Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness

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Abstract

Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N = 20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.

Section snippets

Participants

Data were drawn from the CPES, which is an integration of three national surveys of mental health in residents of the United States: the National Comorbidity Survey Replication, the National Study of American Life, and the National Latino and Asian American Study of Mental Health. Data were collected between May 2002 and November 2003. The CPES has been described in detail elsewhere (Heeringa et al., 2004), but an abbreviated description of each of the constituent datasets is discussed here.

National comorbidity survey replication (NCS-R)

The

Demographic characteristics

As shown in Table 1, the total sample (N = 20,013) examined in this study consisted of 11,463 women and 8550 men. The women examined in this study were older (M = 43.74 vs. 42.90, F = 12.54, p < 0.001) and had a significantly higher proportion of African Americans (34.4% vs. 26.9%, χ2 = 136.08, p < 0.001) than their male counterparts. The male cohort, on the other hand, had a significantly higher proportion of Asian Americans (12.7% vs. 10.5%) and European Americans (40.4% vs. 36.1%), had obtained a

Discussion

Consistent with previous epidemiological research, we found a preponderance of women among almost all anxiety disorders examined. One in three women met criteria for an anxiety disorder during her lifetime, compared to 22% of men. Overall, the lifetime and past-year rates were approximately 1.5–2 times as common among women, with the greatest differences in PTSD, GAD, and PD. The pattern of gender differences across the anxiety disorders is consistent with data from the NCS of DSM-III-R

Conflict of interest

The authors declare no conflict of interest.

Role of funding

None.

Contributors

Carmen McLean designed the study analyses and wrote the manuscript. Anu Asnaani co-wrote the manuscript and conducted the data analyses. Brett Litz and Stefan Hofmann provided conceptual guidance on study design, provided assistance with data analyses, and co-wrote sections of the manuscript. All authors contributed to and have approved the final manuscript.

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