Incidence and Risk Patterns of Anxiety and Depressive Disorders and Categorization of Generalized Anxiety Disorder | Anxiety Disorders | JAMA Psychiatry | JAMA Network
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1.
Pine  DSCohen  PGurley  DBrook  JMa  Y The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders.  Arch Gen Psychiatry 1998;55 (1) 56- 64PubMedGoogle ScholarCrossref
2.
Wittchen  H-UKessler  RCPfister  HLieb  R Why do people with anxiety disorders become depressed? a prospective-longitudinal community study.  Acta Psychiatr Scand 2000;102(suppl 406)14- 23Google ScholarCrossref
3.
Pine  DSCohen  PJohnson  JBrook  J Adolescent life events as predictors of adult depression.  J Affect Disord 2002;68 (1) 49- 57PubMedGoogle ScholarCrossref
4.
Brown  TACampbell  LALehman  CLGrisham  JRMancill  RB Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.  J Abnorm Psychol 2001;110 (4) 585- 599PubMedGoogle ScholarCrossref
5.
Kessler  RCChiu  WTDemler  OMerikangas  KRWalters  EE Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005;62(7):709].  Arch Gen Psychiatry 2005;62 (6) 617- 627PubMedGoogle ScholarCrossref
6.
Jacobi  FWittchen  H-UHölting  CHöfler  MPfister  HMüller  NLieb  R Prevalence, comorbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS).  Psychol Med 2004;34 (4) 597- 611PubMedGoogle ScholarCrossref
7.
Krueger  RF The structure of common mental disorders.  Arch Gen Psychiatry 1999;56 (10) 921- 926PubMedGoogle ScholarCrossref
8.
Krueger  RFCaspi  AMoffitt  TESilva  PA The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study.  J Abnorm Psychol 1998;107 (2) 216- 227PubMedGoogle ScholarCrossref
9.
Vollebergh  WAMIedema  JBijl  RVde Graaf  RSmit  FOrmel  J The structure and stability of common mental disorders: the NEMESIS Study.  Arch Gen Psychiatry 2001;58 (6) 597- 603PubMedGoogle ScholarCrossref
10.
Slade  TWatson  D The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population.  Psychol Med 2006;36 (11) 1593- 1600PubMedGoogle ScholarCrossref
11.
American Psychatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994
12.
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision. Washington, DC: American Psychiatric Press; 2000
13.
Andrews  GAnderson  TMSlade  TSunderland  T Classification of anxiety and depressive disorders: problems and solutions.  Depress Anxiety 2008;25 (4) 274- 281PubMedGoogle ScholarCrossref
14.
Watson  DO’Hara  MWStuart  S Hierarchical structures of affect and psychopathology and their implications for the classification of emotional disorders.  Depress Anxiety 2008;25 (4) 282- 288PubMedGoogle ScholarCrossref
15.
Mennin  DSHeimberg  RGFresco  DMRitter  MR Is generalized anxiety disorder an anxiety or mood disorder? considering multiple factors as we ponder the fate of GAD.  Depress Anxiety 2008;25 (4) 289- 299PubMedGoogle ScholarCrossref
16.
Hettema  JM The nosological relationship between generalized anxiety disorder and major depression.  Depress Anxiety 2008;25 (4) 300- 316PubMedGoogle ScholarCrossref
17.
Kendler  KS Major depression and generalised anxiety disorder: same genes, (partly) different environments? revisited.  Br J Psychiatry Suppl 1996;168(30)68- 75PubMedGoogle ScholarCrossref
18.
Kendler  KSNeale  MCKessler  RCHeath  ACEaves  LJ Major depression and generalized anxiety disorder: same genes, (partly) different environments?  Arch Gen Psychiatry 1992;49 (9) 716- 722PubMedGoogle ScholarCrossref
19.
Roy  M-ANeale  MCPedersen  NLMathe  AAKendler  KS A twin study of generalized anxiety disorder and major depression.  Psychol Med 1995;25 (5) 1037- 1049PubMedGoogle ScholarCrossref
20.
