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Epidemiology anxiety disorders

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Epidemiology anxiety disorders

  1. 1. The Epidemiology of Anxiety Disorders
  2. 2. Epidemiologic Data Sources <ul><li>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). </li></ul><ul><ul><li>Nationally representative household survey </li></ul></ul><ul><ul><li>9,282 respondents age 18 and older </li></ul></ul><ul><ul><li>Face-to-face interviews between 2001 and 2003 </li></ul></ul><ul><ul><li>Survey response rate: 70.9% </li></ul></ul>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. 3. Measures <ul><li>Lifetime prevalence: </li></ul><ul><ul><li>The proportion of a sample that has ever experienced a given disorder at sometime in their life (up to their age at study) </li></ul></ul><ul><li>12-month prevalence: </li></ul><ul><ul><li>The proportion of a sample that has experienced a given disorder in the 12 months preceding the study </li></ul></ul><ul><li>Age of onset </li></ul>
  4. 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. 5. Lifetime Prevalence <ul><li>Anxiety disorders are the most prevalent class of mental disorders </li></ul><ul><li>Lifetime prevalence is lowest in the oldest age group </li></ul><ul><li>It is unclear whether this is due to methodological factors… </li></ul><ul><ul><li>The exclusion of people living in institutions (e.g., nursing homes) from population surveys </li></ul></ul><ul><ul><li>Those with anxiety disorders may have risk factors for early mortality </li></ul></ul><ul><li>… or due to increasing risk among those born into younger generations </li></ul>
  6. 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. 7. Age of Onset (AOO) <ul><li>The phobias and separation anxiety disorder (SAD) have very early AOO distributions </li></ul><ul><ul><li>25 th to 75 th percentiles: 4 – 20 years </li></ul></ul><ul><li>The other anxiety disorders have later AOO distributions </li></ul>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. 8. Limitations of Epidemiologic Data Sources <ul><li>The NCS-R focused on household populations </li></ul><ul><ul><li>Exclusion of the homeless </li></ul></ul><ul><ul><li>Exclusion of those living in institutions </li></ul></ul><ul><li>Survey participation may be systematically higher in those who do not have mental disorders </li></ul><ul><li>Survey responses are based on retrospective recall </li></ul><ul><ul><li>Possibility of recall errors or conscious nonreporting </li></ul></ul><ul><li>As a result of these limitations, the prevalence of anxiety disorders is likely underestimated </li></ul>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. 9. Sociodemographic Factors Associated with Anxiety Disorders <ul><li>Female </li></ul><ul><li>Whites </li></ul><ul><li>Widowed, divorced, or unmarried </li></ul><ul><li>Unemployment, having no occupation </li></ul><ul><li>Low level of education </li></ul><ul><li>Low income </li></ul>Sources: Michael T, Margraf J. Epidemiology of anxiety disorders. Psychiatry 2004;3(4):2-6. National Institute of Mental Health Statistics.
  10. 10. Risk Factors for Anxiety Disorders <ul><li>Behavioral inhibition during childhood </li></ul><ul><li>Negative life events </li></ul><ul><li>Family history of anxiety disorders (genetic factors) </li></ul>Sources: Michael T, Margraf J. Epidemiology of anxiety disorders. Psychiatry 2004;3(4):2-6.
  11. 11. Comorbid Conditions <ul><li>The level of comorbidity among anxiety disorders is high </li></ul><ul><li>Anxiety disorders and affective disorders are strongly associated </li></ul><ul><ul><li>Panic disorder and affective disorders </li></ul></ul><ul><ul><li>GAD and affective disorders </li></ul></ul><ul><li>Anxiety disorders and substance abuse disorders are associated, but not as strongly as comorbidity with affective disorders or other anxiety disorders </li></ul>Sources: Michael T, Margraf J. Epidemiology of anxiety disorders. Psychiatry 2004;3(4):2-6.

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