Factors predicting the clinical course of generalised anxiety disorder

Abstract

Background: Cross-sectional data show that generalised anxiety disorder (GAD) is a chronic condition with episodes lasting much longer than the six- month minimum required by DSM-III-R and DSM-IV. Although GAD is chronic, little is known about factors influencing illness duration. Aims: To investigate variables that influence the clinical course of GAD. Method: A total of 167 patients with GAD participated in the Harvard-Brown Anxiety Research Program. Patients were assessed at intake and re-examined at six-to twelve-month intervals for five years. Kaplan-Meier curves were constructed to assess the likelihood of remission. Regression analysis was used to investigate factors predicting full or partial remission. Results: The rate of remission was 0.38 after five years. Diminished likelihood of remission was associated with low overall life satisfaction, poor spousal or family relationships, a concurrent cluster B or C personality disorder and a low global assessment score. Conclusions: Full or partial remissions were less likely to occur in patients with poor relationships and personality disorders. These patients should be given more intensive and possibly multi- modal therapy. Declaration of interest: Practical support from the Upjohn Company and the National Institute of Mental Health (see Acknowledgements).