Kendler  KSDavis  CGKessler  RC The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: a family history study.  Br J Psychiatry 1997;170541- 548PubMedGoogle ScholarCrossref
21.
Brown  TAChorpita  BFBarlow  DH Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal.  J Abnorm Psychol 1998;107 (2) 179- 192PubMedGoogle ScholarCrossref
22.
Hettema  JMPrescott  CAKendler  KS Genetic and environmental sources of covariation between generalized anxiety disorder and neuroticism.  Am J Psychiatry 2004;161 (9) 1581- 1587PubMedGoogle ScholarCrossref
23.
Hettema  JMNeale  MCMyers  JMPrescott  CAKendler  KS A population-based twin study of the relationship between neuroticism and internalizing disorders.  Am J Psychiatry 2006;163 (5) 857- 864PubMedGoogle ScholarCrossref
24.
Kessler  RCGruber  MHettema  JMHwang  ISampson  NYonkers  KA Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up.  Psychol Med 2008;38 (3) 365- 374PubMedGoogle Scholar
25.
Moffitt  TECaspi  AHarrington  HMilne  BJMelchior  MGoldberg  DPoulton  R Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32.  Psychol Med 2007;37 (3) 441- 452PubMedGoogle ScholarCrossref
26.
Goldberg  D Towards DSM-V: the relationship between generalized anxiety disorder and major depressive episode.  Psychol Med 2008;38 (11) 1671- 1675PubMedGoogle ScholarCrossref
27.
Kendler  KSMyers  JPrescott  CA Parenting and adult mood, anxiety and substance use disorders in female twins: an epidemiological, multi-informant, retrospective study.  Psychol Med 2000;30 (2) 281- 294PubMedGoogle ScholarCrossref
28.
Brown  TA Temporal course and structural relationships among dimensions of temperament and DSM-IV anxiety and mood disorder constructs.  J Abnorm Psychol 2007;116 (2) 313- 328PubMedGoogle ScholarCrossref
29.
Kendler  KSHettema  JMButera  FGardner  COPrescott  CA Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalized anxiety.  Arch Gen Psychiatry 2003;60 (8) 789- 796PubMedGoogle ScholarCrossref
30.
Kendler  KSKarkowski  LMPrescott  CA Stressful life events and major depression: risk period, long-term contextual threat, and diagnostic specificity.  J Nerv Ment Dis 1998;186 (11) 661- 669PubMedGoogle ScholarCrossref
31.
Martin  EINemeroff  CB The biology of generalized anxiety disorder and major depressive disorder: commonalities and distinguishing features.  In: Goldberg  DP, Kendler  KS, eds.  The Future of Psychiatric Diagnosis: Refining the Research Agenda Depression and Generalized Anxiety Disorder. Arlington, VA: American Psychiatric Association. In press Google Scholar
32.
Beesdo  K Wie entstehen Generalisierte Ängste? Eine prospektiv-longitudinale, klinisch-epidemiologische Studie bei Jugendlichen und jungen Erwachsenen.  Dresden, Germany: TUDpress; 2006
33.
Kessler  RCKeller  MBWittchen  H-U The epidemiology of generalized anxiety disorder.  Psychiatr Clin North Am 2001;24 (1) 19- 39PubMedGoogle ScholarCrossref
34.
Bruce  SEYonkers  KAOtto  MWEisen  JLWeisberg  RBPagano  MShea  MTKeller  MB Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study.  Am J Psychiatry 2005;162 (6) 1179- 1187PubMedGoogle ScholarCrossref
35.
Mathews  AMacLeod  C Cognitive vulnerability to emotional disorders.  Annu Rev Clin Psychol 2005;1167- 195PubMedGoogle ScholarCrossref
36.
Mogg  KBradley  BP Attentional bias in generalized anxiety disorder versus depressive disorder.  Cognit Ther Res 2005;29 (1) 29- 45Google ScholarCrossref
37.
