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

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.; Altwaijri Y.A.; Andrade L.H.; Benjet C.; Caldas-De-Almeida J.M.; Cía A.H.; Degenhardt L.; Harris M.G.; Hinkov H.; Hu C.-Y.; Karam G.; Kazdin A.E.; Kawakami N.; Khaled S.; McGrath J.J.; Medina-Mora M.E.; Moskalewicz J.; ten Have M.; Vigo D.V.; Williams D.R.; Wojtyniak B.; Woodruff P.; Xavier M.; Zaslavsky A.M. · Psychological Medicine (2024) · DOI: 10.1017/s003329172400182x

Resumen

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. © The Author(s), 2024.

Instituciones: Universidad Peruana Cayetano Heredia