Soc Psychiatry Psychiatr Epidemiol (2008) 43:898–904
1007/s00127-008-0379-0
ORIGINAL PAPER
Khitam Muhsen Æ Joshua Lipsitz Æ Noga Garty-Sandalon Æ Raz Gross Æ Manfred S. Green
Correlates of generalized anxiety disorder: independent
of co-morbidity with depression
Findings from the first Israeli National Health Interview Survey (2003–2004)
Received: 26 December 2007 / Accepted: 15 May 2008 / Published online: 19 July 2008
j Abstract Background Generalized anxiety disor-
der (GAD) is a prevalent psychiatric disorder with
chronic symptoms and is commonly comorbid with
depression. Objectives To identify correlates of GAD
among adults and to describe treatment patterns and
functional limitations among individuals with this
disorder. Methods Data for 2,082 subjects aged
‡21 years from the first Israeli national health inter-
view survey (INHIS-1) (2003–2004) were analyzed.
Information on GAD was collected using the short
form of the Composite International Diagnostic
Interview. Data were also obtained on socio-demo-
graphic, physical health characteristics, history of life
threatening events, treatment seeking behaviors, use
of medication and functional impairment. Results
The prevalence of GAD was highest among people
aged 40–59 years, in those with asthma, hypertension
K. Muhsen (&) Æ N. Garty-Sandalon Æ M.S. Green
Israel Center for Disease Control, Ministry of Health
Gertner Institute, Chaim Sheba Medical Center
Tel-Hashomer 52621, Israel
Tel.: +972-3/737-1500
Fax: +972-3/534-9881
E-Mail: khitam.m@icdc.health.gov.il
K. Muhsen Æ R. Gross Æ M.S. Green
Dept. of Epidemiology and Preventive Medicine
School of Public Health, Sackler Faculty of Medicine
Tel Aviv University
Ramat Aviv
Tel Aviv, Israel
J. Lipsitz
Dept. of Psychology
Ben Gurion University of the Negev
Be’er Sheva, Israel
R. Gross
The Gertner Institute for Epidemiology
SPPE 379
and Health Policy Research
Chaim Sheba Medical Center
Tel-Hashomer, Israel
DOI 10.
and in those with osteoporosis. Regular exercise was
associated with reduced prevalence for GAD (adjusted
OR 0.46, 95% CI 0.22–0.95). The exclusion of indi-
viduals with major depression from analysis
strengthened the association with age (adjusted OR
5.7, 95% CI 1.7, 19.7), weakened the association
between GAD and osteoporosis (adjusted OR 3.4, 95%
CI 1.2, 9.8), asthma (adjusted OR 3.4, 95% CI 1.2, 9.5)
and regular exercise (adjusted OR 0.47 95% CI 0.2,
1.14). In this sub-sample, hypertension was no longer
associated with GAD, and a significant association
was found between GAD and past experience of life
threatening events (adjusted OR 2.3, 95% CI 1.1–4.9).
Psychiatric and psychological consultations were low
among people with GAD (11.5% and 26.4% for those
without and with comorbid depression, respectively),
concurrent with a high degree of functional limita-
tion. Conclusions Middle age, history of traumatic life
events, and certain chronic medical diseases (e.g.,
asthma and osteoporosis) are important risk factors
for GAD. They could be used to help identify and treat
people with GAD.
j Key words generalized anxiety disorder –
epidemiology – correlates – impairment – treatment
Introduction
Generalized anxiety disorder (GAD) is characterized
by persistent excessive worry, anxiety and tension and
is associated with significantly increased symptoms of
hyper-vigilance and somatic symptoms of anxiety [47,
48]. GAD runs a fluctuating but chronic course [48]. It
is associated with personal suffering and decreased
quality of life [10]. Furthermore, a high burden of
disease is attributed to GAD due to impairment,
disability and decreased work productivity [14, 15,
29, 47].