Hoyer  JBeesdo  KGloster  ATRunge  JHöfler  MBecker  ES Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder.  Psychother Psychosom 2009;78 (2) 106- 115PubMedGoogle ScholarCrossref
38.
Moffitt  TEHarrington  HCaspi  AKim-Cohen  JGoldberg  DGregory  AMPoulton  R Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years.  Arch Gen Psychiatry 2007;64 (6) 651- 660PubMedGoogle ScholarCrossref
39.
de Graaf  RBijl  RSpijker  JBeekman  ATFVollebergh  WAM Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study.  Soc Psychiatry Psychiatr Epidemiol 2003;38 (1) 1- 11PubMedGoogle ScholarCrossref
40.
Ruscio  AMChiu  WTRoy-Byrne  PStang  PEStein  DJWittchen  H-UKessler  RC Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey replication.  J Anxiety Disord 2007;21 (5) 662- 676PubMedGoogle ScholarCrossref
41.
Andrews  GSlade  TIMIssakidis  C Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being.  Br J Psychiatry 2002;181 (4) 306- 314PubMedGoogle ScholarCrossref
42.
Kessler  RCAndrade  LBijl  ROfford  DDemler  OStein  DJInternational Consortium in Psychiatric Epidemiology, The effects of co-morbidity on the onset and persistence of generalized anxiety disorder in the ICPE surveys.  Psychol Med 2002;32 (7) 1213- 1225PubMedGoogle ScholarCrossref
43.
Grant  BFHasin  DSStinson  FSDawson  DAJune Ruan  WGoldstein  RBSmith  SMSaha  TDHuang  B Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Psychol Med 2005;35 (12) 1747- 1759PubMedGoogle ScholarCrossref
44.
Wittchen  H-UPerkonigg  ALachner  GNelson  CB Early Developmental Stages of Psychopathology Study (EDSP): objectives and design.  Eur Addict Res 1998;4 (1-2) 18- 27PubMedGoogle ScholarCrossref
45.
Wittchen  H-UNelson  CBLachner  G Prevalence of mental disorders and psychosocial impairments in adolescents and young adults.  Psychol Med 1998;28 (1) 109- 126PubMedGoogle ScholarCrossref
46.
Lieb  RIsensee  Bvon Sydow  KWittchen  H-U The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update.  Eur Addict Res 2000;6 (4) 170- 182PubMedGoogle ScholarCrossref
47.
Beesdo  KBittner  APine  DSStein  MBHöfler  MLieb  RWittchen  H-U Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life.  Arch Gen Psychiatry 2007;64 (8) 903- 912PubMedGoogle ScholarCrossref
48.
Bijl  RVvan Zessen  GRavelli  Ade Rijk  CLangendoen  Y The Netherlands Mental Health Survey and Incidence Study (NEMESIS): objectives and design.  Soc Psychiatry Psychiatr Epidemiol 1998;33 (12) 581- 586PubMedGoogle ScholarCrossref
49.
Kessler  RCMerikangas  KR The National Comorbidity Survey Replication (NCS-R): background and aims.  Int J Methods Psychiatr Res 2004;13 (2) 60- 68PubMedGoogle ScholarCrossref
50.
Fergusson  DMHorwood  LJ The Christchurch Health and Development Study: review of findings on child and adolescent mental health.  Aust N Z J Psychiatry 2001;35 (3) 287- 296PubMedGoogle ScholarCrossref
51.
Bittner  AEgger  HLErkanli  ACostello  EJFoley  DLAngold  A What do childhood anxiety disorders predict?  J Child Psychol Psychiatry 2007;48 (12) 1174- 1183PubMedGoogle ScholarCrossref
52.
Wittchen  H-UPfister  H DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12Monate); PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm.  Frankfurt, Germany: Swets & Zeitlinger; 1997
53.
Wittchen  H-ULachner  GWunderlich  UPfister  H Test-retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI).  Soc Psychiatry Psychiatr Epidemiol 1998;33 (11) 568- 578PubMedGoogle ScholarCrossref
54.
