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    Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries
    (CAMBRIDGE UNIV PRESS, 32 AVENUE OF THE AMERICAS, NEW YORK, NY 10013-2473 USA, 2009) Lee, S.; Tsang, A.; Ruscio, A.M.; Haro, J.M.; Stein, D.J.; Alonso, J.; Angermeyer, M.C.; Bromet, E.J.; Demyttenaere, K.; De Girolamo, G.; De Graaf, R.; Gureje, O.; Iwata, N.; Karam, E.G.; Lepine, J.P.; Levinson, D.; Medina-Mora, M.E.; Oakley Browne, M.A.; Posada-Villa, J.; Kessler, R.C.; Chinese Univ Hong Kong, Dept Psychiat, Hong Kong Mood Disorders Ctr, Hong Kong, Hong Kong, Peoples R China; singlee@cuhk.edu.hk
    Background. A number of western studies have suggested that the 6-month duration requirement of generalized anxiety disorder (GAD) does not represent a critical threshold in terms of onset, course, or risk factors of the disorder. No study has examined the consequences of modifying the duration requirement across a wide range of correlates in both developed and developing countries. Method. Population surveys were carried out in seven developing and 10 developed countries using the WHO Composite International Diagnostic Interview (total sample=85052). prevalence and correlates of GAD were compared across mutually exclusive GAD subgroups defined by different minimum duration criteria. Results. Lifetime prevalence estimates for GAD lasting I month, 3 months, 6 months and 12 months were 7.5%, 5.2%, 4.1% and 3.0% for developed countries and 2.7%, 1.8%, 1.5% and 1.2% for developing countries, respectively. There was little difference between GAD of 6 months' duration and GAD of shorter durations (1-2 months, 3-5 months) in age of onset, symptom severity or persistence, co-morbidity or impairment. GAD lasting >= 12 months was the most severe, persistently symptomatic and impaired subgroup. Conclusions. In both developed and developing countries, the clinical profile of GAD is similar regardless of duration. The DSM-IV 6-month duration criterion excludes a large number of individuals who present with shorter generalized anxiety episodes which may be recurrent, impairing and contributory to treatment-seeking. Future iterations of the DSM and ICD should consider modifying the 6-month duration criterion so as to better capture the diversity of clinically salient anxiety presentations.
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    Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative
    (ELSEVIER MASSON, VIA PALEOCAPA 7, 20121 MILANO, ITALY, 2007) Kessler, Ronald C.; Angermeyer, Matthias; Anthony, James C.; De Graaf, Ron; Demyttenaere, Koen; Gasquet, Isabelle; De Girolamo, Giovanni; Gluzman, Semyon; Gureje, Oye; Haro, Josep Maria; Kawakami, Norito; Karam, Aimee; Levinson, Daphna; Medina-Mora, María Elena; Browne, Mark A. Oakley; Posada-Villa, José; Stein, Dan J.; Tsang, Cheuk Him Adley; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Lee, Sing; Heeringa, Steven; Pennell, Beth-Ellen; Berglund, Patricia; Gruber, Michael J.; Petukhova, María; Chatterji, Somnath; Uestuen, T. Bedirhan; Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA; kessler@hcp.med.harvard.edu
    Data are presented on the lifetime prevalence, projected lifetime risk, and age-of-onset distributions of mental disorders in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Face-to-face community surveys were conducted in seventeen countries in Africa, Asia, the Americas, Europe, and the Middle East. The combined numbers of respondents were 85,052. Lifetime prevalence, projected lifetime risk and age of onset of DSM-IV disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI), a fully-structured lay administered diagnostic interview. Survival analysis was used to estimate lifetime risk. Median and inter-quartile range (IQR) of age of onset is very early for some anxiety disorders (7-14, IQR: 8-11) and impulse control disorders (7-15, IQR: 11-12). The age-of-onset distribution is later for mood disorders (29-43, IQR: 35-40), other anxiety disorders (24-50, IQR: 31-41), and substance use disorders (18-29, IQR: 21-26). Median and IQR lifetime prevalence estimates are: anxiety disorders 4.8-31.0% (IQR: 9.9-16.7%), mood disorders 3.3-21.4% (IQR: 9.8-15.8%), impulse control disorders 0.3-25.0% (IQR: 3.1-5.7%), substance use disorders 1.3-15.0% (IQR: 4.8-9.6%), and any disorder 12.0-47.4% (IQR: 18.1-36.1%). Projected lifetime risk is proportionally between 17% and 69% higher than estimated lifetime prevalence (IQR: 28-44%), with the highest ratios in countries exposed to sectarian violence (Israel, Nigeria, and South Africa), and a general tendency for projected risk to be highest in recent cohorts in all countries. These results document clearly that mental disorders are commonly occurring. As many mental disorders begin in childhood or adolescents, interventions aimed at early detection and treatment might help reduce the persistence or severity of primary disorders and prevent the subsequent onset of secondary disorders.