Guilherme Borges

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

Importance 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. Objective 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 147u2009261 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. Results Respondents were 147u2009261 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.

Descriptive Epidemiology of Depression in Latin America and Hispanics in the United States

I am a psychologist by training with further studies and interest in the area of epidemiology and public mental health. My areas of interest are methodological, psychosocial, and epidemiological issues as they relate to addictions and mental health. My special focus of interest, in which I have been working for the last years, is how alcohol and drug consumption is related to several medical and social problems, such as liver cirrhosis, infant health, suicide, and accidents. These topics lead me to further interests in the role of mental health in the modern societies, especially Mexico. I got deeply involved in research on the epidemiology of psychiatric disorders with a special emphasis in the study of suicide with the Consortium of Psychiatric Epidemiology and the WHO World Mental Health Survey Initiative, which includes national household surveys in more than 20 countries around the globe. In the study of suicidality, depression stands as a main topic of interest given its strong relationship with all types of suicide and suicide related behavior. Finally, being a national immigrant since I was about 3 years old, and an international immigrant since I was 14, it is not a surprise that I got interested on mental health issues of Latinos and, more specifically, the Mexican migration to the United States. The work of my colleagues in Mexico and other Hispanic academic leaders in the United States, concerned with the side-effect of immigration on the mental health, profoundly impacted me and has been an incentive for my own intellectual development.