Prevalence and Incidence Studies of Anxiety Disorders: A Systematic Review of the Literature
In recent years, it has been increasingly acknowledged not only that anxiety disorders are highly prevalent, but also that the burden of illness associated with these disorders is often considerable. A broad understanding of the etiology of anxiety includes a multiplicity of factors, such as biological, psychological, and social determinants, which are mediated by a range of risk and protective factors. Cross-cultural studies in epidemiology are a critical source of information regarding the interplay between these factors. Effective forms of intervention are available and are the subject of ongoing research, but it is an immense public health challenge to coordinate the delivery of these programs and services. Studies in comparative epidemiology play a vital role in the development of health policy concerning anxiety. Empirical knowledge of regional prevalence is fundamental to understanding the relative demand for services. Such knowledge is also necessary to identify the most appropriate avenues for intervention.
The present review, which is the fifth in a series of papers that will present systematic reviews of the prevalence and incidence of psychiatric disorders drawn from studies published in the English literature in the years 1980 to 2004, sought to synthesize international research on this topic. Results and observed patterns of heterogeneity are discussed in relation to health services planning as well as implications for additional research.
The methods employed in this review have been presented in more detail elsewhere (1). The MEDLINE and HealthSTAR databases were searched for relevant studies; the key indexing terms epidemiology, prevalence, and incidence were used, combined with the search terms mental disorders, anxiety disorders, panic disorder, phobia, obsessive–compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. The search was limited to English-language studies published between 1980 and 2004. Reference lists of relevant primary and review articles identified were also searched.
Prevalence and incidence studies were eligible for inclusion if they were community surveys using probability sampling techniques. Eligible publications were restricted to studies having sample sizes of 450 people or more that examined age ranges covering the adult population. Only studies using current diagnostic criteria and case identification based on either standardized instruments or clinician diagnosis were included. Prevalence and incidence data, including overall, sex-specific and age-specific rates, were extracted from eligible studies.
Qualitative analyses of variables related to methodology were conducted to summarize and elucidate any observed differences between rates. Each set of rates was also pooled according to a Bayesian approach to metaanalysis; the Fastpro software program was used. Readers interested in a more detailed discussion of this approach should refer to Eddy and others (2). Each of the pooled rates was analyzed for heterogeneity with chi-square tests according to the Fleiss method (3).
Description of Studies
From the citations and abstracts generated by the initial electronic search, we identified 80 prevalence and 10 incidence studies potentially meeting inclusion criteria, in addition to 28 review papers (4–31). The full texts of these articles were retrieved. We searched all reference lists of identified studies and reviews, generating an additional 38 prevalence and 6 incidence studies for which full-text articles were obtained.
Of the 118 prevalence studies for which full-text articles were reviewed, 71 prevalence papers of anxiety disorders met eligibility criteria (32–95,96–102), resulting in a total of 41 unique primary investigations of anxiety disorders included in this review. We excluded a total of 47 studies: 35 studies did not meet eligibility criteria, and 12 presented duplicate data. Of the 16 incidence studies identified, 11 were excluded, 8 did not meet inclusion criteria, and 3 were based on duplicate study samples. This resulted in 5 incidence studies of anxiety disorders that could be included (54,90,103–105). Most studies meeting inclusion criteria used nonhierarchical diagnostic approaches. Predictably, the few studies using hierarchical diagnoses reported relatively lower rates of individual disorders.
Findings, for the 34 papers reporting overall and (or) sex-specific 1-year and (or) lifetime prevalence rates for panic disorder, agoraphobia, social phobia, specific phobia, OCD, PTSD, GAD, and TAD, are presented in Tables 1 to 3. Age-specific lifetime prevalence rates for these disorders are also presented in Figure 1 (33,34,40,44,59,66,73,81, 84,94,101,106). The results of studies reporting only data for point prevalence or 6-month prevalence are not presented (36,37,41,45,49,53,54, 56,6,63,67,69,70,74–76,78,86,87, 92,93,107). Analysis of data was carried out only when 3 or more rates were reported as this was the minimum number of values required to produce pooled rates.
All the studies presented are community surveys using samples ranging from approximately 500 (48) to 20 000 (106) people. For each of these studies, the percentage CI width or error rate for estimated prevalence at a 95%CI may be calculated with the formula provided by Kelsey and colleagues (108, p 282). For the most part, studies used either the DIS or the CIDI administered by trained lay interviewers and applied algorithms to derive diagnoses.
Total Anxiety Disorders
For TADs, 1-year prevalence rates ranged from 4.2% in Florence, Italy (95), to 17.2% in the NCS (39), which is a variation of 4.1-fold (Table 1). The study with the lowest rate, conducted in Florence, Italy, employed the SADS-L to identify cases, whereas most other studies used the CIDI. Lifetime prevalence rates ranged from 9.2% in Korea (40) to 28.7% in Basle, Switzerland (48), a variation of slightly over 3-fold. The study conducted in Basle, Switzerland, was the only one to use clinical interviewers, while all other studies employed lay interviewers and diagnostic algorithms. Further, studies with the lowest rates used the DIS and DSM-III criteria, whereas other studies used the CIDI and DSM-III-R criteria.
