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

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dc.contributor.affiliationDepartment of Psychology, University of Pennsylvania, Philadelphia, PA, USA
dc.contributor.emailkessler@hcp.med.harvard.edu (Ronald C. Kessler)
dc.creatorMeron Ruscio, Ayelet
dc.creatorRassaby, Madeleine
dc.creatorStein, Murray B.
dc.creatorStein, Dan J.
dc.creatorAguilar-Gaxiola, Sergio
dc.creatorAl-Hamzawi, Ali
dc.creatorAlonso, Jordi
dc.creatorAtwoli, Lukoye
dc.creatorBorges, Guilherme
dc.creatorBromet, Evelyn J.
dc.creatorBruffaerts, Ronny
dc.creatorBunting, Brendan
dc.creatorCardoso, Graça
dc.creatorChardoul, Stephanie
dc.creatorGirolamo, Giovanni de
dc.creatorJonge, Peter de
dc.creatorGureje, Oye
dc.creatorHaro, Josep Maria
dc.creatorKaram, Elie G.
dc.creatorKaram, Aimee
dc.creatorKiejna, Andrzej
dc.creatorKovess-Masfety, Viviane
dc.creatorLee, Sue
dc.creatorNavarro-Meteu, Fernando
dc.creatorNishi, Daisuke
dc.creatorPiazza, Marina
dc.creatorPosada-Villa, José
dc.creatorSampson, Nancy A.
dc.creatorScott, Kate M.
dc.creatorSlade, Tim
dc.creatorStagnaro, Juan Carlos
dc.creatorTorres, Yolanda
dc.creatorViana, Maria Carmen
dc.creatorVladescu, Cristian
dc.creatorZarkov, Zahari
dc.creatorKessler, Ronald C.
dc.creatorWorld Mental Health Survey collaborators
dc.date2024
dc.date.accessioned2026-05-19T20:45:11Z
dc.date.issued2024
dc.date.published2024
dc.descriptionBackground: 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.
dc.formatPDF
dc.identifierJC09DIEP24
dc.identifier.doi10.1017/S003329172400182X
dc.identifier.eissn1469-8978
dc.identifier.issn0033-2917
dc.identifier.organizacionInstituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
dc.identifier.placeInglaterra
dc.identifier.urihttps://repositorio.inprf.gob.mx/handle/123456789/19
dc.identifier.urihttps://doi.org/10.1017/S003329172400182X
dc.language.isoeng
dc.publisherCambridge University Press
dc.relation54(12):3447-3458
dc.relation.jnabreviadoPSYCHOL MED
dc.relation.journalPsychological Medicine
dc.rightsAcceso Cerrado
dc.subject.kwClassification
dc.subject.kwDiagnosis
dc.subject.kwEpidemiology
dc.subject.kwGeneralized anxiety disorder
dc.subject.kwGlobal mental health
dc.subject.kwWorry
dc.titleThe case for eliminating excessive worry as a requirement for generalized anxiety disorder: a cross-national investigation
dc.typeArtículo

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