Reed  VGander  FPfister  HSteiger  ASonntag  HTrenkwalder  CSonntag  AHundt  WWittchen  H-U To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? testing validity issues in a clinical sample.  Int J Methods Psychiatr Res 1998;7 (3) 142- 155Google ScholarCrossref
55.
Wittchen  H-U Reliability and validity studies of the WHO Composite International Diagnostic Interview (CIDI): a critical review.  J Psychiatr Res 1994;28 (1) 57- 84PubMedGoogle ScholarCrossref
56.
Wittchen  H-ULieb  RSchuster  POldehinkel  AJ When is onset? investigations into early developmental stages of anxiety and depressive disorders.  In: Rapoport  JL, ed.  Childhood Onset of “Adult” Psychopathology: Clinical and Research Advances. Washington, DC: American Psychiatric Press; 1999:259-302Google Scholar
57.
Cox  BJClara  IPEnns  MW Posttraumatic stress disorder and the structure of common mental disorders.  Depress Anxiety 2002;15 (4) 168- 171PubMedGoogle ScholarCrossref
58.
Watson  D Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V J Abnorm Psychol 2005;114 (4) 522- 536PubMedGoogle ScholarCrossref
59.
Kendler  KSGardner  COPrescott  CA Toward a comprehensive developmental model for major depression in women.  Am J Psychiatry 2002;159 (7) 1133- 1145PubMedGoogle ScholarCrossref
60.
Rapee  RM Potential role of childrearing practices in the development of anxiety and depression.  Clin Psychol Rev 1997;17 (1) 47- 67PubMedGoogle ScholarCrossref
61.
Lieb  RIsensee  BHöfler  MPfister  HWittchen  H-U Parental major depression and the risk of depressive and other mental disorders in offspring: a prospective-longitudinal community study.  Arch Gen Psychiatry 2002;59 (4) 365- 374PubMedGoogle ScholarCrossref
62.
Merikangas  KRMehta  RLMolnar  BEWalters  EESwendsen  JDAguilar-Gaziola  SBijl  RBorges  GCaraveo-Anduaga  JJDewit  DJKolody  BVega  WAWittchen  H-UKessler  RC Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology.  Addict Behav 1998;23 (6) 893- 907PubMedGoogle ScholarCrossref
63.
Reznick  JSHegeman  IMKaufman  ERWoods  SWJacobs  M Retrospective and concurrent self-report of behavioral inhibition and their relation to adult mental health.  Dev Psychopathol 1992;4301- 321Google ScholarCrossref
64.
Rohrbacher  HHoyer  JBeesdo  KHöfler  MBittner  ALieb  RWittchen  H-U Psychometric properties of the Retrospective Self Report of Inhibition (RSRI) in a representative German sample.  Int J Methods Psychiatr Res 2008;17 (2) 80- 88PubMedGoogle ScholarCrossref
65.
Weyers  PKrebs  JJanke  W Reliability and construct validity of the German version of Cloninger's Tridimensional Personality Questionnaire.  Pers Individ Dif 1995;19 (6) 853- 861Google ScholarCrossref
66.
Cloninger  CR A systematic method for clinical description and classification of personality variants: a proposal.  Arch Gen Psychiatry 1987;44 (6) 573- 588PubMedGoogle ScholarCrossref
67.
Cloninger  CR Neurogenetic adaptive mechanisms in alcoholism.  Science 1987;236 (4800) 410- 416PubMedGoogle ScholarCrossref
68.
Wagnild  GMYoung  HM Development and psychometric evaluation of the Resilience Scale.  J Nurs Meas 1993;1 (2) 165- 178PubMedGoogle Scholar
69.
Werner  EE Resilience in development.  Curr Dir Psychol Sci 1995;4 (3) 81- 85Google ScholarCrossref
70.
Schumacher  JLeppert  KGunzelmann  TStrauß  BBrähler  E Die Resilienzskala: Ein Fragebogen zur Erfassung der psychischen Widerstandsfähigkeit als Personenmerkmal.  Z Klin Psychol Psychiatr Psychother 2005;5316- 39Google Scholar
71.