Tables 2 and 3 present findings from studies reporting sex-specific 1-year and lifetime prevalence rates, respectively, for anxiety disorders. For TADs, 1-year and lifetime prevalence rates were generally found to be about twice as high for women, compared with men. Studies reporting 1-year and lifetime sex-specific rates for panic disorder showed consistently higher rates for women, compared with men, but varied in the magnitude of this difference with rates that were 1.2-fold (34) to 6.8-fold (40) higher for women than men. Most rates for panic disorder, however, were generally found to be between 2 and 3.5 times higher for women, compared with men. With regard to phobic disorders, 1-year and lifetime prevalence rates were generally found to be between 2 and 4 times higher for women, compared with men, for agoraphobia and specific phobia. While most 1-year and lifetime rates for social phobia were found to be between 1.2 and 2.6 times higher for women, compared with men, there were studies reporting lifetime rates for women that were 5 times (38) and 12.5 times (40) rates for men. Furthermore, there were studies demonstrating higher lifetime prevalence rates for social phobia in men, compared with women (38,43).
For OCD, there was little consistency observed for sex-specific rates. Most rates were found to be higher for women than for men but several studies demonstrated higher rates for men, compared with women (32,34,38). For studies reporting higher female rates, most rates were 1.1 to 1.8 times higher for women than for men, while one study found a female rate that was 14.8 times that of the male rate (77). With regard to GAD, the 1-year and lifetime rates were generally found to be 1.5 to 2 times higher for women, compared with men.
Age-Specific Lifetime Prevalence
Figure 1 presents results from each study reporting age-specific lifetime prevalence rates for anxiety disorders. As shown, lifetime prevalence rates for agoraphobia and OCD appear to remain fairly stable throughout ages 18 to 64 years. For social phobia, there seems to be a slight decrease in prevalence with increasing age. When all anxiety disorders are taken together, there appears to be an increase in lifetime prevalence throughout ages 18 to 64 years.
Qualitative observations associated with individual anxiety disorders appear alongside the results presented in the following section.
Estimation and Heterogeneity Analysis of Pooled Best-Estimate Rates
Total Anxiety Disorders
The best-estimate rates for 1-year and lifetime prevalence of TADs were 10.6% (95%CI, 7.5% to 14.3%) and 16.6% (95%CI, 12.7% to 21.1%), respectively (Table 1). The CI variations for the 1-year and lifetime prevalence estimates are 1.9-fold and 1.7-fold, respectively, which are lower than the respective 4.1-fold and 3.1-fold variations observed across individual rates. Heterogeneity analysis of 1-year and lifetime prevalence rates revealed significant differences across each set of proportions. Chi-square tests for heterogeneity were conducted for the following variables: country studied, year study published, type of sample (that is, national, regional, or municipal); sample size; sample inclusion (that is, community only or community and institutional), diagnostic instrument used, type of interviewer (that is, lay or clinician), mode of establishing diagnosis (that is, algorithm or clinical judgment), and diagnostic criteria used. Variables that may be contribute to heterogeneity are shown in Table 4. For lifetime prevalence, the diagnostic criteria and instruments used were variables that may have contributed to heterogeneity (Table 4). Studies that employed the DIS and DSM-III criteria had pooled lifetime rates that were almost 2 times lower than those of studies that used other diagnostic instruments and criteria.
The best-estimate rates for 1-year and lifetime prevalence were 0.99% (95%CI, 0.55% to 1.5%) and 1.2% (95%CI, 0.7% to 1.9%), respectively (Table 1). The variations in the 1-year and lifetime prevalence rates, as shown by the CIs, are both 2.7-fold. Across individual studies, the 1-year prevalence rates ranged from 0.13% in rural villages in Taiwan (38) to 3.2% in Florence, Italy (95), which is a difference of almost 25-fold. Lifetime prevalence rates for panic disorder ranged from 0.13% in rural villages in Taiwan (38) to 3.8% in the Netherlands (32), a variation of approximately 29-fold. Heterogeneity analysis demonstrated significant differences across 1-year and lifetime prevalence rates of panic disorder. For studies conducted in Asia, the pooled 1-year rates were found to be approximately 9 times lower than that of studies conducted elsewhere (Table 4). All studies with lifetime prevalence rates under 3.0% used DSM-III criteria and, for the most part, the DIS, whereas all studies with rates above 3.0% employed the CIDI and DSM-III-R criteria.