The prevalence of GAD in population-based
epidemiological studies, range between 1.5 and 3% for
current GAD, 1.2–5% for GAD in the past year and
0.8–7% for lifetime GAD [5, 6, 13, 17, 21, 25, 31, 42,
46]. Using consistent and standard diagnostic meth-
ods (the composite international diagnostic interview
(CIDI)) in the framework of the world health orga-
nization’s world mental survey (WHO’s -WMS) [19],
enabled more valid cross-national comparisons in the
prevalence of GAD [5, 6 17, 25, 31, 42, 46]. Higher
estimates of 8% for current GAD have been reported
in primary care settings [23].
GAD is linked to high use of health services such as
visits to primary care physicians, emergency depart-
ment admissions and hospitalizations [3, 16, 37, 47,
49]. However, only a small portion of these patients
consult their physician regarding their emotional
problems and the vast majority of them are undiag-
nosed or treated only years after onset of the disorder
[20, 32]. Thus, identifying groups at high risk for GAD
is essential for early diagnosis and adequate treatment
and to eventually reduce the extent of impairment and
disability caused by this disorder.
The Israeli component of the WHO’s WMHS, which
was carried out in 2003–2004 in a representative sample
of adults aged ‡21 years, following the procedures
established by the WHO/WMH Survey indicated a
12 month- prevalence of GAD of 1.8% and life time
prevalence of 2.7% [27]. A second major health study,
the first Israel national health interview survey (INHIS-
1), was also conducted in 2003–2004, in Israel, as a part
of the European health interview survey (EUROHIS)
project of the WHO Regional office of the European
region. In the current study, we used data derived from
the mental health supplement (module) of the INHIS-1.
The aims of our study were: (1) To examine the cor-
relates of GAD in the general adult population in Israel.
(2) To characterize the patterns of seeking treatment
and role limitation among subjects with GAD.
Methods
INHIS-1 is based on the European WHO project aimed at devel-
oping common instruments for health surveys for international
comparisons of health data [30]. INHIS-I was a telephone survey
undertaken in 2003–2004 at the Israel Center for Disease Control.
A description of the survey was published elsewhere [2].
j Study population
The survey was carried out among non-institutionalized adults
aged ‡21 years. The current study included only Jewish partici-
pants due to differences in some of the questions in Arabic.
j Sampling
A random sample of telephone numbers was selected from a
computerized list of subscribers to the national telephone com-
pany. About ninety one percent of the Israeli households have
899
telephone lines [7]. After exclusion of fax numbers, disconnected
numbers, commercial numbers and households without a resident
aged ‡21 years old the number of eligible households was 21,326. A
total of 4,980 (23.4%) of the eligible households could not be
located, thus leaving a total of 16,346 households that were con-
tacted, of these 9,509 subjects (58.2%) completed the interview.
Non-compliance comprised of refusals (29.4%), incomplete inter-
view (2.2%) and repeated postponements (10.2%). INHIS-1 was
conducted in four modules and the current study is based on 2,082
Jewish participants of the mental health module in which the
response rate was 54.4%.
j Collection of data
Data collection was carried out by telephone by trained inter-
viewers. The questionnaire comprised of two parts: the core
questionnaire, which was administrated to all respondents of the
INHIS-1 and an addition of a specific mental health module [30].
The core questionnaire includes information on socio-demographic
variables such as gender, age, martial status, employment status,
academic degree, and family income. The participants were asked if
they have any long-standing illness or health problem and also if
they have or have ever had certain chronic diseases such as asthma,
hypertension, high blood lipids, myocardial infarction, stroke,
congestive heart failure, rheumatic arthritis, osteoporosis, diabetes
mellitus, and cancer. Data were also obtained on regular exercise
which was defined in the current study as practicing any type of
physical activity such as walking, jogging, swimming, or gymnastics
for at least 20 consecutive minutes, every day or almost every day.
