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Cost of anxiety disorders in Europe

Anxiety disorders, as defined by current diagnostic classification systems (DSM-IV, APA and ICD-10), comprise a wide range of phenotypically quite different conditions. The spectrum of anxiety disorders ranges from panic disorder and generalized anxiety disorders (GAD) to various types of phobic disorders (social phobia, agoraphobia, specific phobia subtypes, etc.) and might even include conditions like obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Because of the lack of cost data, the latter two conditions are not considered here in this overview. For historical reasons it should be noted that panic disorder and GAD closely resemble what has been labelled in the past anxiety neurosis , whereas phobias were lumped together in the past under the term phobic neuroses . Despite the seemingly striking differences in symptomatology and impairment, their natural course and severity, anxiety disorders all share the same core diagnostic features: namely the core role of anxiety reactions and avoidance behaviour in the development and/or the expression of the illness. With the exception of panic disorder and GAD, they also share with a few notable exceptions an early onset – mostly before age of 16 – and a considerable degree of persistence over the patient’s lifetime (Wittchen et al., 2001). Family genetic studies also demonstrate that anxiety disorders run in families , although the mechanisms of this familiar aggregation remain poorly understood. According to most more recent epidemiological studies, anxiety disorders overall were almost always confirmed to be among the most prevalent mental disorders, with a lifetime cumulative incidence risk of 11% to over 20%, depending on the range of anxiety disorders covered, with females revealing approximately twice the prevalence of males (Wittchen et al., 2001). The incidence for anxiety disorders in general is characterized by steep increases between ages 6 to about 16. After this age considerable incidence rates are noteworthy for panic disorder, agoraphobia and particularly for GAD. Epidemiological studies have also demonstrated some sequential and simultaneous comorbidity between various anxiety disorders and a substantial degree of continuity of childhood expression of anxiety disorders (such as separation anxiety disorder, or overanxious disorders) to various forms of adolescent and adult anxiety and affective disorders. In fact there is growing recognition for the suggestion that anxiety disorders are also a potent risk constellation for depressive disorders (Bittner et al., 2004). The latter two issues of comorbidity and continuity are essential for understanding the considerable degree of lasting impairments and disabilities associated with these disorders that persist from childhood to late adulthood in the majority of cases.