The best-estimate rates for 1-year and lifetime prevalence were 1.6% (95%CI, 1.0% to 2.3%) and 3.8% (95%CI, 2.5% to 5.6%), respectively (Table 1). The variations in the CIs for these 1-year and lifetime prevalence rates are 2.3-fold and 2.2-fold, respectively. By contrast, 1-year prevalence rates for agoraphobia ranged, among different studies, from 0.6% in Florence, Italy, to 2.9% (95) in Christchurch, New Zealand (55), which is a 4.5-fold variation. The lifetime prevalence rates for agoraphobia ranged from 0.73% in Hong Kong (35) to 10.8% in Basle, Switzerland (48), a variation of almost 15-fold. Heterogeneity was demonstrated for 1-year and lifetime prevalence rates of agoraphobia. For studies employing lay interviewers, the pooled 1-year rate was over 2.5 times higher than that of studies using clinical interviewers (Table 4). Studies conducted in Asian countries produced a pooled lifetime rate that was almost 4 times lower than studies carried out in non-Asian countries.
The best-estimate rates for 1-year and lifetime prevalence were 4.5% (95%CI, 3.0% to 6.4%) and 3.6% (95%CI, 2.0% to 5.6%), respectively (Table 1). Across individual studies, 1-year prevalence rates ranged from 2.3% in France (62) to 44.2% in Udmurtia, Udmurt Republic (a sovereign republic within the Russian Federation) (50), an approximate 19-fold difference. Excluding the outlying value reported in Udmurtia, the rates vary up to 7.9%, which is a much smaller difference of 3.4-fold. Both studies reporting the highest and lowest 1-year rates used the CIDI and clinician diagnoses. With respect to lifetime prevalence of social phobia, the rates ranged from 0.53% in Korea (40) to 45.6% in Udmurtia (50). This is a difference of 86-fold. Excluding the outlying rate reported in Udmurtia, the rates vary up to 16.0%, which is a variation of approximately 30-fold. The CI variations for the 1-year and lifetime best-estimate rates are 2.1-fold and 2.8-fold, respectively, which are much lower than the respective 3.4-fold and 30-fold differences observed across individual rates. Inclusion of the outlying rate in the pooled estimate would produce a 1-year and lifetime prevalence of 6.3% (95%CI, 2.9% to 10.8%) and 4.5% (95%CI, 2.3% to 7.2%), respectively. Significant differences were found among 1-year and lifetime prevalence rates of social phobia. For studies using the DIS, the pooled lifetime prevalence was 4 times lower than that of studies using other diagnostic instruments (Table 4). Similarly, for studies using DSM-III criteria, the pooled lifetime prevalence was over 5 times lower than that of studies using other diagnostic criteria. In general, studies reporting lifetime rates under 4.0% employed the DIS and DSM-III criteria, while studies reporting rates above 4.0% used the CIDI and DSM-III-R criteria.
The best-estimate rates for 1-year and lifetime prevalence were 3.0% (95%CI, 0.98% to 5.8%) and 5.3% (95%CI, 3.4% to 7.9%), respectively (Table 1). The variations in the CI for these 1-year and lifetime prevalence rates are almost 6-fold and 2.3-fold respectively. By contrast, prevalence rates reported across individual studies ranged from 0.2% in Northern Ireland (100) to 8.8% in the US (NCS) (39), a 44-fold variation. The lifetime prevalence rates across individual studies ranged from 0.63% in Florence, Italy (88), to 11.3% in the US (NCS) (39), which is a difference of almost 18-fold. Heterogeneity was demonstrated for 1-year and lifetime prevalence rates of specific phobia. For studies conducted in North America, the pooled 1-year rate was almost 4 times higher, compared with that of studies outside North American countries (Table 4). For both 1-year and lifetime rates, the study conducted in Italy, which reported the lowest rates, employed the SADS-L, whereas the remaining studies used the CIDI or DIS.
The best-estimate rates for 1-year and lifetime prevalence were 0.54% (95%CI, 0.28% to 0.86%) and 1.3% (95%CI, 0.86% to 1.8%), respectively (Table 1). The variations in the CIs for these 1-year and lifetime prevalence rates are approximately 3-fold and 2-fold respectively. Across individual studies, variations of 13.8-fold and 10.7-fold respectively, were observed. Heterogeneity was demonstrated for 1-year and lifetime prevalence rates of OCD. For studies conducted in Asian countries or with response rates of 80% or lower, the pooled 1-year rates were approximately 4 times lower, compared with those of studies conducted outside Asian countries or with response rates of more than 80% (Table 4). For pooled lifetime rates, studies conducted in Asian countries produced rates that were almost 2 times lower than studies conducted outside Asia. Examination of each of the studies does not reveal any relevant methodological differences that might help to explain the variation in rates of OCD.
Posttraumatic Stress Disorder
The best-estimate rates for 1-year and lifetime prevalence were 1.2% (95%CI, 0.09% to 3.4%) and 2.1% (95%CI, 0.4% to 4.9%), respectively (Table 1). The variation in the CIs for the 1-year pooled rate was approximately 37-fold, which is higher than the 33-fold difference found across individual rates. For lifetime prevalence, the variation in the CIs was approximately 12-fold, which is considerably lower than the 62-fold variation observed across individual rates. Heterogeneity was demonstrated for lifetime prevalence rates of PTSD. Further analysis to determine which variables may be contributing to heterogeneity was not carried out, owing to the small number of rates. The lowest rate reported was based on the SADS-L and clinical interviews and diagnoses, while all other studies were based on the DIS or CIDI and lay interviewers.
