Epidemiology of Anxiety Disorders

  • Ronald C. Kessler
  • Ayelet Meron Ruscio
  • Katherine Shear
  • Hans-Ulrich Wittchen


This chapter presents an overview of the descriptive epidemiology of anxiety disorders based on recently completed surveys of the general population. The overall prevalence of anxiety disorders is shown to be quite high, but with considerable variation from the most prevalent (specific phobias) to the least prevalent (agoraphobia without a history of panic disorder) disorders. Age-of-onset (AOO) of anxiety disorders is typically in childhood or adolescence and the course is often chronic-recurrent. Anxiety disorders are highly comorbid with each other and with other mental disorders. Because of their early AOO, they are often the temporally primary disorders in comorbid profiles, raising the question whether early interventions to treat anxiety disorders might have a positive effect on the onset, persistence, or severity of secondary disorders such as mood and substance use disorders. This possibility has not yet been extensively explored but warrants further study given the high societal costs of anxiety disorders.


Epidemiology Anxiety disorders Agoraphobia Generalized anxiety disorder Obsessive-compulsive disorder Separation anxiety disorder Comorbidity Societal costs 


  1. Andlin-Sobocki P, Jönsson B, Wittchen H-U, Olesen J (2005) Cost of disorders of the brain in Europe. Eur J Neurol 12(Suppl 1):1–27PubMedCrossRefGoogle Scholar
  2. Andlin-Sobocki P, Wittchen H-U (2005) Cost of anxiety disorders in Europe. Eur Neurol 12(Suppl 1):39–44Google Scholar
  3. Andrews G, Slade T (2002) Agoraphobia without a history of panic disorder may be part of the panic disorder syndrome. J Nerv Ment Dis 190:624–630PubMedCrossRefGoogle Scholar
  4. Beesdo K, Bittner A, Pine DS, Stein MB, Höfler M, Lieb R, Wittchen H-U (2007) Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry 64:903–912PubMedCrossRefGoogle Scholar
  5. Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BA, Grados MA, Nestadt G (2000) The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry 48:287–293Google Scholar
  6. Bruce ML, Leaf PJ, Rozal GP, Florio L, Hoff RA (1994) Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study. Am J Psychiatry 151:716–721PubMedGoogle Scholar
  7. Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, Shea MT, Keller MB (2005) 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 162:1179–1187PubMedCrossRefGoogle Scholar
  8. Brugha TS, Jenkins R, Taub N, Meltzer H, Bebbington PE (2001) A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Psychol Med 31:1001–1013PubMedCrossRefGoogle Scholar
  9. Christiana JM, Gilman SE, Guardino M, Mickelson K, Morselli PL, Olfson M, Kessler RC (2000) Duration between onset and time of obtaining initial treatment among people with anxiety and mood disorders: an international survey of members of mental health patient advocate groups. Psychol Med 30:693–703PubMedCrossRefGoogle Scholar
  10. Cox BJ, Clara IP, Enns MW (2002) Posttraumatic stress disorder and the structure of common mental disorders. Depress Anxiety 15:168–171PubMedCrossRefGoogle Scholar
  11. Diener ML, Kim D-Y (2004) Maternal and child predictors of preschool children's social competence. J Appl Dev Psychol 25:3–24CrossRefGoogle Scholar
  12. Fehm L, Pelissolo A, Furmark T, Wittchen HU (2005) Size and burden of social phobia in Europe. Eur Neuropsychopharmacol 15:453–462PubMedCrossRefGoogle Scholar
  13. Goldsmith T, Shapiro MA, Phillips KA, McElroy SL (1998) Conceptual foundations of obsessive-compulsive spectrum disorders. In: Swinson RP, Anthony MM, Rachman S, Richter MA (eds) Obsessive-compulsive disorder: theory, research, and treatment. Guilford, New York, pp 397–425Google Scholar
  14. Goodwin RD, Faravelli C, Rosi S, Cosci F, Truglia E, de Graaf R, Wittchen HU (2005) The epidemiology of panic disorder and agoraphobia in Europe. Eur Neuropsychopharmacol 15:435–443PubMedCrossRefGoogle Scholar
  15. Grant BF, Hasin DS, Stinson FS, Dawson DA, Goldstein RB, Smith S, Huang B, Saha TD (2006) The epidemiology of DSM-IV panic disorder and agoraphobia in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 67:363–374PubMedCrossRefGoogle Scholar
  16. Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ (1999) The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 60:427–435PubMedCrossRefGoogle Scholar
