The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation

Year: 2024

Type: article

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 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.

Source: Psychological Medicine

DOI: 10.1017/s003329172400182x

Institutions: University of Pennsylvania, San Diego State University, University of California San Diego, VA San Diego Healthcare System, South African Medical Research Council, University of Cape Town, UC Davis Health, University of Al-Qadisiyah, Universitat Pompeu Fabra, Instituto de Salud Carlos III, Municipal Institute for Medical Research, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Hospital del Mar Research Institute, Aga Khan University, Aga Khan University Nairobi, Aga Khan University, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Stony Brook University, KU Leuven, University of Ulster, University of Lisbon, Lisbon Institute of Global Mental Health, Universidade Nova de Lisboa, University of Michigan, Institute for Social Research, Centro San Giovanni di Dio Fatebenefratelli, University of Groningen, University College Hospital, University College Hospital, Ibadan, Centro de Investigación Biomédica en Red de Salud Mental, Parc Sanitari Sant Joan de Déu, Saint George Hospital, Institute for Development, Research, Advocacy and Applied Care, DSW Ideis University, Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé, Harvard University, Servicio Murciano de Salud, The University of Tokyo, Universidad Peruana Cayetano Heredia, Universidad Colegio Mayor de Cundinamarca, University of Otago, The University of Sydney, Universidad de Buenos Aires, Universidad CES, Universidade Federal do Espírito Santo, Titu Maiorescu University, Institutul Național de Management al Serviciilor de Sănătate, National Center of Public Health and Analyses

Language: English

Topic: Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Subfield: Experimental and Cognitive Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,450

Funders: U.S. Department of Defense, U.S. Department of Veterans Affairs, Robert Wood Johnson Foundation, John D. and Catherine T. MacArthur Foundation, John W. Alden Trust, Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, GlaxoSmithKline, World Health Organization, University of Otago, Universidad CES, European Commission, Generalitat de Catalunya, National Insurance Institute of Israel, Ministerio de Salud de la Nación, Department of Health and Aged Care, Australian Government, University of Tokyo, Universidad de Buenos Aires, Fundação Calouste Gulbenkian, Ministerio de Ciencia y Tecnología, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, Fundação Champalimaud, Universidade Federal do Espírito Santo, Substance Abuse and Mental Health Services Administration, U.S. Public Health Service, Pfizer Foundation, Pan American Health Organization, EEA Grants, National Institute of Mental Health, National Institute on Drug Abuse, Fogarty International Center, Ortho-McNeil Pharmaceutical

OpenAlex ID: W4403133995