Generalized Anxiety Disorder
The best-estimate rates for 1-year and lifetime prevalence were 2.6% (95%CI, 1.4% to 4.2%) and 6.2% (95%CI, 4.0% to 9.2%), respectively (Table 1). The variations in the CIs for these 1-year and lifetime prevalence rates are 3-fold and 2.3-fold, respectively. Across individual studies, 1-year prevalence ranged from 0.15% in Northern Ireland (100) to 12.7% in Christchurch, New Zealand (55). Lifetime prevalence rates ranged from 1.9% in Basle, Switzerland (48) to 31.1% in Christchurch, New Zealand (55). Heterogeneity was demonstrated for 1-year and lifetime prevalence rates of GAD. Studies employing DIS–DSM-III or published before 1994 produced a pooled 1-year rate that was 4.5 times higher than that of studies using other diagnostic instruments and criteria and published on or after 1994 (Table 4). For studies conducted in European countries, the pooled lifetime rate was approximately 3 times lower, compared with that of studies conducted outside European countries. There were no apparent methodological differences to account for the variation in lifetime prevalence rates.
Five studies provided data on 1-year incidence rates of anxiety disorders. The incidence studies conducted in Edmonton, Canada (104) and the US (90,103,105) were prospective follow-up studies of community-based samples with total populations ranging from 1964 to 12 823. The study conducted in Norway (54) was also based on a community sample but involved a retrospective assessment of incidence. The prospective studies used the DIS and an algorithm to extract diagnoses, whereas the retrospective study employed the CIDI and a clinician diagnosis. An inadequate number of rates from unique primary investigations were available for the various anxiety disorder categories; therefore, the rates are presented for the sake of interest, and no analyses of the rates were performed.
The results of this study further confirm the high international prevalence of anxiety disorders, and illustrate patterns of considerable heterogeneity. Best-estimates for the 1-year and lifetime prevalence of TADs were 10.6% and 16.6%, respectively. The ratio between 1-year and lifetime rates indicates that a large number of people experience anxiety disorders on a continuing or recurring basis.
Across studies, anxiety disorders were approximately twice as prevalent among women, with overall age-specific rates remaining relatively stable or increasing across the lifespan. Overall, the results suggest a burden of illness that eclipses the capacity of specialized mental health service providers.
Between studies, there was considerable variability on all observed prevalence rates. For most categories of anxiety disorder there was at least a 10-fold variation between the prevalence rates reported by different studies. In contrast, the degree of variability between rates of TADs was much smaller than the variation associated with individual disorders. Perhaps a predisposition to one of several anxiety disorders could be differentially expressed in other contexts. Similarly, specific anxiety symptoms may vary over the course of time, crossing diagnostic boundaries but without relief from suffering. Alternatively, there may be cross-cultural differences in the genetic basis of one or more of the anxiety disorders. The pattern of results is consistent with the view that anxiety disorders are determined by a multiplicity of factors, including biological, psychological, and social variables.
A few methodological factors were associated with the observed heterogeneity between rates. Pooled rates for TADs were lower in studies that incorporated DIS and DSM-III criteria than in studies using the CIDI and DSM-III-R. This pattern was also observed for some studies that estimate the prevalence of individual disorders. Several other factors were associated with heterogeneity, including the country studied, the response rate, and the size of the study sample. However, each of these factors was available for evaluation in relation to a small number of individual disorders. In most cases, different studies were distinguished on the basis of several factors simultaneously (for example, location, type of disorders investigated, method of diagnosis, and sample size). Hence, it is not possible to attribute unique variance to any one of these potential sources of variability. Three studies used different diagnostic schemes with the same subjects. However, there was no consistent pattern to the results associated with different criteria across this small number of studies.
An insufficient number of incidence studies were available for inclusion, signalling an important omission in the epidemiologic literature. Further knowledge is required about the onset of anxiety disorders, including risk and protective factors, as well as social variables that may mediate the expression of these disorders and help explain the level of heterogeneity observed in the present study.
There is a dearth of information regarding the prevalence of anxiety disorders among special populations. Some research suggests that risk of anxiety may be greater within certain subgroups, such as medical patients (109) and residents of nursing homes (110). Further investigation of these and other subgroups is required to identify concentrations of need and hasten the deployment of requisite services.
As a class, anxiety disorders are seldom treated. Only a limited subset of treatment appears to be consistent with evidence-based recommendations (79). The challenge of reducing the burden of illness associated with anxiety disorders is immense. To meet this challenge, it is essential to further clarify the epidemiology of anxiety, which will allow for the targeted deployment of programs and services on the basis of a probabilistic understanding of need.
Funding and Support
This review received no funding or support.
1. Goldner EM, Hsu L, Waraich P, Somers JM. Prevalence and incidence studies of schizophrenia: a systematic review of the literature. Forthcoming.
