Document Type
Article
Department
Internal Medicine (East Africa)
Abstract
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 largescale, 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.
Publication (Name of Journal)
Psychological Medicine
DOI
https://doi.org/10.1017/S003329172400182X
Recommended Citation
Ruscio, A. M.,
Rassaby, M.,
Stein, M.,
Stein, D.,
Aguilar-Gaxiola, S.,
Al-Hamzawi, A.,
Alonso, J.,
Atwoli, L.,
Borges, G.,
Bromet, E.
(2024). he case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation. Psychological Medicine, 54(12), 3448-3458.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_intern_med/443
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.