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Factors predicting the clinical course of generalised anxiety disorder

Departments of Psychiatry and Obstetrics & Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX, USA

INGRID R. DYCK, MPH, MEREDITH WARSHAW, MSW and MARTIN B. KELLER, MD

Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA

Correspondence: Kimberly A. Yonkers, MD, Department of Psychiatry, Yale University School of Medicine, 15 Honeysuckle Hill Lane, Easton, CT 06612, USA. Tel: (203) 452-9762; fax: (203) 452-9762; e-mail: Kim-Charlie{at}worldnet.att.net

Declaration of interest Practical support from the Upjohn Company and the National Institute of Mental Health (see Acknowledgements).

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.

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