2. Eddy DM, Hasselblad V, Shachter R. Meta-analysis by the confidence interval method. The statistical synthesis of evidence. San Diego (CA): Academic Press Inc; 1992.
3. Fleiss JL. Statistical methods for rates and proportions, 2nd ed. New York (NY): John Wiley and Sons; 1981.
4. Hidalgo RB, Davidson JRT. Posttraumatic stress disorder: epidemiology and health-related considerations. J Clin Psychiatry 2000;61(Suppl 7):5–13.
5. Ballenger JC, Davidson JRT, Lecrubier Y, Nutt DJ, Foa EB, Kessler RC, and others. Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry 2000;61(Suppl 5):60–6.
6. Kessler RC. Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 2000;61(Suppl 5):4–12.
7. Solomon SD, Davidson JRT. Trauma: prevalence, impairment, service use, and cost. J Clin Psychiatry 1997;58(Suppl 9):5–11.
8. Yehuda R, McFarlane AC. Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis. Am J Psychiatry 1995;152:1705–13.
9. Hollander E. Obsessive-compulsive disorder: the hidden epidemic. J Clin Psychiatry 1997;58(Suppl 12):3–6.
10. Hirschfeld RMA. Panic disorder: diagnosis, epidemiology, and clinical course. J Clin Psychiatry1996;57(Suppl 10):3–8.
11. Brawman-Mintzer O, Lydiard RB. Generalized anxiety disorder: issues in epidemiology. J Clin Psychiatry 1996;57(Suppl 7):3–8.
12. Judd LL. Social phobia: a clinical overview. J Clin Psychiatry 1994;55 (Suppl 6):5–9.
13. Schatzberg AF. Overview of anxiety disorders: prevalence, biology, course, and treatment. J Clin Psychiatry 1991;52(Suppl 7):5–9.
14. Brom D, Kleber RJ, Witztum E. The prevalence of posttraumatic psychopathology in the general and the clinical population. Isr J Psychiatry Relat Sci 1991;28(4):53–63.
15. Eaton WW. Progress in the epidemiology of anxiety disorders. Epidemiol Rev 1995;17(1):32–8.
16. Rogers P, Liness S. Post-traumatic stress disorder. Nurs Stand 2000;14(22):47–52.
17. Wittchen H-U, Essau CA. Epidemiology of panic disorder: progress and unresolved issues. J Psychiatry Res 1993;27(1):47–68.
18. Marshall RD, Pierce D. Implications of recent findings in posttraumatic stress disorder and the role of pharmacotherapy. Harv Rev Psychiatry 2000;7:247–56.
19. Sasson Y, Zohar J, Chopra M, Lustig M, Iancu I, Hendler T. Epidemiology of obsessive-compulsive disorder: a world view. J Clin Psychiatry 1997;58(Suppl 12):7–10.
20. Regier DA, Rae DS, Narrow WE, Kaelber CT, Schatzberg AF. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. Br J Psychiatry 1998;173(Suppl 34):24–8.
21. Pigott TA. Obsessive-compulsive disorder: symptom overview and epidemiology. Bull Menninger Clin 1998;62(Suppl A):A4–A32.
22. Attiullah N, Eisen JL, Rasmussen SA. Clinical features of obsessive-compulsive disorder. Psychiatr Clin North Am 2000;23:469–91.
23. Horwath E, Weissman MM. The epidemiology and cross-national presentation of obsessive-compulsive disorder. Psychiatr Clin North Am 2000;23:493–507.
24. Castle DJ, Groves A. The internal and external boundaries of obsessive-compulsive disorder. Aust N Z J Psychiatry 2000;34:249–55.
25. Brunello N, den Boer JA, Judd LL, Kasper S, Kelsey JE, Lader M, and others. Social phobia: diagnosis and epidemiology, neurobiology and pharmacology, comorbidity and treatment. J Affect Disord 2000;60:61–74.
26. Sareen J, Stein M. A review of the epidemiology and approaches to the treatment of social anxiety disorder. Drugs 2000;59:497–509.
27. Moutier CY, Stein MB. The history, epidemiology, and differential diagnosis of social anxiety disorder. J Clin Psychiatry 1999;60(Suppl 9):4–8.
28. Heimberg RG, Stein MB, Hiripi E, Kessler RC. Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades. Eur Psychiatry 2000;15:29–37.
29. Rasmussen SA, Eisen JL. Epidemiology of obsessive–compulsive disorder. J Clin Psychiatry 1990;51(Suppl 2):10–3.
30. Wittchen H-U. The many faces of social anxiety disorder. Int Clin Psychopharmacol 2000;15(Suppl 1):S7–S12.
31. Kessler RC. The epidemiology of pure and comorbid generalized anxiety disorder: a review and evaluation of recent research. Acta Psychiatr Scand 2000;102(Suppl 406):7–13.
32. Bijl R, Ravelli A, van Zessen G. Prevalence of psychiatric disorder in the general population: results of the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 1998;33:587–95.
