Generalized Anxiety Disorder–a sign of the times?

Generalized Anxiety Disorder--a sign of the times?

Quick bibliography: Reviews/recent articles on Generalized Anxiety Disorder (GAD)–a sign of our times?

**Updated January 2021**

Classic review:

*Tyrer, P. & Baldwin, D. (2006). Generalised anxiety disorder. Lancet,  368 (9553), 2156-2166. [PDF] [Cited by]

Generalised anxiety disorder is a persistent and common disorder, in which the patient has unfocused worry and anxiety that is not connected to recent stressful events, although it can be aggravated by certain situations. This disorder is twice as common in women than it is in men. Generalised anxiety disorder is characterised by feelings of threat, restlessness, irritability, sleep disturbance, and tension, and symptoms such as palpitations, dry mouth, and sweating. ”

Other reviews/articles:

*Carl, E., Witcraft, S. M., Kauffman, B. Y., Gillespie, E. M., Becker, E. S., Cuijpers, P., . . . Powers, M. B. (2020). Psychological and pharmacological treatments for generalized anxiety disorder (GAD): A meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 49(1), 1-21. [Cited by] **New**

“The purpose of this meta-analysis was to provide updated pooled effect sizes of evidence-based psychotherapies and medications for generalized anxiety disorder (GAD) and to investigate potential moderators of outcomes. Seventy-nine randomized controlled trials (RCT) including 11,002 participants with a diagnosis of GAD were included in a meta-analysis that tested the efficacy of psychotherapies or medications for GAD. Psychotherapy showed a medium to large effect size (g = 0.76) and medication showed a small effect size (g = 0.38) on GAD outcomes. Psychotherapy also showed a medium effect on depression outcomes (g = 0.64) as did medications (g = 0.59). Younger age was associated with a larger effect size for psychotherapy (p < 0.05). There was evidence of publication bias in psychotherapy studies. This analysis found a medium to large effect for empirically supported psychotherapy interventions on GAD outcomes and a small effect for medications on GAD outcomes. Both groups showed a medium effect on depression outcomes. Because medication studies had more placebo control conditions than inactive conditions compared to psychotherapy studies, effect sizes between the domains should not be compared directly. Patient age should be further investigated as a potential moderator in psychotherapy outcomes in GAD.

*Goossen, B., van der Starre, J., & van der Heiden, C. (2019). A review of neuroimaging studies in generalized anxiety disorder: “So where do we stand?” Journal of neural transmission, 126 (9), 1203-1216. [Cited by]

“The aim of this review is to provide a coherent understanding of the functional neuroanatomy of GAD. Certain theoretical models of GAD describe our understanding of this disorder and form the basis for treatment interventions. However, fMRI research thus far has failed to validate these models.”

*Haller, H., Cramer, H., Lauche, R., Gass, F., & Dobos, G.J. (2014).  The prevalence and burden of subthreshold generalized anxiety disorder: A systematic review. BMC Psychiatry,  14, 128.  [PDF] [Cited by]

“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. Subthreshold 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.”

*Kertz, S.J., & Woodruff-Borden, J. (2011). Human and economic burden of GAD, subthreshold GAD, and worry in a primary care sample. Journal of Clinical Psychology in Medical Settings, 18 (3), 281-290.  [Cited by]

Generalized anxiety disorder (GAD) has been associated with significant impairment and estimates of human and economic burden associated with the disorder are substantial. Little has been done, however, to examine impairment associated with subthreshold presentations of the disorder in medically underserved populations.”

*Nutt, D., Argyropoulos, S., Hood, S., & Potokar, J. (2006). Generalized anxiety disorder: A comorbid disease. European Neuropsychopharmacology, 16 (Suppl 2), S109-S118. [Cited by]

Generalized anxiety disorder (GAD) frequently occurs comorbidly with other conditions, including depression and somatic complaints. Comorbid GAD sufferers have increased psychologic and social impairment, request additional treatment, and have an extended course and poorer outcome than those with GAD alone.”

*Ooi, S.L., Henderson, P., & Pak, S.C. (2018). Kava for Generalized Anxiety Disorder: A Review of Current Evidence. Journal of alternative and complementary medicine, 24 (8), 770-780. [PDF] [Cited by]

“Generalized anxiety disorder (GAD) is a chronic and debilitating condition characterized by persistent and overpowering anxiety. Treatment of GAD with antidepressants and benzodiazepines is only moderately effective and not free from side effects. Kava (Piper methysticum) has been explored as a potential phytotherapeutic option for GAD. Current evidence, although promising, is insufficient to confirm the effect of Kava for GAD treatment beyond placebo.”

*Singh, P., Cumberland, W. G., Ugarte, D., Bruckner, T., & Young, S. D. (2020). Association between generalized anxiety disorder scores and online activity among US adults during the COVID-19 pandemic: Cross-sectional analysis. Journal of Medical Internet Research, 22(9), 7. [PDF] **New**

“Background: Evidence from past pandemics suggests that fear, uncertainty, and loss of control during large-scale public health crises may lead to increased pandemic-related information seeking, particularly among persons predisposed to high anxiety. In such groups, a greater consumption of information pertaining to the COVID-19 pandemic may increase anxiety.

Objective: In this study, we examine the association between online activity and Generalized Anxiety Disorder 7 (GAD-7) scores in the United States.

Methods: We recruited participants for an online survey through advertisements on various platforms such as Google, Facebook, and Reddit. A total of 406 adult US participants with moderate to severe (≥10) GAD-7 scores met the inclusion criteria and completed the survey. Anxiety levels measured using the GAD-7 scale formed our primary outcome. Our key independent variables were average daily time spent online and average daily time spent online searching about COVID-19 within the past 14 days. We used as controls potential confounders of the relation between our key independent variables and GAD-7 scores, namely, sleep quality, the COVID-19 Fear Inventory scale, binge drinking, substance use, prescription drug abuse, and sociodemographic attributes.

Results: Linear multivariate regression analyses showed that GAD-7 scores were higher among those who spent >4 hours online (per day) searching for information about COVID-19 (coefficient 1.29, P=.002), controlling for all other covariates. The total time spent online was not statistically associated with GAD-7 scores.

Conclusions: Results from this study indicate that limiting pandemic-related online information seeking may aid anxiety management in our study population.”

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