ, Antony MM, Swinson RP (2003) Obsessive-compulsive spectrum conditions in obsessive-compulsive disorder and other anxiety disorders. Depress Anxiety 18:118–127
Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA (1988) The composite international diagnostic interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077
Ruscio AM, Chiu WT, Roy-Byrne P, Stang PE, Stein DJ, Wittchen HU, Kessler RC (2007) Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord 21:662–676
Ruscio AM, Lane M, Roy-Byrne P, Stang PE, Stein DJ, Wittchen HU, Kessler RC (2005) Should excessive worry be required for a diagnosis of generalized anxiety disorder? Results from the US National Comorbidity Survey Replication. Psychol Med 35:1761–1772
Ruscio AM, Stein DJ, Chiu WT, Kessler RC (2008) The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry [Epub ahead of print]
Schreier A, Wittchen H-U, Höfler M, Lieb R (2008) Anxiety disorders in mother and their children: Results from a prospective-longitudinal community study. Br J Psychiatry 192:308–309
Shear K, Jin R, Ruscio AM, Walters EE, Kessler RC (2006) Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. Am J Psychiatry 163:1074–1083
Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F (2005) Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study. Psychol Med 35:1175–1184
Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, McCulloch J, Petukhova MZ, Kessler RC (2007) Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 298:1401–1411
Wang PS, Simon GE, Kessler RC (2008) Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study. J Occup Environ Med 50:468–475
Watson D (2005) Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. J Abnorm Psychol 114:522–536
Whiteside SP, Port JD, Abramowitz JS (2004) A meta-analysis of functional neuroimaging in obsessive-compulsive disorder. Psychiatry Res 132:69–79
Wittchen HU (1994) Reliability and validity studies of the WHO – Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 28:57–84
Wittchen HU, Jacobi F (2005) Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15:357–376
Wittchen H-U, Kessler RC, Pfister H, Höfler M, Lieb R (2000a) Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand 102(Suppl 406):14–23
Wittchen H-U, Lieb R, Pfister H, Schuster P (2000b) The waxing and waning of mental disorders: Evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry 41(Suppl 1):122–132
Wittchen HU, Kessler RC, Zhao S, Abelson J (1995) Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder. J Psychiatr Res 29:95–110
Wittchen HU, Lieb R, Schuster P, Oldehinkel AJ (1999) When is onset? investigations into early developmental stages of anxiety and depressive disorders. In: Rapoport JL (ed) Childhood onset of adult psychopathology: clinical and research advances. American Psychiatric Press, Washington, DC, pp 259–302
Wittchen HU, Nocon A, Beesdo K, Pine DS, Hofler M, Lieb R, Gloster AT (2008) Agoraphobia and panic. Prospective-longitudinal relations suggest a rethinking of diagnostic concepts. Psychother Psychosom 77:147–157
Wittchen HU, Reed V, Kessler RC (1998b) The relationship of agoraphobia and panic in a community sample of adolescents and young adults. Arch Gen Psychiatry 55:1017–1024
Yaryura-Tobias JA, Grunes MS, Todaro J, McKay D, Neziroglu FA, Stockman R (2000) Nosological insertion of axis I disorders in the etiology of obsessive-compulsive disorder. J Anxiety Disord 14:19–30
Zimmermann P, Wittchen HU, Hofler M, Pfister H, Kessler RC, Lieb R (2003) Primary anxiety disorders and the development of subsequent alcohol use disorders: a 4-year community study of adolescents and young adults. Psychol Med 33:1211–1222
Acknowledgments
The National Comorbidity Survey Replication (NCS-R) is supported by NIMH (U01-MH60220) with supplemental support from the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044780), and the John W. Alden Trust. Preparation of this chapter was also supported by NIHM Career Development Award K01-MH076162 to A. M. Rusico. Collaborating NCS-R investigators include Ronald C. Kessler (Principal Investigator, Harvard Medical School), Kathleen Merikangas (Co-Principal Investigator, NIMH), James Anthony (Michigan State University), William Eaton (The Johns Hopkins University), Meyer Glantz (NIDA), Doreen Koretz (Harvard University), Jane McLeod (Indiana University), Mark Olfson (New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University), Harold Pincus (University of Pittsburgh), Greg Simon (Group Health Cooperative), Michael Von Korff (Group Health Cooperative), Philip Wang (Harvard Medical School), Kenneth Wells (UCLA), Elaine Wethington (Cornell University), and Hans-Ulrich Wittchen (Institute for Clinical Psychology and Psychotherapy, Technische Universitaet Dresden). The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or U.S. Government. A complete list of NCS publications and the full text of all NCS-R instruments can be found at http://www.hcp.med.harvard.edu/ncs. Send correspondence to ncs@hcp.med.harvard.edu.
The NCS-R is carried out in conjunction with the WHO WMH Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centers for assistance with instrumentation, fieldwork, and consultation on data analysis. These activities were supported by the National Institute of Mental Health (R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (U13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol-Myers Squibb, and Shire. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.
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Kessler, R.C., Ruscio, A.M., Shear, K., Wittchen, HU. (2009). Epidemiology of Anxiety Disorders. In: Stein, M., Steckler, T. (eds) Behavioral Neurobiology of Anxiety and Its Treatment. Current Topics in Behavioral Neurosciences, vol 2. Springer, Berlin, Heidelberg. https://doi.org/10.1007/7854_2009_9
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DOI: https://doi.org/10.1007/7854_2009_9
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