33. Bland RC, Orn H, Newman SC. Lifetime prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand 1988;77(Suppl 338):24–32.
34. Canino GJ, Bird HR, Shrout PE, Rubio-Stipec M, Bravo M, Martinez R, and others. The prevalence of specific psychiatric disorders in Puerto Rico. Arch Gen Psychiatry 1987;44:727–35.
35. Chen CN, Wong J, Lee N, Chan-Ho M-W, Lau JT, Fung M. The Shatin Community Mental Health Survey in Hong Kong. Arch Gen Psychiatry 1993;50:125–33.
36. Clayer JR, McFarlane AC, Bookless CL, Air T, Wright G, Czechowicz AS. Prevalence of psychiatric disorders in rural South Australia. Med J Aust 1995;163:124–9.
37. Hodiamont P, Peer N, Syben N. Epidemiological aspects of psychiatric disorder in a Dutch health area. Psychol Med 1987;17:505.
38. Hwu HG, Yeh EK, Chang LY. Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule. Acta Psychiatr Scand 1989;79:136–47.
39. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, and others. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8–19.
40. Lee CK, Kwak YS, Rhee H, Kim YS, Han JH, Choi JO, and others. The nationwide epidemiological study of mental disorders in Korea. J Korean Med Sci 1987;2(1):19–34.
41. Lehtinen V, Joukamaa M, Lahtela K, Raitasalo R, Jyrkinen E, Maatela J, and others. Prevalence of mental disorders among adults in Finland: basic results from the Mini Finland Health Survey. Acta Psychiatr Scand 1990;81:418–25.
42. Offord DR, Boyle MH, Campbell D, and others. One-year prevalence of psychiatric disorder in Ontarians 15 to 64 years of age. Can J Psychiatry 1996;41:559–63.
43. Wells JE, Bushnell JA, Hornblow AR, Joyce PR, Oakley-Browne MA. Christchurch Psychiatric Epidemiology Study, Part I: methodology and lifetime prevalence for specific psychiatric disorders. Aust N Z J Psychiatry 1989;23:315–26.
44. Wittchen H-U, Essau CA, von Zerssen D, Krieg J-C, Zaudig M. Lifetime and six-month prevalence of mental disorders in the Munich Follow-up Study. Euro Arch Psychiatry Clin Neurosci 1992;241:247–58.
45. Jenkins R, Lewis G, Bebbington P, Brugha T, Farrell M, Gill B, and others. The National Psychiatric Morbidity Surveys of Great Britain—initial findings from the Household Survey. Psychol Med 1997;27:775–89.
46. Bourdon KH, Rae DS, Locke BZ, Narrow WE, Regier DA. Estimating the prevalence of mental disorders in US adults from the Epidemiologic Catchment Area Survey. Public Health Rep 1992;107:663–8.
47. Henderson S, Andrews G, Hall W. Australia’s mental health: overview of the general population survey. Aust N Z J Psychiatry 2000;34:197–205.
48. Wacker HR, Mullejans R, Klein KH, Battegay R. Identification of cases of anxiety disorders and affective disorders in the community according to ICD-10 and DSM-III-R by using the Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 1992;2:91–100.
49. Bebbington P, Hurry J, Tennant C, Sturt E, Wing JK. Epidemiology of mental disorders in Camberwell. Psychol Med 1981;11:561–79.
50. Pakriev S, Vasar V, Aluoja A, Saarma M, Shlik J. Prevalence of mood disorders in the rural population of Udmurtia. Acta Psychiatr Scand 1998;97:169–74.
51. Bland RC, Newman SC, Orn H. Period prevalence of psychiatric disorders in Edmonton. Acta Psychiatr Scand 1988;77(Suppl 338):33–42.
52. Fournier L, Lesage AD, Toupin J, Cyr M. Telephone surveys as an alternative for estimating prevalence of mental disorders and service utilization: a Montreal Catchment Area Study. Can J Psychiatry 1997;42:737–43.
53. Roca M, Gili M, Ferrer V, Bernardo M, Montano JJ, Salva JJ, and others. Mental disorders on the island of Formentera: prevalence in general population using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Soc Psychiatry Psychiatr Epidemiol 1999;34:410–15.
54. Sandanger I, Nygard JF, Ingebrigtsen G, Sorensen T, Dalgard OS. Prevalence, incidence and age at onset of psychiatric disorders in Norway. Soc Psychiatry Psychiatr Epidemiol 1999;34:570–9.
55. Oakley-Browne MA, Joyce PR, Wells E, Bushnell JA, Hornblow AR. Christchurch Psychiatric Epidemiology Study, Part II: six month and other period prevalences of specific psychiatric disorders. Aust N Z J Psychiatry 1989;23:327–40.
56. Morosini PL, Coppo P, Veltro F, Pasquini P. Prevalence of mental disorders in Tuscany: a community study in Lari (Pisa). Annali dell Istituto Superiore di Sanita 1992;28:547–52.
