Increasing Incidence of Anxiety Disorders

 

Anxiety among Americans seems to be on the increase. Even before the terrorist attacks of 9/11, researchers had warned that depression and anxiety among Americans were at serious levels. The centers for Disease Control estimates the lifetime prevalence for anxiety among Americans at 15% with the 12-month prevalence at over 10, which makes anxiety disorders the most common mental disorder in the country (CDC, 2013). Worldwide, the lifetime prevalence estimates among developed countries ranges from 13.6% to 28.8% (Tanja, 2007). Over half the college students in 2015 who visited college counseling centers were there for anxiety (Tate, 2017)

Twenge’s (2000) meta-analysis of studies involving 12,000 subjects ages 9 to 17, conducted between 1954 and 1981, as well as 40,000 college students studied between 1952-1993 found that the levels of anxiety had risen sharply in the last 50 years. Twenge found that the average score for American children in 1981 on self-reported anxiety measures was higher than those for children psychiatrically hospitalized in the 1950’s. The factors which she believes responsible for this increase appear to have either remained stable or intensified in the last decade.

Twenge argues that the broad social trends are as responsible for anxiety among children as are genetics and family dynamics combined. According to her review, anxiety levels rise and fall in rough tandem with “perceived overall threats,” such as fears, nuclear war, violent crimes, or AIDS and with “social connectedness,” measured by such statistics as divorce rates, birth rates and the number of single-person households. “Until people feel both safe and connected to each other,” said Twenge, “anxiety is likely to remain high.” Twenge, who has also done considerable research on narcissism among younger people, has also tied anxiety into status-and affluence-seeking and to diminished face to face social connectedness.

In the years since her meta-analysis, the rising incidences of terrorism and the growing threat of climate change has likely altered the negative zeitgeist, and so it’s safe to say that anxiety has gotten worse for older Americans as well. A national survey by Shuster (2001) taken between September 14 and September 16, 2001—just after the World Trade Center attack—showed that anxiety among Americans had reached unprecedented levels. Respondents were asked to rate their experience of various symptoms of anxiety, such as disturbing memories, difficulty concentrating, sleeping problems and increased irritability, on a scale of one to five. Forty-four percent rated their experience of at least one of the symptoms as “substantial” (4 or 5 on the scale), and 46 percent rated their experience of at least one symptom as “moderate” (2 or 3). Adults also reported that 35 percent of their children were suffering from elevated stress levels. Parents who felt substantial anxiety were more than twice as likely to report higher stress in their children. It’s unclear how much of that represents the contagion of stress and how much is parental projection. Meanwhile, counseling centers on college campuses reported a steady increase in demand for services which has continued today. Once the shock of 9/11 began to wear off, in the months following, service requests at Harvard increased from 400 per week to 600 per week—an unprecedented number. At Boston College the average waiting time to see a campus psychologist jumped from the usual three days to two weeks.

Wessley (2001), an expert in stress and chronic fatigue syndrome, predicted that the high stress levels would continue: “The general level of malaise may remain high for years, exacerbating pre-existing psychiatric disorders and further heightening the risk of mass sociogenic illness.” His prediction seems to have come true.

Luthar (2002) looked at affluent seventh graders and found that 14 percent of the girls had depression and stress scores above the clinical cutoff level, twice the national norm for seventh grade girls. One in five of the girls in the study had clinically significant anxiety, also several points above the national norm. The boys in the study fared no better: they were three times as likely to use alcohol or drugs than the average boy that age. Luthar found two factors most frequently associated with depression, anxiety and substance use: emotional and physical isolation from parents, and pressure—both external and internal—to achieve. Interestingly, such achievement pressures had no significant correlation with grades. When Luthar’s study appeared, many people took it as a criticism of affluent, two-parent working families who were seemingly more interested in earning money than in taking proper care of their children, but Luthar pointed out that the parents were just as trapped as their children by a society that over-emphasized achievement at the cost of connectedness. Luthar insisted on not blaming parents but instead other societal forces. Luthar was quick to defend affluent parents against charges that they were pursuing their careers at their kids’ expense. “I’ve never talked to a parent who doesn’t care deeply about their children,” she said. Affluent parents, she believes, trying to raise their children in the best environments and schools, and to keep them away from substandard schools and the dangers of the streets, become trapped into working long hours just to meet the high costs and long commutes that are part of where they live.

Luthar’s findings are all the more significant because Henker (2002) found that highly anxious students were seven times as likely to exhibit anger, two to three times as likely to smoke, and almost twice as likely to drink alcohol than their less anxious peers. The study also found that highly anxious students were 11 times more likely to report sadness, interacted less with peers in person or on the phone, and spent less time on entertaining activities. These anxious students spent more time on achievement-oriented activities, a finding that echoes Luthar’s research. When these students did interact with friends or family, they felt significantly better, suggesting that such teens need to socialize more.

Anxiety disorders are considered the most common class of disorders among the general population. Oquendo (2004) agrees with most researchers that women are diagnosed with an anxiety disorder over twice as often as men. Overall, the incidence of anxiety disorders is difficult to determine for several reasons. It is often undiagnosed or misdiagnosed as somatic symptoms. (See article 2 in this course). Also, the categorization of anxiety disorders has changed with various DSM editions. Studies may parse out trauma-related disorders or phobias. Methodology in incidence studies also varies; studies may deal with diagnosed cases while others look at symptoms. Kessler et al. (2009) estimates the lifetime prevalence of any anxiety disorder at over 15%, with the 12-month prevalence over 10% and says, as do most sources, that the rates are higher in developed countries.

Whatever the true incidence, the costs are enormous. Fifteen years ago,, Greenburg (1999) estimated the annual non-psychiatric medical treatment cost as $42.3 billion. That did not include lost productivity and other indirect nonmedical costs.

For other estimates of prevalence see Article 3 Psychodynamic overview of anxiety disorder – PDM approach.

References:

Centers for Disease Control and Prevention (2013). Burden of mental illness. Retrieved from https://www.cdc.gov/mentalhealth/basics/burden.htm

Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry 60 (7)

Henker, B, Whalen, CK, Jamner, LD & Delfino, RJ (2002). Anxiety, affect and activity in teenagers: monitoring daily life with electronic diaries. Journal of Child and Adolescent Psychiatry, 41(6)

Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, Ustün TB, Wang PS. (2009) The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemioogicall Psichiatr Soc 2009;18(1):23–33.

Luthar, S & Becker, B (2002). Privileged but pressured? A study of affluent youth. Child Development, 73 (5)

Oquendo MA, Lizardi D, Greenwald S, Weissman MM, Mann JJ. (2004). Rates of lifetime suicide attempt and rates of lifetime major depression in different ethnic groups in the United States. Acta Psychiatrica Scandanavia 110:446–451

Shuster, MA (2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks. New England Journal of Medicine. 345 (20)

Tanja, M., Ulrike, Z., Jergen, M (2007). Epidemiology of anxiety disorders. Psychiatry, 6 (4), 136-41.

Tate, E (2017). Anxiety on the rise, Inside Higher Ed, March 29, 2017. Retrieved from https://www.insidehighered.com/news/2017/03/29/anxiety-and-depression-are-primary-concerns-students-seeking-counseling-services

Twenge, J. M. (2000). The age of anxiety? Birth cohort change in anxiety and neuroticism, 1952-1993. Journal of Personality and Social Psychology, 79, 1007-1021.

Wessely, S, Hyams, KC & Bartholomew, R (2001). Psychological implications of chemical and biological weapons: Long term social and psychological effects may be worse than acute ones. British Medical Journal 323(7318)