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

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, cros...

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Autores: Ruscio, Ayelet Meron, Alonso Caballero, Jordi, World Mental Health Survey collaborators
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/69128
Acceso en línea:http://hdl.handle.net/10230/69128
http://dx.doi.org/10.1017/S003329172400182X
Access Level:acceso abierto
Palabra clave:Classification
Diagnosis
Epidemiology
Generalized anxiety disorder
Global mental health
Worry
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spelling The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigationRuscio, Ayelet MeronAlonso Caballero, JordiWorld Mental Health Survey collaboratorsClassificationDiagnosisEpidemiologyGeneralized anxiety disorderGlobal mental healthWorryBackground: 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.Cambridge University Press202520252024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/69128http://dx.doi.org/10.1017/S003329172400182Xreponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésPsychol Med. 2024 Oct 4;54(12):1-12Copyright © The Author(s), 2024. Published by Cambridge University Press. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10230/691282026-05-29T05:05:01Z
dc.title.none.fl_str_mv The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
title The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
spellingShingle The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
Ruscio, Ayelet Meron
Classification
Diagnosis
Epidemiology
Generalized anxiety disorder
Global mental health
Worry
title_short The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
title_full The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
title_fullStr The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
title_full_unstemmed The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
title_sort The case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
dc.creator.none.fl_str_mv Ruscio, Ayelet Meron
Alonso Caballero, Jordi
World Mental Health Survey collaborators
author Ruscio, Ayelet Meron
author_facet Ruscio, Ayelet Meron
Alonso Caballero, Jordi
World Mental Health Survey collaborators
author_role author
author2 Alonso Caballero, Jordi
World Mental Health Survey collaborators
author2_role author
author
dc.subject.none.fl_str_mv Classification
Diagnosis
Epidemiology
Generalized anxiety disorder
Global mental health
Worry
topic Classification
Diagnosis
Epidemiology
Generalized anxiety disorder
Global mental health
Worry
description 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.
publishDate 2024
dc.date.none.fl_str_mv 2024
2025
2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/69128
http://dx.doi.org/10.1017/S003329172400182X
url http://hdl.handle.net/10230/69128
http://dx.doi.org/10.1017/S003329172400182X
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Psychol Med. 2024 Oct 4;54(12):1-12
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Cambridge University Press
publisher.none.fl_str_mv Cambridge University Press
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
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