  17. Gureje O, Lasebikan VO, Kola L, Makanjuola VA (2006) Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being. Br J Psychiatry 188:465–471PubMedCrossRefGoogle Scholar
  18. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lépine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC (2006) Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 15:167–180PubMedCrossRefGoogle Scholar
  19. Kendall PC, Kessler RC (2002) The impact of childhood psychopathology interventions on subsequent substance abuse: policy implications, comments, and recommendations. J Consult Clin Psychol 70:1303–1306PubMedCrossRefGoogle Scholar
  20. Kendler KS, Prescott CA, Myers J, Neale MC (2003) The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Arch Gen Psychiatry 60:929–937PubMedCrossRefGoogle Scholar
  21. Kessler RC (1995) Epidemiology of psychiatric comorbidity. In: Tsuang MT, Tohen M, Zahner GEP (eds) Textbook in Psychiatric Epidemiology. Wiley, New York, pp 179–197Google Scholar
  22. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Üstün TB (2007a) Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry 20:359–364PubMedCrossRefGoogle Scholar
  23. Kessler RC, Angermeyer M, Anthony JC, DEG R, Demyttenaere K, Gasquet I, DEG G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Üstün TB (2007b) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6:168–176PubMedGoogle Scholar
  24. Kessler RC, Brandenburg N, Lane M, Roy-Byrne P, Stang PD, Stein DJ, Wittchen HU (2005a) Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Comorbidity Survey Replication. Psychol Med 35:1073–1082PubMedCrossRefGoogle Scholar
  25. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005b) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627PubMedCrossRefGoogle Scholar
  26. Kessler RC, Merikangas KR (2004) The National Comorbidity Survey Replication (NCS-R): background and aims. Int J Methods Psychiatr Res 13:60–68PubMedCrossRefGoogle Scholar
  27. Kessler RC, Üstün TB (2008) The WHO World Mental Health Surveys: Global Perspectives on the Epidemiology of Mental Disorders. Cambridge University Press, New YorkGoogle Scholar
  28. Klein DF, Gorman JM (1987) A model of panic and agoraphobic development. Acta Psychiatr Scand Suppl 335:87–95PubMedCrossRefGoogle Scholar
  29. Knight DC, Nguyen HT, Bandettini PA (2005) The role of the human amygdala in the production of conditioned fear responses. Neuroimage 26:1193–1200PubMedCrossRefGoogle Scholar
  30. Kringlen E, Torgersen S, Cramer V (2001) A Norwegian psychiatric epidemiological study. Am J Psychiatry 158:1091–1098PubMedCrossRefGoogle Scholar
  31. Lépine JP (2002) The epidemiology of anxiety disorders: prevalence and societal costs. J Clin Psychiatry 63(Suppl 14):4–8PubMedGoogle Scholar
  32. Lieb R (2005) Anxiety disorders: clinical presentation and epidemiology. Handb Exp Pharmacol 169:405–432PubMedCrossRefGoogle Scholar
  33. Lieb R, Becker E, Altamura C (2005) The epidemiology of generalized anxiety disorder in Europe. Eur Neuropsychopharmacol 15:445–452PubMedCrossRefGoogle Scholar
  34. Marciniak M, Lage MJ, Landbloom RP, Dunayevich E, Bowman L (2004) Medical and productivity costs of anxiety disorders: case control study. Depress Anxiety 19:112–120PubMedCrossRefGoogle Scholar
  35. Neziroglu F, Henricksen J, Yaryura-Tobias JA (2006) Psychotherapy of obsessive-compulsive disorder and spectrum: established facts and advances, 1995–2005. Psychiatr Clin North Am 29:585–604PubMedCrossRefGoogle Scholar
  36. Olfson M, Guardino M, Struening E, Schneier FR, Hellman F, Klein DF (2000) Barriers to the treatment of social anxiety. Am J Psychiatry 157:521–527Google Scholar
  37. Patel A, Knapp M, Henderson J, Baldwin D (2002) The economic consequences of social phobia. J Affect Disord 68:221–233Google Scholar
  38. Richter MA, Summerfeldt LJ, Antony MM, Swinson RP (2003) Obsessive-compulsive spectrum conditions in obsessive-compulsive disorder and other anxiety disorders. Depress Anxiety 18:118–127PubMedCrossRefGoogle Scholar
  39. Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA (1988) The composite international diagnostic interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077PubMedCrossRefGoogle Scholar
  40. Ruscio AM, Chiu WT, Roy-Byrne P, Stang PE, Stein DJ, Wittchen HU, Kessler RC (2007) Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord 21:662–676PubMedCrossRefGoogle Scholar
