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Epidemiology anxiety disorders
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Epidemiology anxiety disorders

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    • 1. The Epidemiology of Anxiety Disorders
    • 2. Epidemiologic Data Sources
      • The most recent estimates of the prevalence of DSM-IV mental disorders in the United States come from the National Comorbidity Survey Replication (NCS-R).
        • Nationally representative household survey
        • 9,282 respondents age 18 and older
        • Face-to-face interviews between 2001 and 2003
        • Survey response rate: 70.9%
      Source: Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Rev Public Health 2008;29:115-129.
    • 3. Measures
      • Lifetime prevalence:
        • The proportion of a sample that has ever experienced a given disorder at sometime in their life (up to their age at study)
      • 12-month prevalence:
        • The proportion of a sample that has experienced a given disorder in the 12 months preceding the study
      • Age of onset
    • 4. Lifetime Prevalence of Anxiety Disorders by Age Source: Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593-602. Total (%) 18-29 (%) 30-44 (%) 45-59 (%) 60+ Any anxiety disorder 28.8 30.2 35.1 30.8 15.3 Panic disorder 4.7 4.4 5.7 5.9 2.0 Agoraphobia (w/o panic) 1.4 1.1 1.7 1.6 1.0 Specific phobia 12.5 13.3 13.9 14.1 7.5 Social phobia 12.1 13.6 14.3 12.4 6.6 Generalized anxiety disorder 5.7 4.1 6.8 7.7 3.6 Post-traumatic stress disorder 6.8 6.3 8.2 9.2 2.5 Obsessive-compulsive disorder 1.6 2.0 2.3 1.3 0.7 Separation anxiety disorder 5.2 5.2 5.1 NA NA
    • 5. Lifetime Prevalence
      • Anxiety disorders are the most prevalent class of mental disorders
      • Lifetime prevalence is lowest in the oldest age group
      • It is unclear whether this is due to methodological factors…
        • The exclusion of people living in institutions (e.g., nursing homes) from population surveys
        • Those with anxiety disorders may have risk factors for early mortality
      • … or due to increasing risk among those born into younger generations
    • 6. Twelve-Month Prevalence of Anxiety Disorders by Severity Source: Kessler RC et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:593-602. Total (%) Serious (% of all cases) Moderate (% of all cases) Mild (% of all cases) Any anxiety disorder 18.1 22.8 33.7 43.5 Panic disorder 2.7 44.8 29.5 25.7 Agoraphobia (w/o panic) 0.8 40.6 30.7 28.7 Specific phobia 8.7 21.9 30.0 48.1 Social phobia 6.8 29.9 38.8 31.3 Generalized anxiety disorder 3.1 32.3 44.6 23.1 Post-traumatic stress disorder 3.5 36.6 33.1 30.2 Obsessive-compulsive disorder 1.0 50.6 34.8 14.6 Separation anxiety disorder 0.9 43.3 24.8 31.9
    • 7. Age of Onset (AOO)
      • The phobias and separation anxiety disorder (SAD) have very early AOO distributions
        • 25 th to 75 th percentiles: 4 – 20 years
      • The other anxiety disorders have later AOO distributions
      Source: Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Rev Public Health 2008;29:115-129.
    • 8. Limitations of Epidemiologic Data Sources
      • The NCS-R focused on household populations
        • Exclusion of the homeless
        • Exclusion of those living in institutions
      • Survey participation may be systematically higher in those who do not have mental disorders
      • Survey responses are based on retrospective recall
        • Possibility of recall errors or conscious nonreporting
      • As a result of these limitations, the prevalence of anxiety disorders is likely underestimated
      Source: Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annual Rev Public Health 2008;29:115-129.
    • 9. Sociodemographic Factors Associated with Anxiety Disorders
      • Female
      • Whites
      • Widowed, divorced, or unmarried
      • Unemployment, having no occupation
      • Low level of education
      • Low income
      Sources: Michael T, Margraf J. Epidemiology of anxiety disorders. Psychiatry 2004;3(4):2-6. National Institute of Mental Health Statistics.
    • 10. Risk Factors for Anxiety Disorders
      • Behavioral inhibition during childhood
      • Negative life events
      • Family history of anxiety disorders (genetic factors)
      Sources: Michael T, Margraf J. Epidemiology of anxiety disorders. Psychiatry 2004;3(4):2-6.
    • 11. Comorbid Conditions
      • The level of comorbidity among anxiety disorders is high
      • Anxiety disorders and affective disorders are strongly associated
        • Panic disorder and affective disorders
        • GAD and affective disorders
      • Anxiety disorders and substance abuse disorders are associated, but not as strongly as comorbidity with affective disorders or other anxiety disorders
      Sources: Michael T, Margraf J. Epidemiology of anxiety disorders. Psychiatry 2004;3(4):2-6.