Prevalence for Generalized Anxiety Disorder

Before GAD was given the status of a separate nosological entity in the DSM-III, the overall estimation of the prevalence of anxiety neurosis varied widely. One study gave an estimation of 2.9%, but this study of course, like all others, did not distinguish between panic and GAD. Owing to the above reviewed continuing changes in the diagnostic criteria for GAD, the prevalence rates of this disorder have varied accordingly. In fact, DSM-III-R rates are different from the International Classification of Diseases (ICD-10) rates, or even the Research Diagnostic Criteria (RDC) rates. The National Comorbidity Survey of psychiatric disorders (NCS) performed an epidemiological study in the USA about the prevalence of GAD, according to the diagnostic criteria of DSM-III-R.

In a representative national sample of 8098 individuals, the prevalence rates were 1.6% for current GAD (defined as the most recent six-month period of anxiety), 3.1% for 12-month period of GAD and 5.1% for lifetime GAD. These rates are definitely higher than rates of panic disorders . These data agree with the Epidemiological Catchment Area Study (ECA). This study reported a 12-month GAD prevalence of 3% and lifetime prevalence of 4–6%. According to Anderson et al., the 12-months prevalence rates of overanxious anxiety disorder (the GAD equivalent for children) are 2.9%. On the other hand, the elderly showed GAD prevalence rates higher than any other anxiety disorder, varying from 0.7% to 7.1%.

In primary care centres, the GAD prevalence is approximate. This implies that GAD is the most frequently diagnosed anxiety disorder in primary care centres. Noteworthy in these centres is that the GAD diagnosis is often unrecognised. In addition, most GAD diagnoses are in primary care associated with a high rate of psychiatric comorbidity. Contrasting herewith, in mental health centres, the GAD prevalence is one of the lowest compared with other anxiety disorders. Thus, it appears that the bulk of subjects meeting the criteria for a GADdiagnosis are confined to the primary care setting, whereGAD should be a very common condition, even though GAD is underdiagnosed.

One of the consequences of this situation is the relatively small number of good studies on GAD. Apparently, as a rule, patients with GAD complaints do not seek treatment in specialised care setting.

According to Noyes et al., only 10% of the patients with anxiety disorders who are treated by psychiatrists, have a diagnosis of GAD. Nevertheless, in spite of the changing diagnostic criteria, and in spite of being an underdiagnosed condition, the available data strongly suggest that GAD is one of the most common anxiety disorders. Patients with GAD more often visit primary care centres than mental health centres. In primary care centres, the diagnosis is frequently either incomplete or overlooked at all, probably as a result of the high comorbidity rate with other psychiatric disorders.

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