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Threshold and subthreshold generalized anxiety disorder among US adolescents: prevalence, sociodemographic, and clinical characteristics

Published online by Cambridge University Press:  02 January 2014

M. Burstein ,
K. Beesdo-Baum ,
J.-P. He  and
K. R. Merikangas
M. Burstein
Affiliation:
Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD, USA
K. Beesdo-Baum
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
J.-P. He
Affiliation:
Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD, USA
K. R. Merikangas*
Affiliation:
Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD, USA
*
*Address for correspondence: K. R. Merikangas, Ph.D., National Institute of Mental Health, Genetic Epidemiology Research Branch, Building 35, Room 1A201, 35 Convent Drive, MSC #3720, Bethesda, MD 20892, USA. (Email: [email protected])
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Abstract

Background

Threshold and subthreshold forms of generalized anxiety disorder (GAD) are highly prevalent and impairing conditions among adults. However, there are few general population studies that have examined these conditions during the early life course. The primary objectives of this study were to: (1) examine the prevalence, and sociodemographic and clinical characteristics of threshold and subthreshold forms of GAD in a nationally representative sample of US youth; and (2) test differences in sociodemographic and clinical characteristics between threshold and subthreshold forms of the disorder.

Method

The National Comorbidity Survey-Adolescent Supplement is a nationally representative face-to-face survey of 10 123 adolescents 13 to 18 years of age in the continental USA.

Results

Approximately 3% of adolescents met criteria for threshold GAD. Reducing the required duration from 6 months to 3 months resulted in a 65.7% increase in prevalence (5.0%); further relaxing the uncontrollability criterion led to an additional 20.7% increase in prevalence (6.1%). Adolescents with all forms of GAD displayed a recurrent clinical course marked by substantial impairment and co-morbidity with other psychiatric disorders. There were few significant differences in sociodemographic and clinical characteristics between threshold and subthreshold cases of GAD. Results also revealed age-related differences in the associated symptoms and clinical course of GAD.

Conclusions

Findings demonstrate the clinical significance of subthreshold forms of GAD among adolescent youth, highlighting the continuous nature of the GAD construct. Age-related differences in the associated symptoms and clinical course of GAD provide further support for criteria that capture variation in clinical features across development.

Keywords

Adolescentschildrenepidemiologygeneralized anxiety disordersubthreshold
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 11 , August 2014 , pp. 2351 - 2362
Copyright
Copyright © Cambridge University Press 2014 

