The Developmental Epidemiology of Anxiety Disorders: Phenomenology, Prevalence, and Comorbidity

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Prevalence and comorbidity

This article reviews the epidemiologic literature on anxiety disorder in general and, when they are specified, on separation anxiety disorder (SAD), generalized anxiety disorder (GAD), overanxious disorder (OAD), specific phobias, panic, agoraphobia, social phobia, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, many epidemiologic studies have reported on “anxiety” in general, without distinguishing among the specific categories set out in, for example,

Anxiety and disability

One of the most hotly debated areas in the past few years has been the relationship between psychiatric diagnosis and the level of functioning. When the first versions of the DIS for Children (DISC) were introduced in the 1980s, they were found to generate extremely high prevalence rates for some disorders, among which were some anxiety disorders [3], [52]; for example, according to data from the four-site Methods for the Epidemiology of Child and Adolescent (MECA) mental disorders study, 39.5%

Sex and age differences in the prevalence of anxiety disorders

Girls are somewhat more likely than boys are to report an anxiety disorder of some sort. However, at the level of individual diagnoses, few of the gender differences are large. If we assume that the difference is likely to be clinically and statistically meaningful if twice as many girls as boys reported a diagnosis, then only the eight studies cited in Table 2 reported any meaningful gender differences. Three studies reported more specific phobias in girls; two studies reported more panic

Comorbidity among anxiety disorders

Comorbidity among anxiety disorders has historically been a problem, not only for nosology and epidemiology but also for diagnosis and treatment. This is an area in which the high level of comorbidity found in clinical samples is mirrored in community samples. A review of published studies yields inconclusive results because (1) not all diagnoses were included in every study, and the number of anxiety disorders included in the analyses of comorbidity varies from study to study; (2) there is a

Comorbidity with other disorders

A review of comorbidity with anxiety disorders published in 1999 [59] showed that, controlling for other comorbid conditions, the highest level of anxious comorbidity was with depression, with a median odds ratio of 8.2 (95% CI, 5.8–12.0). This means that across all available studies, depression was 8.2 times as likely in children with anxiety disorders as in children without anxiety disorders and that 95 of 100 times the increase in likelihood of depression in the presence of anxiety would lie

Homotypic and heterotypic continuity

An important question for clinicians is whether children with anxiety disorders can be expected to have further episodes of the same disorder (homotypic continuity) or to develop other psychiatric conditions (heterotypic continuity). There are few studies that deal thoughtfully with issues of concurrent versus sequential comorbidity [62]. Some studies have suggested that childhood anxiety predicts adolescent depression [5], but there also is evidence that early depression predicts anxiety [6].

Summary

This article argues that the quality (accuracy, reliability, validity) of measures used to measure anxiety disorders in the child and adolescent population have improved enormously in the past few years. As a result, prevalence estimates are less erratic, our understanding of comorbidity is increasing, and the role of impairment as a criterion for “caseness” is more carefully considered. Several of the instruments developed for epidemiologic research are now being used in clinical settings. The

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    This work is based in part on Costello EJ, Egger HL, Angold A. The developmental epidemiology of anxiety disorders. In: Ollendick T, March J, editors. Phobic and anxiety disorders in children and adolescents. New York: Oxford University Press; 2004. p. 61–91; copyright 2004, Oxford University Press; with permission.

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