Schumacher  JEisemann  MBrähler  E Rückblick auf die Eltern: der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE).  Diagnostica 1999;45194- 204Google ScholarCrossref
72.
Perris  CJacobsson  LLindström  Hvon Knorring  LPerris  H Development of a new inventory for assessing memories of parental rearing behaviour.  Acta Psychiatr Scand 1980;61 (4) 265- 274PubMedGoogle ScholarCrossref
73.
Arrindell  WAPerris  CEisemann  MVan der Ende  JGaszner  PIwawaki  SMaj  MZhang  JE Parental rearing behaviour from a cross-cultural perspective: a summary of data obtained in 14 nations.  In: Perris  C, Arrindell  WA, Eisemann  M, eds.  Parenting and Psychopathology. New York, NY: Wiley & Sons; 1994:145-171Google Scholar
74.
Epstein  NBBaldwin  LMBishop  DS The McMaster Family Assessment Device.  J Marital Fam Ther 1983;9 (2) 171- 180Google ScholarCrossref
75.
Kabacoff  RMiller  IWBishop  DSEpstein  NBKeitner  GI A psychometric study of the McMaster Family Assessment Device in psychiatric, medical, and nonclinical samples.  J Fam Psychol 1990;3 (4) 431- 439Google ScholarCrossref
76.
 STATA [computer program].  Version 10. College Station, TX: STATA Corp; 2007
77.
Royall  RM Model robust confidence intervals using maximum likelihood estimators.  Int Stat Rev 1986;54 (2) 221- 226Google ScholarCrossref
78.
Therneau  TMGrambsch  PM Modeling Survival Data: Extending the Cox Model.  New York, NY: Springer; 2000
79.
Ruscio  AMLane  MRoy-Byrne  PStang  PEStein  DJWittchen  H-UKessler  RC  Should excessive worry be required for a diagnosis of generalized anxiety disorder? results from the US National Comorbidity Survey Replication.  Psychol Med 2005;35 (12) 1761- 1772PubMedGoogle ScholarCrossref
80.
Kessler  RCBrandenburg  NLane  MRoy-Byrne  PStang  PEStein  DJWittchen  H-U Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication.  Psychol Med 2005;35 (7) 1073- 1082PubMedGoogle ScholarCrossref
81.
Krueger  RFMarkon  KE Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology.  Annu Rev Clin Psychol 2006;2111- 133PubMedGoogle ScholarCrossref
82.
Clark  LAWatson  D Distress and fear disorders: an alternative empirically based taxonomy of the “mood” and “anxiety” disorders.  Br J Psychiatry 2006;189481- 483PubMedGoogle ScholarCrossref
83.
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Press; 1980
84.
Kessler  RC Evidence that generalized anxiety disorder is an independent disorder.  In: Nutt  DJ, Rickels  K, Stein  DJ, eds.  Generalized Anxiety Disorder: Symptomatology, Pathogenesis and Management. London, England: Martin Dunitz; 2002:3-10Google Scholar
85.
Hoyer  JBeesdo  KBecker  ESWittchen  H-U Epidemiologie und nosologischer Status der Generalisierten Angststörung.  Z Klin Psychol Psychother 2003;32 (4) 267- 275Google ScholarCrossref
86.
Mennin  DSHeimberg  RGTurk  CL Clinical presentation and diagnostic features.  In: Heimberg  RG, Turk  CL, Mennin  DS, eds.  Generalized Anxiety Disorder: Advances in Research and Practice. New York, NY: Guilford; 2004:3-28Google Scholar
87.
Klein  DNLewinsohn  PMRohde  PSeeley  JRShankman  SA Family study of co-morbidity between major depressive disorder and anxiety disorders.  Psychol Med 2003;33 (4) 703- 714PubMedGoogle ScholarCrossref
88.
Avenevoli  SStolar  MLi  JDierker  LMerikangas  KR Comorbidity of depression in children and adolescents: models and evidence from a prospective high-risk family study.  Biol Psychiatry 2001;49 (12) 1071- 1081PubMedGoogle ScholarCrossref
89.
