Child and Adolescent Psychiatric Clinics of North America
The Developmental Epidemiology of Anxiety Disorders: Phenomenology, Prevalence, and Comorbidity
Section snippets
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
References (65)
- et al.
The NIMH diagnostic interview schedule for children (DISC 2.3): description, acceptability, prevalences, and performance in the MECA study
J Am Acad Child Adolesc Psychiatry
(1996) - et al.
Genetic and environmental influences on the temporal association between earlier anxiety and later depression in girls
Biol Psychiatry
(2001) - et al.
Stable behavioral inhibition and its association with anxiety disorder
J Am Acad Child Adolesc Psychiatry
(1992) - et al.
A 3-year follow-up of children with and without behavioral inhibition
J Am Acad Child Adolesc Psychiatry
(1993) - et al.
Early childhood predictors of adult anxiety disorders
Biol Psychiatry
(1999) - et al.
Further evidence of an association between behavioral inhibition and anxiety disorders: results from a family study of children from a non-clinical sample
J Psychiatr Res
(1991) - et al.
DSM-III-R disorders in preschool children from low-income families
J Am Acad Child Adolesc Psychiatry
(1997) - et al.
Prevalence rates and correlates of psychiatric disorders among preschool children
J Am Acad Child Adolesc Psychiatry
(1996) - et al.
Mental health in pediatric settings: distributions of disorders and factors related to service juse
J Am Acad Child Adolesc Psychiatry
(2000) - et al.
Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents
J Anxiety Disord
(1997)
Is early separation anxiety a risk factor for adult panic disorder? A critical review
Compr Psychiatry
Adolescent outcomes of childhood disorders: the consequences of severity and impairment
J Am Acad Child Adolesc Psychiatry
Psychiatric disorder among American Indian adolescents: prevalence in northern plains youth
J Am Acad Child Adolesc Psychiatry
Prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds
J Am Acad Child Adolesc Psychiatry
Mental health disorders from age 15 to age 18 years
J Am Acad Child Adolesc Psychiatry
Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors
J Am Acad Child Adolesc Psychiatry
Child and adolescent anxiety disorders and early attachment
J Am Acad Child Adolesc Psychiatry
Traumas and posttraumatic stress disorder in a community population of older adolescents
J Am Acad Child Adolesc Psychiatry
Impaired but undiagnosed
J Am Acad Child Adolesc Psychiatry
Continuity of psychopathology in a community sample of adolescents
J Am Acad Child Adolesc Psychiatry
Diagnostic issues
The developmental epidemiology of anxiety disorders
Prevalence of psychiatric disorders in childhood and adolescence
Anxiety and depression in childhood: prevention and intervention
Manual for the child behavior checklist 4–18 and 1991 profile
Developmental issues
Infant predictors of inhibited and uninhibited profiles
Psychol Sci
Psychiatric correlates of behavioral inhibition in young children of parents with and without psychiatric disorders
Arch Gen Psychiatry
The physiology and psychology of behavioral inhibition in young children
Child Dev
Behavioral inhibition in children: a possible precursor to panic disorder or social phobia
J Clin Psychiatry
Comorbidity of parental anxiety disorders as risk for childhood-onset anxiety in inhibited children
Am J Psychiatry
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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.