Week 6: Anxiety disorders Epidemiology & Correlates

Question 1

Prevalence of Anxiety Disorders

Answer 1

NCS A

• Lifetime prevalence of any anxiety disorder during childhood and adolescence is 32%
• Specific phobia: 19% (most do not get treatment)
• Separation anxiety: 8%
• Social Phobia: 9%
• Generalized anxiety disorder: 2%
• Panic Disorder :

(Not from NAC)

• Estimated prevalence of OCD 1% 2%
• Estimated prevalence of selective mutism is 0.7%

Question 2

Gender and anxiety disorders

Answer 2

Girls are more likely than are boys to meet diagnostic criteria for an
anxiety disorder
-2:1 female:male ratio except OCD which is 2:1 male to fmale
-Gender gap is present across development
Starts early and grows with age

Question 3

Socioeconomic Status and

Ethnicity

Answer 3

Note that anxiety is present across socioeconomic strata and across cultures
-Specific, contextual experiences may shape what anxiety looks like
(what disorder and what the manifestation of the disorder is varies)

-NCS A
-Socioeconomic status
-Lower levels of parental education and living in a single parent headed
household associated with greater likelihood of having an anxiety
disorder
-Ethnicity, not consistent differences except for anxiety
-Anxiety disorders more common among Black youth than among White
youth
Also black youth access less services than whites

Question 4

Comorbidity: Anxiety Disorders

Answer 4

Youth who have one anxiety disorder often meet criteria for others

Selective mutism
-80% of youth with selective mutism meet diagnostic criteria for another
anxiety disorder

-69% of youth with selective mutism meet diagnostic criteria for social
phobia

-There are youth with selective mutism who do not report experiencing
significant anxiety

Question 5

Comorbidity: Depression

Answer 5

Diagnostic co morbidity can be as high as 75 to 80%

Ontario Child Health Study
-6 month prevalence
-77% of adolescents who meet criteria for Major Depression also meet criteria for an anxiety disorder
-45% of adolescents who meet criteria for an anxiety disorder also meet criteria for major depression
-Youth experiencing depression are often also highly anxious
-Youth with anxiety are more likely than are youth without anxiety to be experiencing depression, but there are youth who have just
anxiety
-Anxiety symptoms/disorders often precede depression

Question 6

Comorbidity: Anxiety and

Depression

Answer 6

Symptom overlap

-GAD and MDD: fatigue, sleep disturbance, irritability, concentration
difficulties
-Very similar
-Negative affectivity
(Common to both)
-Extent to which person feels distress
-High negative affectivity is associated with both anxiety and depression
-Note that positive affectivity extent to which person feels positive affect is an independent dimension
-Negatively correlated with depression, but is independent of anxiety
symptoms and diagnoses

This lack of positive affect can be used to discriminate depression and anxiety

Question 7

Clinical Correlates

academic

Answer 7

Academic difficulties

-Youth with anxiety disorders typically have IQs in the typical range
-Symptoms may interfere with academic functioning
(might do worse at school)
-Impact of worry on concentration

School refusal can be a typical symptom
Refusal to go to school
Difficulty remaining in school
(find ways to come home)
Separation anxiety, social anxiety

Selective mutism
Will not talk in specific social settings
You have to talk in school, this can be a problem

Question 8

Clinical Correlates

social

Answer 8

Social Difficulties

Shy/withdrawn children become increasingly rejected by the peer
group with age

Younger kids do not mind, older ones do not like this

More likely to experience peer victimization

Shy/withdrawn children are as likely as peers to have friends, but they
perceive these relationships to be of lower quality

They rate this as being less close etc but they DO have friends

Question 9

Developmental Course of Anxiety Disorders

Answer 9

Some fears, worries, and rituals developmentally appropriate

Different “typical” age of onset for each fear

• 2 years of age: Loud noises, animals, the dark, separation from parents
• 5 years of age: Animals, dark, separation from parents, bodily injuries, “bad” people
• 7 to 8 years of age: Dark, supernatural beings, staying alone, bodily injuries

Worries more complex as youth age

Young children may not realize that their fears or behaviors are
excessive or abnormal

Young children may not realize that their fears or behavior are
excessive or atypical
-As children become older, they may become more embarrassed

Young children may not be able to tell you how they are feeling

Defiance, acting out

This could look like ODD but it could be caused by fear

Question 10

Ages of onset of anxiety disorders

Answer 10

Different Anxiety Disorders Show Different Ages of Onset
Separation Anxiety Disorder (7 to 8 years)
OCD (9 to 12 years)
Some children will show it very early 6 to 10 years

Generalized Anxiety Disorder (10 to 14 years)
Social Phobia adolescence
Panic Disorder adolescence

Question 11

Prognosis of Anxiety Disorders

Answer 11

Research is ongoing to determine what the long term outcomes of
anxiety disorders are
Homotypic continuity
-Anxiety disorders predict subsequent anxiety disorders
Heterotypic continuity
-An anxiety disorder predicts other types of disorders

Large, population representative sample

Measured anxiety disorders between 14 and 16 years of age

Measure mental health and educational outcomes between 16 and 21 years of age

As anxiety disorder number increased there was increase heterotypic and homotypic risk

This was true even when controlling for other relevant factors

Question 12

Homotypic & Heterotypic

Answer 12

Homotypic continuity
-Anxiety disorders predict subsequent anxiety disorders
Heterotypic continuity
-An anxiety disorder predicts other types of disorders