57. Mumford DB, Saeed K, Ahmad I, Latif S, Mubbashar MH. Stress and psychiatric disorder in rural Punjab. A community survey. Br J Psychiatry 1997;170:473–8.
58. Eaton WW, Kessler RC, Wittchen H-U, Magee WJ. Panic and panic disorder in the United States. Am J Psychiatry 1994;151:413–20.
59. Schneier FR, Johnson J, Hornig CD, Liebowitz M, Weissman MM. Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 1992;49:282–8.
60. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995;52:1048–60.
61. Ohayon MM, Shapiro CM. Sleep disturbances and psychiatric disorders associated with posttraumatic stress disorder in the general population. Compr Psychiatry 2000;41:469–78.
62. Lepine JP, Lellouch J. Classification and epidemiology of social phobia. Euro Arch Psychiatry Clin Neurosci 1995;244:290–6.
63. Leon AC, Portera L, Weissman MM. The social costs of anxiety disorders. Br J Psychiatry 1995;166(Suppl 27):19–22.
64. Davidson JRT, Hughes D, Blazer DG, George LK. Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 1991;21:713–21.
65. Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 1993;61:984–91.
66. Dick CL, Sowa B, Bland RC, Newman SC. Phobic disorders. Acta Psychiatr Scand 1994;Suppl 376:36–44.
67. Boyd JH, Rae DS, Thompson JW, Burns BJ, Bourdon K, Locke BZ, and others. Phobia: prevalence and risk factors. Soc Psychiatry Psychiatr Epidemiol 1990;25:314–23.
68. Helzer JE, Robins LN, McEvoy L. Post-traumatic stress disorder in the general population. Findings of the Epidemiologic Catchment Area Survey. New Engl J Med 1987;317:1630–4.
69. Pollard CA, Henderson JG. Four types of social phobia in a community sample. J Nerv Ment Dis 1988;176:440–5.
70. Regier DA, Narrow WE, Rae DS. The epidemiology of anxiety disorders: the Epidemiologic Catchment Area (ECA) experience. J Psychiatr Res 1990;24(Suppl 2):3–14.
71. Davidson JRT, Hughes DL, George LK, Blazer DG. The epidemiology of social phobia: findings from the Duke Epidemiological Catchment Area Study. Psychol Med 1993;23:709–18.
72. Wittchen H-U, Zhao S, Kessler RC, Eaton WW. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:355–64.
73. Magee WJ, Eaton WW, Wittchen H-U, McGonagle KA, Kessler RC. Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 1996;53:159–68.
74. Stein MB, Forde DR, Anderson G, Walker JR. Obsessive-compulsive disorder in the community: an epidemiologic survey with clinical reappraisal. Am J Psychiatry 1997;154:1120–6.
75. Stein MB, Walker JR, Hazen AL, Forde DR. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 1997;154:1114–9.
76. Furmark T, Tillfors M, Everz P-O, Marteinsdottir I, Gefvert O, Fredrikson M. Social phobia in the general population: prevalence and sociodemographic profile. Soc Psychiatry Psychiatr Epidemiol 1999;34:416–24.
77. Grabe HJ, Meyer C, Hapke U, Rumpf H-J, Freyberger HJ, Dilling H, and others. Prevalence, quality of life and psychosocial function in obsessive-compulsive disorder and subclinical obsessive-compulsive disorder in northern Germany. Euro Arch Psychiatry Clin Neurosci 2000;250:262–8.
78. Hybels CF, Blazer DG, Kaplan BH. Social and personal resources and the prevalence of phobic disorder in a community population. Psychol Med 2000;30:705–16.
79. Wang PS, Berglund P, Kessler RC. Recent care of common mental disorders in the United States. Prevalence and conformance with evidence-based recommendations. J Gen Intern Med 2000;15:284–92.
80. Stein MB, Torgrud L, Walker JR. Social phobia symptoms, subtypes, and severity. Findings from a community survey. Arch Gen Psychiatry 2000;57:1046–52.
81. Stein MB, Kean YM. Disability and quality of life in social phobia: epidemiologic findings. Am J Psychiatry 2000;157:1606–13.
82. Faravelli C, Zucchi T, Viviani B, Salmoria R, Perone A, Paionni A, and others. Epidemiology of social phobia: a clinical approach. Eur Psychiatry 2000;15:17–24.
83. Pelissolo A, Andre C, Moutard-Martin F, Wittchen H-U, Lepine JP. Social phobia in the community: relationship between diagnostic threshold and prevalence. Eur Psychiatry 2000;15:25–8.
84. Lepine JP, Lellouch J. Diagnosis and epidemiology of agoraphobia and social phobia. Clin Neuropharmacol 1995;18(2):S15–S26.
85. Karno M, Golding JM, Sorenson SB, Burnam A. The epidemiology of obsessive-compulsive disorder in five US communities. Arch Gen Psychiatry 1988;45:1094–9.
86. Weissman MM. Panic disorder: clinical characteristics, epidemiology, and treatment. Psychopharmacology Bulletin 1986;22:787–891.
