| Source: |
Ruscio, A M, Rassaby, M, Stein, M B, Stein, D J, Aguilar-Gaxiola, S, Al-Hamzawi, A, Alonso, J, Atwoli, L, Borges, G, Bromet, E J, Bruffaerts, R, Bunting, B, Cardoso, G, Chardoul, S, De Girolamo, G, De Jonge, P, Gureje, O, Haro, J M, Karam, E G, Karam, A, Kiejna, A, Kovess-Masfety, V, Lee, S, Navarro-Mateu, F, Nishi, D, Piazza, M, Posada-Villa, J, Sampson, N A, Scott, K M, Slade, T, Stagnaro, J C, Torres, Y, Viana, M C, Vladescu, C, Zarkov, Z & Kessler, R C 2024, 'The case for eliminating excessive worry as a requirement for generalized anxiety .... |
| Description: |
Background Around the world, people living in objectively difficult circumstances who experience symptoms of generalized anxiety disorder (GAD) do not qualify for a diagnosis because their worry is not 'excessive' relative to the context. We carried out the first large-scale, cross-national study to explore the implications of removing this excessiveness requirement. Methods Data come from the World Health Organization World Mental Health Survey Initiative. A total of 133 614 adults from 12 surveys in Low- or Middle-Income Countries (LMICs) and 16 surveys in High-Income Countries (HICs) were assessed with the Composite International Diagnostic Interview. Non-excessive worriers meeting all other DSM-5 criteria for GAD were compared to respondents meeting all criteria for GAD, and to respondents without GAD, on clinically-relevant correlates. Results Removing the excessiveness requirement increases the global lifetime prevalence of GAD from 2.6% to 4.0%, with larger increases in LMICs than HICs. Non-excessive and excessive GAD cases worry about many of the same things, although non-excessive cases worry more about health/welfare of loved ones, and less about personal or non-specific concerns, than excessive cases. Non-excessive cases closely resemble excessive cases in socio-demographic characteristics, family history of GAD, and risk of temporally secondary comorbidity and suicidality. Although non-excessive cases are less severe on average, they report impairment comparable to excessive cases and often seek treatment for GAD symptoms. Conclusions Individuals with non-excessive worry who meet all other DSM-5 criteria for GAD are clinically significant cases. Eliminating the excessiveness requirement would lead to a more defensible GAD diagnosis. |