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JAMA Psychiatry. 2017 May 1;74(5):465-475. doi: 10.1001/jamapsychiatry.2017.0056.

Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe.

Author information

Department of Psychology, University of Pennsylvania, Philadelphia.
Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.
Center for Reducing Health Disparities, University of California Davis Health System, Sacramento.
College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq.
Health Services Research Unit, Institut Municipal d'Investigació Médica-Hospital del Mar Medical Research Institute, Barcelona, Spain7Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain 8CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
Calzada México Xochimilco No. 101 Delegación Tlalpan, Distrito Federal, Mexico.
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York.
School of Psychology, Ulster University, Londonderry, United Kingdom.
Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.
Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
National School of Public Health, Management and Professional Development, Bucharest, Romania.
Istituto Di Ricovero e Cura a Carattere Scientifico, St John of God Clinical Research Centre, Brescia, Italy.
Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red Salud Mental, Universitat de Barcelona, Barcelona, Spain.
Shanghai Mental Health Center, Shanghai, China.
National Center for Public Health and Analyses, Sofia, Bulgaria.
Shenzhen Institute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China.
Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, the Netherlands23Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands.
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon25Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon26Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon.
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot and Paris Descartes, Paris, France.
Ministry of Health Israel, Mental Health Services, Jerusalem, Israel.
Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon30Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor.
Unidad de Docencia, Investigación y Formación en Salud Mental, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública-Murcia, Murcia, Spain.
Colegio Mayor de Cundinamarca University, Bogota, Colombia.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa.
Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia.
Health, Social Welfare, and Environmental Department, Kagoshima Regional Promotion Bureau, Kagoshima Prefecture, Japan.
Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland.



Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5.


To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact.

Design, Setting, and Participants:

Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016.

Main Outcomes and Measures:

The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking.


Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]).

Conclusions and Relevance:

The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.

[Indexed for MEDLINE]
Free PMC Article

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