Abstract
BackgroundTo review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources.MethodsA systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations.ResultsInclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality.ConclusionsSubthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
Highlights
To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources
Whilst previous systematic research has revealed consistent evidence of the impact of various subthreshold mental disorders [12,13,14,15,16,17,18], past studies of generalized anxiety disorder (GAD) below the current diagnostic thresholds have varied widely in their quality and results, with only nonsystematic reviews having been conducted to date [19]
21 studies [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42] were excluded because they reported outcome data only for mixed subthreshold diagnoses, for subthreshold diagnoses other than GAD or because they contained data analyzed in already included articles
Summary
To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources. Mental disorders and anxiety disorders in particular seem to continually increase in incidence and prevalence [1,2,3], raising questions about the early detection of potential risk factors and the nature of ‘subthreshold’ states Individuals in such states experience psychopathological symptoms that are mild, atypical, masked and/or brief but recurrent; which fail to reach the Diagnostic and Statistical Manual of Mental Disorders (DSM) [4] or World Health Organization’s International Classification of Diseases (ICD) [5] standardized diagnostic thresholds by reason of their number and/or duration. The current review aimed to systematically assess prevalence, chronicity risk, human and economic burden as well as treatment need of subthreshold GAD
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