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References

Andrews, G, Hobbs, MJ (2010). The effect of the draft DSM-5 criteria for GAD on prevalence and severity. Australian and New Zealand Journal of Psychiatry 44, 784–790.CrossRefGoogle Scholar
Andrews, G, Hobbs, MJ, Borkovec, TD, Beesdo, K, Craske, MG, Heimberg, RG, Rapee, RM, Ruscio, AM, Stanley, MA (2010). Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depression and Anxiety 27, 134–147.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Baldwin, DS, Ajdacic-Gross, V, Rossler, W (2009). The generalized anxiety spectrum: prevalence, onset, course and outcome. European Archives of Psychiatry and Clinical Neuroscience 259, 37–45.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Bienvenu, OJ, Eaton, WW, Ajdacic, V, Eich, D, Rössler, W (2006). Varying temporal criteria for generalized anxiety disorder: prevalence and clinical characteristics in a young age cohort. Psychological Medicine 36, 1283–1292.CrossRefGoogle Scholar
Beesdo, K, Knappe, S, Pine, DS (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics of North America 32, 483–524.CrossRefGoogle ScholarPubMed
Beesdo, K, Pine, DS, Lieb, R, Wittchen, HU (2010). Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Archives of General Psychiatry 67, 47–57.Google ScholarPubMed
Beesdo-Baum, K, Winkel, S, Pine, DS, Hoyer, J, Hofler, M, Lieb, R, Wittchen, HU (2011). The diagnostic threshold of generalized anxiety disorder in the community: a developmental perspective. Journal of Psychiatric Research 45, 962–972.CrossRefGoogle ScholarPubMed
Bittner, A, Egger, HL, Erkanli, A, Jane Costello, E, Foley, DL, Angold, A (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry 48, 1174–1183.CrossRefGoogle ScholarPubMed
Burstein, M, Georgiades, K, Lamers, F, Swanson, SA, Cui, L, He, JP, Avenevoli, S, Merikangas, KR (2012). Empirically derived subtypes of lifetime anxiety disorders: developmental and clinical correlates in U.S. adolescents. Journal of Consulting and Clinical Psychology 80, 102–115.CrossRefGoogle ScholarPubMed
Carter, RM, Wittchen, HU, Pfister, H, Kessler, RC (2001). One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety 13, 78–88.CrossRefGoogle Scholar
Comer, JS, Gallo, KP, Korathu-Larson, P, Pincus, DB, Brown, TA (2012 a). Specifying child anxiety disorders not otherwise specified in the DSM-IV. Depression and Anxiety 29, 1004–1013.CrossRefGoogle Scholar
Comer, JS, Pincus, DB, Hofmann, SG (2012 b). Generalized anxiety disorder and the proposed associated symptoms criterion change for DSM-5 in a treatment-seeking sample of anxious youth. Depression and Anxiety 29, 994–1003.CrossRefGoogle Scholar
Costello, EJ, Angold, A, Burns, BJ, Stangl, DK, Tweed, DL, Erkanli, A, Worthman, CM (1996). The Great Smoky Mountains Study of Youth. Goals, design, methods, and the prevalence of DSM-III-R disorders. Archives of General Psychiatry 53, 1129–1136.Google ScholarPubMed
Essau, CA, Conradt, J, Petermann, F (2000). Frequency, co-morbidity, and psychosocial impairment of anxiety disorders in German adolescents. Journal of Anxiety Disorders 14, 263–279.CrossRefGoogle ScholarPubMed
Fairburn, CG, Bohn, K (2005). Eating disorder NOS (EDNOS): an example of the troublesome ‘not otherwise specified’ (NOS) category in DSM-IV. Behavior Research and Therapy 43, 691–701.CrossRefGoogle ScholarPubMed
Grant, BF, Hasin, DS, Stinson, FS, Dawson, DA, Ruan, WJ, Goldstein, RB, Smith, SM, Saha, TD, Huang, B (2005). Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine 35, 1747–1759.Google ScholarPubMed
Hallion, LS, Ruscio, AM (2013). Should uncontrollable worry be removed from the definition of GAD? A test of incremental validity. Journal of Abnormal Psychology 122, 369–375.Google Scholar
Hoyer, J, Becker, ES, Margraf, J (2002). Generalized anxiety disorder and clinical worry episodes in young women. Psychological Medicine 32, 1227–1237.CrossRefGoogle ScholarPubMed
Kendall, PC, Pimentel, SS (2003). On the physiological symptom constellation in youth with generalized anxiety disorder (GAD). Journal of Anxiety Disorders 17, 211–221.CrossRefGoogle ScholarPubMed
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1992). Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry 49, 267–272.CrossRefGoogle ScholarPubMed
Kessler, RC, Avenevoli, S, Costello, EJ, Georgiades, K, Green, JG, Gruber, MJ, He, JP, Koretz, D, McLaughlin, KA, Petukhova, M, Sampson, NA, Zaslavsky, AM, Merikangas, KR (2012 a). Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry 69, 372–380.Google ScholarPubMed
