期刊
JAMA PSYCHIATRY
卷 74, 期 5, 页码 465-475出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jamapsychiatry.2017.0056
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资金
- National Institute of Mental Health (NIMH) [R01 MH070884]
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- US Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center [FIRCA R03-TW006481]
- Pan American Health Organization
- Eli Lilly and Company
- Ortho-McNeil Pharmaceutical, Inc
- GlaxoSmithKline
- Bristol-Myers Squibb
- Australian Government Department of Health and Ageing
- State of Sao Paulo Research Foundation Thematic Project [03/00204-3]
- Ministry of Health
- National Center for Public Health Protection
- Shenzhen Bureau of Health
- Shenzhen Bureau of Science, Technology, and Information
- Ministry of Social Protection
- Center for Excellence on Research in Mental Health (CES University)
- Medellin
- European Commission [QLG5-1999-01042, SANCO 2004123, EAHC 20081308]
- Fondo de Investigacion Sanitaria
- Instituto de Salud Carlos III, Spain [FIS 00/0028]
- Ministerio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]
- Departament de Salut, Generalitat de Catalunya, Spain
- Instituto de Salud Carlos III [CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP]
- Japanese and European Funds through United Nations Development Group Iraq Trust Fund
- Israel National Institute for Health Policy and Health Services Research
- National Insurance Institute of Israel
- Japan Ministry of Health, Labour and Welfare [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]
- Lebanese Ministry of Public Health
- WHO (Lebanon)
- National Institute of Health/Fogarty International Center [R03 TW006481-01]
- Algorithm
- AstraZeneca
- Benta
- Bella Pharma
- Eli Lilly
- Lundbeck
- Novartis
- Servier
- Phenicia
- Union Pharmaceutique d'Orient SAL
- National Institute of Psychiatry Ramon de la Fuente grant [INPRFMDIES 4280]
- National Council on Science and Technology grant [CONACyT-G30544-H]
- New Zealand Ministry of Health
- Alcohol Advisory Council
- Health Research Council
- WHO (Geneva)
- WHO (Nigeria)
- Federal Ministry of Health, Abuja, Nigeria
- Health AMP
- Social Care Research AMP
- Development Division of the Public Health Agency
- National Institute of Health of the Ministry of Health of Peru
- European Economic Area Financial Mechanism and the Norwegian Financial Mechanism
- Polish Ministry of Health
- Champalimaud Foundation
- Gulbenkian Foundation
- Foundation for Science and Technology
- Ministry of Public Health
- Eli Lilly Romania SRL
- US NIMH [R01-MH059575, R01-MH61905]
- National Institute of Drug Abuse
- South African Department of Health
- University of Michigan
- Regional Health Authorities of Murcia
- Servicio Murciano de Salud
- Consejeria de Sanidad y Politica Social
- Fundacion para la Formacion e Investigacion Sanitarias of Murcia
- NIMH [U01-MH60220, R01 MH094425]
- Substance Abuse and Mental Health Services Administration
- Robert Wood Johnson Foundation [044708]
- John W. Alden Trust
- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [03/00204-3] Funding Source: FAPESP
IMPORTANCE Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. OBJECTIVE To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. DESIGN, SETTING, AND PARTICIPANTS Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. RESULTS Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7%(0.1%), 12-month prevalence of 1.8%(0.1%), and 30-day prevalence of 0.8%(0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6%[0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0%[0.9%]) and other anxiety (51.7%[0.9%]) disorders. Severe role impairment is common across life domains (50.6%[1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2%[1.2%]), especially those with severe role impairment (59.4%[1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0%[1.3%]). CONCLUSIONS AND RELEVANCE The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.
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