Weissman  MMWickramaratne  PJAdams  PBLish  JDHorwath  ECharney  DWoods  SWLeeman  EFrosch  E The relationship between panic disorder and major depression: a new family study.  Arch Gen Psychiatry 1993;50 (10) 767- 780PubMedGoogle ScholarCrossref
90.
Levitan  RDRector  NASheldon  TGoering  P Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of co-morbidity and specificity.  Depress Anxiety 2003;17 (1) 34- 42PubMedGoogle ScholarCrossref
91.
Phillips  NKHammen  CLBrennan  PANajman  JMBor  W Early adversity and the prospective prediction of depressive and anxiety disorders in adolescents.  J Abnorm Child Psychol 2005;33 (1) 13- 24PubMedGoogle ScholarCrossref
92.
Biederman  JRosenbaum  JFBolduc-Murphy  EAFaraone  SVChaloff  JHirshfeld  DRKagan  J A 3-year follow-up of children with and without behavioral inhibition.  J Am Acad Child Adolesc Psychiatry 1993;32 (4) 814- 821PubMedGoogle ScholarCrossref
93.
Biederman  JHirshfeld-Becker  DRRosenbaum  JFHérot  CFriedman  DSnidman  NKagan  JFaraone  SV Further evidence of association between behavioral inhibition and social anxiety in children.  Am J Psychiatry 2001;158 (10) 1673- 1679PubMedGoogle ScholarCrossref
94.
Hayward  CKillen  JDKraemer  HCTaylor  CB Linking self-reported childhood behavioral inhibition to adolescent social phobia.  J Am Acad Child Adolesc Psychiatry 1998;37 (12) 1308- 1316PubMedGoogle ScholarCrossref
95.
Beesdo  KLau  JYGuyer  AE McClure-Tone  EBMonk  CSNelson  EEFromm  SSGoldwin  MWittchen  H-ULeibenluft  EErnst  MPine  DS Common and distinct amygdala-function perturbations in depressed vs anxious adolescents.  Arch Gen Psychiatry 2009;66 (3) 275- 285PubMedGoogle ScholarCrossref
96.
Bittner  AGoodwin  RDWittchen  H-UBeesdo  KHöfler  MLieb  R What characteristics of primary anxiety disorders predict subsequent major depressive disorder?  J Clin Psychiatry 2004;65 (5) 618- 626PubMedGoogle ScholarCrossref
97.
Merikangas  KRZhang  HAvenevoli  SAcharyya  SNeuenschwander  MAngst  JZurich Cohort Study, Longitudinal trajectories of depression and anxiety in a prospective community study.  Arch Gen Psychiatry 2003;60 (10) 993- 1000PubMedGoogle Scholar
98.
Woodward  LJFergusson  DM Life course outcomes of young people with anxiety disorders in adolescence.  J Am Acad Child Adolesc Psychiatry 2001;40 (9) 1086- 1093PubMedGoogle ScholarCrossref
99.
Costello  EJMustillo  SErkanli  AKeeler  GAngold  A Prevalence and development of psychiatric disorders in childhood and adolescence.  Arch Gen Psychiatry 2003;60 (8) 837- 844PubMedGoogle ScholarCrossref
100.
Kessler  RCNelson  CB McGonagle  KALiu  JSchwartz  MBlazer  DG Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey.  Br J Psychiatry Suppl 1996; (30) 17- 30PubMedGoogle Scholar
101.
Hettema  JMPrescott  CAKendler  KS The effects of anxiety, substance use and conduct disorders on risk of major depressive disorders.  Psychol Med 2003;33 (8) 1423- 1432PubMedGoogle ScholarCrossref
102.
Kessler  RCStang  PWittchen  H-UStein  MBWalters  EE Lifetime comorbidities between social phobia and mood disorders in the US National Comorbidity Survey.  Psychol Med 1999;29 (3) 555- 567PubMedGoogle ScholarCrossref
103.