Kessler, RC, Avenevoli, S, Costello, EJ, Green, JG, Gruber, MJ, Heeringa, S, Merikangas, KR, Pennell, BE, Sampson, NA, Zaslavsky, AM (2009). Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). International Journal of Methods in Psychiatric Research 18, 69–83.CrossRefGoogle ScholarPubMed
Kessler, RC, Avenevoli, S, Costello, J, Green, JG, Gruber, MJ, McLaughlin, KA, Petukhova, M, Sampson, NA, Zaslavsky, AM, Merikangas, KR (2012 b). Severity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Archives of General Psychiatry 69, 381–389.Google ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005 a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.CrossRefGoogle ScholarPubMed
Kessler, RC, Brandenburg, N, Lane, M, Roy-Byrne, P, Stang, PD, Stein, DJ, Wittchen, HU (2005 b). Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psycholological Medicine 35, 1073–1082.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Kessler, RC, Wittchen, HU (2002). Patterns and correlates of generalized anxiety disorder in community samples. Journal of Clinical Psychiatry 63 (Suppl. 8), 4–10.Google ScholarPubMed
Knauper, B, Cannell, CF, Schwarz, N, Bruce, ML, Kessler, RC (1999). Improving the accuracy of major depression age of onset reports in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research 8, 39–48.CrossRefGoogle Scholar
Lawrence, AE, Brown, TA (2009). Differentiating generalized anxiety disorder from anxiety disorder not otherwise specified. Journal of Nervous and Mental Disease 197, 879–886.CrossRefGoogle Scholar
Layne, AE, Bernat, DH, Victor, AM, Bernstein, GA (2009). Generalized anxiety disorder in a nonclinical sample of children: symptom presentation and predictors of impairment. Journal of Anxiety Disorders 23, 283–289.CrossRefGoogle Scholar
Lee, S, Tsang, A, Ruscio, AM, Haro, JM, Stein, DJ, Alonso, J, Angermeyer, MC, Bromet, EJ, Demyttenaere, K, de Girolamo, G, de Graaf, R, Gureje, O, Iwata, N, Karam, EG, Lepine, JP, Levinson, D, Medina-Mora, ME, Oakley Browne, MA, Posada-Villa, J, Kessler, RC (2009). Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries. Psychological Medicine 39, 1163–1176.CrossRefGoogle ScholarPubMed
Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehan, DV (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93–105.CrossRefGoogle ScholarPubMed
Lieb, R, Becker, E, Altamura, C (2005). The epidemiology of generalized anxiety disorder in Europe. European Neuropsychopharmacology 15, 445–452.CrossRefGoogle ScholarPubMed
Merikangas, K, Avenevoli, S, Costello, J, Koretz, D, Kessler, RC (2009). National comorbidity survey replication adolescent supplement (NCS-A): I. Background and measures. Journal of the American Academy of Child and Adolescent Psychiatry 48, 367–369.CrossRefGoogle ScholarPubMed
Merikangas, KR, He, JP, Burstein, M, Swanson, SA, Avenevoli, S, Cui, LH, Benjet, C, Georgiades, K, Swendsen, J (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry 49, 980–989.CrossRefGoogle ScholarPubMed
Merikangas, KR, He, JP, Burstein, M, Swendsen, J, Avenevoli, S, Case, B, Georgiades, K, Heaton, L, Swanson, S, Olfson, M (2011). Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). Journal of the American Academy of Child amd Adolescent Psychiatry 50, 32–45.CrossRefGoogle ScholarPubMed
Pina, AA, Silverman, WK, Alfano, CA, Saavedra, LM (2002). Diagnostic efficiency of symptoms in the diagnosis of DSM-IV: generalized anxiety disorder in youth. Journal of Child Psychology and Psychiatry 43, 959–967.CrossRefGoogle ScholarPubMed
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. Journal of Anxiety Disorders 21, 662–676.CrossRefGoogle ScholarPubMed
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. Psychological Medicine 35, 1761–1772.CrossRefGoogle ScholarPubMed
SAS Institute (2008). SAS/STAT® User's Guide. SAS Institute: Cary, NC.Google Scholar
Tracey, SA, Chorpita, BF, Douban, J, Barlow, DH (1997). Empirical evaluation of DSM-IV generalized anxiety disorder criteria in children and adolescents. Journal of Clinical Child Psychology 26, 404–414.CrossRefGoogle ScholarPubMed
Wittchen, HU (2002). Generalized anxiety disorder: prevalence, burden, and cost to society. Depression and Anxiety 16, 162–171.CrossRefGoogle ScholarPubMed
Wu, P, Hoven, CW, Cohen, P, Liu, X, Moore, RE, Tiet, Q, Okezie, N, Wicks, J, Bird, HR (2001). Factors associated with use of mental health services for depression by children and adolescents. Psychiatric Services 52, 189–195.CrossRefGoogle ScholarPubMed
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