  41. Ruscio AM, Lane M, Roy-Byrne P, Stang PE, Stein DJ, Wittchen HU, Kessler RC (2005) Should excessive worry be required for a diagnosis of generalized anxiety disorder? Results from the US National Comorbidity Survey Replication. Psychol Med 35:1761–1772PubMedCrossRefGoogle Scholar
  42. Ruscio AM, Stein DJ, Chiu WT, Kessler RC (2008) The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry [Epub ahead of print]Google Scholar
  43. Schreier A, Wittchen H-U, Höfler M, Lieb R (2008) Anxiety disorders in mother and their children: Results from a prospective-longitudinal community study. Br J Psychiatry 192:308–309PubMedCrossRefGoogle Scholar
  44. Shear K, Jin R, Ruscio AM, Walters EE, Kessler RC (2006) Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the National Comorbidity Survey Replication. Am J Psychiatry 163:1074–1083PubMedCrossRefGoogle Scholar
  45. Toft T, Fink P, Oernboel E, Christensen K, Frostholm L, Olesen F (2005) Mental disorders in primary care: prevalence and co-morbidity among disorders. results from the functional illness in primary care (FIP) study. Psychol Med 35:1175–1184PubMedCrossRefGoogle Scholar
  46. Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, McCulloch J, Petukhova MZ, Kessler RC (2007) Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 298:1401–1411PubMedCrossRefGoogle Scholar
  47. Wang PS, Simon GE, Kessler RC (2008) Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study. J Occup Environ Med 50:468–475PubMedCrossRefGoogle Scholar
  48. Watson D (2005) Rethinking the mood and anxiety disorders: a quantitative hierarchical model for DSM-V. J Abnorm Psychol 114:522–536PubMedCrossRefGoogle Scholar
  49. Whiteside SP, Port JD, Abramowitz JS (2004) A meta-analysis of functional neuroimaging in obsessive-compulsive disorder. Psychiatry Res 132:69–79PubMedCrossRefGoogle Scholar
  50. Wittchen HU (1994) Reliability and validity studies of the WHO – Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 28:57–84PubMedCrossRefGoogle Scholar
  51. Wittchen HU, Jacobi F (2005) Size and burden of mental disorders in Europe – a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15:357–376PubMedCrossRefGoogle Scholar
  52. Wittchen H-U, Kessler RC, Pfister H, Höfler M, Lieb R (2000a) Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand 102(Suppl 406):14–23CrossRefGoogle Scholar
  53. Wittchen H-U, Lieb R, Pfister H, Schuster P (2000b) The waxing and waning of mental disorders: Evaluating the stability of syndromes of mental disorders in the population. Compr Psychiatry 41(Suppl 1):122–132PubMedCrossRefGoogle Scholar
  54. Wittchen HU, Kessler RC, Zhao S, Abelson J (1995) Reliability and clinical validity of UM-CIDI DSM-III-R generalized anxiety disorder. J Psychiatr Res 29:95–110PubMedCrossRefGoogle Scholar
  55. Wittchen HU, Lieb R, Schuster P, Oldehinkel AJ (1999) 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. American Psychiatric Press, Washington, DC, pp 259–302Google Scholar
  56. Wittchen HU, Nocon A, Beesdo K, Pine DS, Hofler M, Lieb R, Gloster AT (2008) Agoraphobia and panic. Prospective-longitudinal relations suggest a rethinking of diagnostic concepts. Psychother Psychosom 77:147–157Google Scholar
  57. Wittchen HU, Reed V, Kessler RC (1998b) The relationship of agoraphobia and panic in a community sample of adolescents and young adults. Arch Gen Psychiatry 55:1017–1024PubMedCrossRefGoogle Scholar
  58. Yaryura-Tobias JA, Grunes MS, Todaro J, McKay D, Neziroglu FA, Stockman R (2000) Nosological insertion of axis I disorders in the etiology of obsessive-compulsive disorder. J Anxiety Disord 14:19–30PubMedCrossRefGoogle Scholar
  59. Zimmermann P, Wittchen HU, Hofler M, Pfister H, Kessler RC, Lieb R (2003) Primary anxiety disorders and the development of subsequent alcohol use disorders: a 4-year community study of adolescents and young adults. Psychol Med 33:1211–1222PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Ronald C. Kessler
    • 1
  • Ayelet Meron Ruscio
    • 2
  • Katherine Shear
    • 3
  • Hans-Ulrich Wittchen
    • 4
  1. 1.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  2. 2.Department of PsychologyUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Columbia University School of Social WorkNew YorkUSA
  4. 4.Institute of Clinical Psychology and PsychotherapyTechnische Universitaet DresdenDresdenGermany

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