____________________________________________________________________________ Anxiety Disorders
COMPARISON OF PREVALENCE, MORBID RISK, AND RATIO OF LIFETIME PREVALENCE TO MORBID RISK FOR ANXIETY DISORDERS Anxiety Disorder 12-month Lifetime Lifetime Morbid Risk Lifetime/Lifetime Morbid Risk Generalized anxiety disorder 2.0% 4.3% 9.0% 0.5 Panic disorder 2.4% 3.8% 6.8% 0.5 Agoraphobia 1.7% 2.5% 3.7% 0.7 Social anxiety disorder 7.4% 10.7% 13.0% 0.8 Specific phobia 12.1% 15.6% 18.4% 0.8 Separation anxiety disorder 1.2% 6.7% 8.7% 0.8 Source: [7] Table 1
OVERALL RISK FACTORS Demographic
CLINICAL COURSE Anxiety disorders in the aggregate show a U-shaped age of onset—higher in childhood and young adulthood and lower in adolescence. The greatest concentration occurs during transi- tion to early adulthood. Unlike biologically driven pubertal transitions, adulthood transitions involve distinct psychosocial events (e.g., independent living, full-time employment), and this represents a key period for understanding the develop- ment of adult anxiety disorders such as panic disorder and agoraphobia [10]. Community studies of persons with sub-diagnostic anxiety symptoms over time often show episodic symptoms and pro- longed periods of remission, with symptoms reappearing or worsening during adverse life events and psychosocial stressors. In contrast, studies of clinical anxiety disorder populations typically show a chronic course with fluctuating symptom severity between periods of remission and relapse, with long- term course varying by disorder [3]. Healthcare Utilization Distressing anxiety symptoms oftentimes consist of somatic complaints, prompting patients to visit an emergency facility or seek out a primary care provider. If anxiety disorder goes unrecognized or is considered a secondary issue, costly medi- cal testing and delay in effective care may result. Societal costs resulting from misdiagnosis, ineffective treatment and work absenteeism attributable to anxiety disorders are substantial. The direct medical expenditure associated with anxiety in adults, including inpatient visits, prescription costs, and office- based visits is estimated at $33.7 billion annually [354]. Recog- nition of the patient with a pattern of subjective worrying and anxiety, coupled with validated screening, targeted examination and selective testing enhances diagnosis. Effective treatment with pharmacotherapy or cognitive-behavioral therapy (CBT) can be expected to relieve symptoms and minimize costs [2; 3].
The odds for a lifetime diagnosis of any anxiety disorder were calculated, and the same pattern was found for past 12 month diagnosis [8]. These odds are organized according to sex, socioeconomic status, education level, and age. Overall, the risk of developing an anxiety disorder is greater for women/ girls than men/boys. Persons in lower income brackets also incur an increased odds of developing an anxiety disorder compared with those in higher income brackets (48% increased risk with $35,000 to $69,000; 52% with $20,000 to $34,000; 100% with $19,000 or less). Lower educational attainment is also a risk factor. Compared with college graduates, the odds of developing an anxiety disorder are increased 44% with 13 to 15 years of education, 76% with 12 years of education, and 86% with 0 to 11 years of education. These disorders are also 40% more likely in persons 15 to 24 years of age compared with older adults (45 to 54 years of age) [8]. Behavioral Inhibition and Temperament Behavioral inhibition has been defined as a childhood tem- perament characterized by high levels of caution, avoidance, and fearful response to unfamiliar people, objects, and situa- tions [352]. Children who display behavioral inhibition may exhibit limited ability to handle stress as they mature and are at increased risk of developing anxiety disorders later in life. A study of heightened anxiety in young adults during the COVID-19 pandemic found that behavioral inhibition in childhood was linked to worry dysregulation in adolescence, which in turn predicted elevated anxiety during the pandemic when participants had reached young adulthood [352; 353]. Behavioral inhibition and introversion are also strongly linked to later development and severity of situational avoidance, which is a core feature and risk factor in agoraphobia and SAD [9].
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