87. Myers JK, Weissman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, and others. Six-month prevalence of psychiatric disorders in three communities: 1980 to 1982. Arch Gen Psychiatry 1984;41:959–67.
88. Faravelli C, Degl’Innocenti BG, Giardinelli L. Epidemiology of anxiety disorders in Florence. Acta Psychiatr Scand 1989;79:308–12.
89. Von Korff MR, Eaton WW, Keyl PM. The epidemiology of panic attacks and panic disorder: results of three community surveys. Am J Epidemiol 1985;122:970–81.
90. Keyl PM, Eaton WW. Risk factors for the onset of panic disorder and other panic attacks in a prospective, population-based study. Am J Epidemiol 1990;131:301–11.
91. Bourdon KH, Boyd JH, Rae DS, Burns BJ, Thompson JW, Locke BZ. Gender differences in phobias: results of the ECA community survey. J Anx Disord 1988;2:227–41.
92. Stein MB, Walker JR, Forde DR. Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety. Am J Psychiatry 1994;151:408–12.
93. Vazquez-Barquero JL, Diez-Manrique JF, Pena C, Aldama J, Samaniego Rodriguez C, Menendez Arango J, and others. A community mental health survey in Cantabria: a general description of morbidity. Psychol Med 1987;17:227–41.
94. Kolada JL, Bland RC, Newman SC. Obsessive-compulsive disorder. Acta Psychiatr Scand 1994;Suppl 376:24–35.
95. Faravelli C, Salvatori S, Galassi F, Aiazzi L, Drei C, Cabras P. Epidemiology of somatoform disorders: a community survey in Florence. Soc Psychiatry Psychiatr Epidemiol 1997;32:24–9.
96. Carter RM, Wittchen H-U, Pfister H, Kessler RC. One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depress Anxiety 2001;13:78–88.
97. Creamer M, Burgess P, McFarlane AC. Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychol Med 2001;31:1237–47.
98. Hunt C, Issakidis C, Andrews G. DSM-IV generalized anxiety disorder in the Australian National Survey of Mental Health and Well-Being. Psychol Med 2002;32:649–59.
99. Kessler RC, Zhao S, Katz SJ, Kouzis AC, Frank RG, Edlund M, and others. Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. Am J Psychiatry 1999;156:115–23.
100. McConnell P, Bebbington P, McClelland R, Gillespie K, Houghton S. Prevalence of psychiatric disorder and the need for psychiatric care in Northern Ireland. Population study in the District of Derry. Br J Psychiatry 2002;181:214–9.
101. Mohammadi MR, Ghanizadeh A, Rahgozar M, Noorbala AA, Davidian H, Afzali HM, and others. Prevalence of obsessive-compulsive disorder in Iran. BMC Psychiatry 2004;4(2). Available: www.biomedcentral.com/1471-244X/4/2. Accessed 15 June 2004.
102. Norris FH, Murphy AD, Baker CK, Perilla JL. Epidemiology of trauma and posttraumatic stress disorder in Mexico. J Abnorm Psychol 2003;112:646–56.
103. Eaton WW, Kramer M, Anthony JC, Dryman A, Shapiro S, Locke BZ. The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatr Scand 1989;79:163–78.
104. Newman SC, Bland RC. Incidence of mental disorders in Edmonton: estimates of rates and methodological issues. J Psychiatr Res 1998;32:273–82.
105. Wells JC, Tien AY, Garrison R, Eaton WW. Risk factors for the incidence of social phobia as determined by the Diagnostic Interview Schedule in a population-based study. Acta Psychiatr Scand 1994;90:84–90.
106. Robins LN, Regier DA. Psychiatric disorders in America. The Epidemiologic Catchment Area Study. New York (NY): The Free Press; 1991.
108. Kelsey JL, Thompson WD, Evans AS. Methods in observational epidemiology. New York (NY): Oxford University Press; 1986.
109. Bland, RC, Newman, SC, Orn, H. Prevalence of psychiatric disorders in the elderly in Edmonton. Acta Psychiatr Scand (Suppl) 1988;338:57–63.
110. Wong, MTH, Pan, PC. Patterns of psychogeriatric referral and attendance at three different settings in Hong Kong. Int Psychogeriatr 1994;65:199–208.
Manuscript received December 2004, revised, and accepted October 2005. This is the fifth in a series of papers that presents systematic reviews of the prevalence and incidence of psychiatric disorders drawn from studies published in the English literature in the years 1980 to 2004. The series discusses the implications of these epidemiologic findings to mental health policy and practice.
1. Associate Professor, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia.
2. Professor, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia.
3. Research Assistant, Mental Health Evaluation and Community Consultation Unit (Mheccu), University of British Columbia.
Address for correspondence: Dr Somers, Faculty of Health Sciences, Simon Fraser University, 7238-515 Hastings Street, Vancouver BC, V6B 5K3
1 | 2
Archives in English | Archives
RCP en français