Shear  MKBjelland  IBeesdo  KGloster  ATWittchen  H-U Supplementary dimensional assessment in anxiety disorders.  Int J Methods Psychiatr Res 2007;16(suppl 1)S52- S64PubMedGoogle ScholarCrossref
104.
Kessler  RCBerglund  PDemler  OJin  RMerikangas  KRWalters  EE Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication [published correction appears in Arch Gen Psychiatry. 2005;62(7):768].  Arch Gen Psychiatry 2005;62 (6) 593- 602PubMedGoogle ScholarCrossref
105.
Carter  RMWittchen  H-UPfister  HKessler  RC One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample.  Depress Anxiety 2001;13 (2) 78- 88PubMedGoogle ScholarCrossref
106.
Hirshfeld-Becker  DRMicco  JASimoes  NAHenin  A High-risk studies and developmental antecedents of anxiety disorders.  Am J Med Genet C Semin Med Genet 2008;148C (2) 99- 117PubMedGoogle ScholarCrossref
107.
Beesdo  KKnappe  SPine  DS Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V Psychiatr Clin North Am 2009;32 (3) 483- 524PubMedGoogle ScholarCrossref
108.
Brückl  TMWittchen  H-UHöfler  MPfister  HSchneider  SLieb  R Childhood separation anxiety and the risk of subsequent psychopathology: results from a community study.  Psychother Psychosom 2007;76 (1) 47- 56PubMedGoogle ScholarCrossref
109.
Starcevic  VUhlenhuth  EHFallon  SPathak  D Personality dimensions in panic disorder and generalized anxiety disorder.  J Affect Disord 1996;37 (2-3) 75- 79PubMedGoogle ScholarCrossref
110.
Kennedy  BLSchwab  JJHyde  JA Defense styles and personality dimensions of research subjects with anxiety and depressive disorders.  Psychiatr Q 2001;72 (3) 251- 262PubMedGoogle ScholarCrossref
111.
Olfson  MShea  SFeder  AFuentes  MNomura  YGameroff  MWeissman  MM Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice.  Arch Fam Med 2000;9 (9) 876- 883PubMedGoogle ScholarCrossref
112.
Ben-Noun  L Generalized anxiety disorder in dysfunctional families.  J Behav Ther Exp Psychiatry 1998;29 (2) 115- 122PubMedGoogle ScholarCrossref
113.
Cassidy  JLichtenstein-Phelps  JSibrava  NJThomas  CL  JrBorkovec  TD Generalized anxiety disorder: connections with self-reported attachment.  Behav Ther 2009;40 (1) 23- 38PubMedGoogle ScholarCrossref
114.
Leonardo  EDHen  R Anxiety as developmental disorder.  Neuropsychopharmacology 2008;33 (1) 134- 140PubMedGoogle ScholarCrossref
115.
Lau  JYFPine  DS Elucidating risk mechanisms of gene-environment interactions on pediatric anxiety: integrating findings from neuroscience.  Eur Arch Psychiatry Clin Neurosci 2008;258 (2) 97- 106PubMedGoogle ScholarCrossref
116.
Rutter  MMoffitt  TECaspi  A Gene-environment interplay and psychopathology: multiple varieties but real effects.  J Child Psychol Psychiatry 2006;47 (3-4) 226- 261PubMedGoogle ScholarCrossref
117.
Wittchen  H-UBeesdo  KKessler  RC The impact of generalized anxiety disorder.  In: Nutt  DJ, Rickels  K, Stein  DJ, eds.  Generalized Anxiety Disorder: Symptomatology, Pathogenesis and Management. London, England: Martin Dunitz; 2002:11-26Google Scholar
118.
Zimmerman  MChelminski  I Generalized anxiety disorder in patients with major depression: is DSM-IV's hierarchy correct?  Am J Psychiatry 2003;160 (3) 504- 512PubMedGoogle ScholarCrossref
119.
Kraemer  HCKazdin  AEOfford  DRKessler  RCJensen  PSKupfer  DJ Coming to terms with the terms of risk.  Arch Gen Psychiatry 1997;54 (4) 337- 343PubMedGoogle ScholarCrossref
120.
