Broadening of Generalized Anxiety Disorders Definition Does not Affect the Response to Psychiatric Care: Findings from the Observational ADAN Study

Enrique Álvarez1, Jose L Carrasco2, José M Olivares3, Vanessa López-Gómez4, Inma Vilardaga5, María Perez4, *
1 Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona, Spain
2 2Department of Psychiatry, Hospital Clínico San Carlos, Madrid, Spain
3 Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo, Spain
4 Medical Unit, Pfizer Spain, Alcobendas (Madrid), Spain
5 Department of Biometric and Statistic, European Biometric Institute, Barcelona, Spain

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 686
Abstract HTML Views: 404
PDF Downloads: 240
Total Views/Downloads: 1330
Unique Statistics:

Full-Text HTML Views: 504
Abstract HTML Views: 288
PDF Downloads: 194
Total Views/Downloads: 986

Creative Commons License
© Álvarez et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Avda. de Europa, 20 B Parque Empresarial La Moraleja 28108 Alcobendas (Madrid); E-mail:



To elucidate the consequences of broadening DSM-IV criteria for generalized anxiety disorder (GAD), we examined prospectively the evolution of GAD symptoms in two groups of patients; one group diagnosed according to DSM-IV criteria and the other, according to broader criteria.


Multicentre, prospective and observational study conducted on outpatient psychiatric clinics. Patients were selected from October 2007 to January 2009 and diagnosed with GAD according to DSM-IV criteria (DSM-IV group) or broader criteria. Broader criteria were considered 1-month of excessive or non-excessive worry and only 2 of the associated symptoms listed on DSM-IV for GAD diagnosis. Socio-demographic data, medical history and functional outcome measures were collected three times during a 6-month period.


3,549 patients were systematically recruited; 1,815 patients in DSM-IV group (DG) and 1,264 in broad group (BG); 453 patients did not fulfil inclusion criteria and were excluded. Most patients (87.9% in DG, 82.0% in BG) were currently following pharmacological therapies (mainly benzodiazepines) to manage their anxiety symptoms. The changes observed during the study were: 49.0% and 58.0%, respectively of patients without anxiety symptoms as per HAM-A scale at the 6 month visit (p=0.261) and 59.7% and 67.7%, respectively (p=0.103) of responder rates (> 50% reduction of baseline scoring).


Broadening of GAD criteria does not seem to affect psychiatric care results in subjects with GAD, is able to identify the core symptoms of the disease according to the DSM-IV criteria and could lead to an earlier diagnosis.

Keywords: Diagnostic and Statistical Manual of Mental Disorders, Generalized anxiety disorder, Hamilton Anxiety Rating Scale, Self-reported quality of life.