Kagan  J Temperamental contributions to social behavior.  Am Psychol 1989;44 (4) 668- 674Google ScholarCrossref
121.
Turner  SMBeidel  DCWolff  PL Is behavioral inhibition related to anxiety disorders?  Clin Psychol Rev 1996;16157- 172Google ScholarCrossref
122.
Smoller  JWRosenbaum  JFBiederman  JKennedy  JDai  DRacette  SRLaird  NMKagan  JSnidman  NHirshfeld-Becker  DTsuang  MTSklar  PBSlaugenhaupt  SA Association of a genetic marker at the corticotropin-releasing hormone locus with behavioral inhibition.  Biol Psychiatry 2003;54 (12) 1376- 1381PubMedGoogle ScholarCrossref
123.
Sen  SBurmeister  MGhosh  D Meta-analysis of the association between a serotonin transporter promoter polymorphism (5-HTTLPR) and anxiety-related personality traits.  Am J Med Genet B Neuropsychiatr Genet 2004;127B (1) 85- 89PubMedGoogle ScholarCrossref
124.
Clark  LA Temperament as a unifying basis for personality and psychopathology.  J Abnorm Psychol 2005;114 (4) 505- 521PubMedGoogle ScholarCrossref
125.
Kendler  KSAppelbaum  PSBell  CCFulford  KWMGhaemi  SNSchaffner  KFWaterman  GSFirst  MBSadler  JZ Issues for DSM-V: DSM-V should include a conceptual issues work group.  Am J Psychiatry 2008;165 (2) 174- 175PubMedGoogle ScholarCrossref
Original Article
January 2010

Incidence and Risk Patterns of Anxiety and Depressive Disorders and Categorization of Generalized Anxiety Disorder

Author Affiliations

Author Affiliations: Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany (Drs Beesdo and Wittchen); Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland (Dr Pine); Max Planck Institute of Psychiatry, Munich, Germany (Drs Lieb and Wittchen); and Institute of Psychology, Epidemiology, and Health Psychology, University of Basel, Switzerland (Dr Lieb).

Arch Gen Psychiatry. 2010;67(1):47-57. doi:10.1001/archgenpsychiatry.2009.177
Abstract

Context  Controversy surrounds the diagnostic categorization of generalized anxiety disorder (GAD).

Objectives  To examine the incidence, comorbidity, and risk patterns for anxiety and depressive disorders and to test whether developmental features of GAD more strongly support a view of this condition as a depressive as opposed to an anxiety disorder.

Design  Face-to-face, 10-year prospective longitudinal and family study with as many as 4 assessment waves. The DSM-IV Munich Composite International Diagnostic Interview was administered by clinically trained interviewers.

Setting  Munich, Germany.

Participants  A community sample of 3021 individuals aged 14 to 24 years at baseline and 21 to 34 years at last follow-up.

Main Outcome Measures  Cumulative incidence of GAD, other anxiety disorders (specific phobias, social phobia, agoraphobia, and panic disorder), and depressive disorders (major depressive disorder, and dysthymia).

Results  Longitudinal associations between GAD and depressive disorders are not stronger than those between GAD and anxiety disorders or between other anxiety and depressive disorders. Survival analyses reveal that the factors associated with GAD overlap more strongly with those specific to anxiety disorders than those specific to depressive disorders. In addition, GAD differs from anxiety and depressive disorders with regard to family climate and personality profiles.

Conclusions  Anxiety and depressive disorders appear to differ with regard to risk constellations and temporal longitudinal patterns, and GAD is a heterogeneous disorder that is, overall, more closely related to other anxiety disorders than to depressive disorders. More work is needed to elucidate the potentially unique aspects of pathways and mechanisms involved in the etiopathogenesis of GAD. Grouping GAD with depressive disorders, as suggested by cross-sectional features and diagnostic comorbidity patterns, minimizes the importance of longitudinal data on risk factors and symptom trajectories.

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