j Threatening and stressful life events
Data on past threatening life events were obtained through the
following question; ‘‘Sometimes people undergo difficult experi-
ences, either one-time or on a continuous basis. Have you ever
undergone a traumatic event, such as a bad accident, a life-
threatening illness, being in a terrorist incident, being attacked, or
any other traumatic event?’’ Additional information on stressful life
events was collected through these questions: ‘‘During the past
12 months did you undergo an event such as ‘‘someone moved
into your home or moved out (including birth, adoption, new
relationship, not including death.)’’, ‘‘you had a severe illness or
injury’’, ‘‘a family member or friend had a severe illness or injury’’,
‘‘death of a family member’’ ‘‘death of a close friend’’?
j 12-month prevalence of generalized anxiety
disorder and major depression
The instrument that was used for identifying cases with GAD and
major depression was the WHO CIDI -short form [30]. The diag-
nosis of GAD based on the CIDI-SF in this study includes persistent
worry of six months duration, difficulty controlling worry, and
three or more of the following symptoms much of the time when
anxious (feeling restless, feeling keyed up or on edge, easily tired,
trouble concentrating, irritability, muscle tension, sleep distur-
bance).
j Medical treatment and seeking help
Receiving prescribed medications for GAD was assessed using the
question ‘‘Have you received prescribed medications for treating
anxiety or relaxation in the past 12 months?’’ Seeking professional
help was defined based on the questions: ‘‘Did you talk about your
worries or anxieties with a psychiatrist in the past 12 months?’’,
‘‘Did you talk about your worries or anxieties with a psychologist,
social worker, psychiatric nurse or other mental health profes-
sional, in the past 12 months?’’ and ‘‘Did you talk about your
900

worries or anxieties with a physician (not a psychiatrist) or other
medical practitioner like a nurse or dietitian, in the past
12 months?’’ Seeking informal help was defined based on the
question: ‘‘did you talk about your worries or anxieties with a
relative or friend in the past 12 months?’’ Seeking religious and
non-professional help was defined based on the questions ‘‘did you
talk about your worries or anxieties with a religious/spiritual lea-
der?’’ and ‘‘did you talk about your worries or anxieties with an
alternative professional like naturopath, homeopath or healer?’’
21–39 and 60+ years, respectively (Table 1). GAD was
more common in individuals who were unemployed,
who had no college education, and those who had
lower family income (Table 1). In women, the prev-
alence of GAD was 1.6 times higher than in men.
However, this association was not statistically signif-
icant (P = 0.09) (Table 1). There were no differences

j Role limitation Table 1 Univariate analysis of the correlates of generalized anxiety disorder
among adult Jews in Israel—INHIS-I
Role limitation was measured using the three-item questions from
the Medical Outcomes Study Short Form—36 item (SF-36) ques- N GAD (%) Prevalence P
tionnaire on limitation of work and day-to-day activities as a result Ratio (95%CIa)
of emotional problems [30]. The questions included ‘‘During the
past 4 weeks have you cut down on the amount of time you spent
Socio-demographic factors
on work and or regular daily activities due to emotional problems
Gender
such as depression or anxiety?’’ ‘‘Have you accomplished less than
Males 945 18 (1.9) Reference 0.09
you would like to due to such problems?’’, ‘‘Did not do work or
Females 1,137 35 (3.1) 1.6 (0.9–2.6)
other activities as carefully as usual?’’
Age group
21–39 737 9 (1.2) Reference 0.054*
40–59 797 29 (3.6) 3.0 (1.4–6.3)
j Data management 60+ 548 15 (2.7) 2.2 (1.0–5.1)
Employment
Data were managed and analyzed using SAS and SPSS softwares. Yes 1,298 24 (1.8) Reference 0.009
No 783 29 (3.7) 2.0 (1.2–3.4)
Family income
j Statistical analysis >5,200 NIS 1,094 23 (2.1) Reference 0.003
£5,200 NIS 493 24 (4.9) 2.3 (1.3–4.1)
The prevalence proportions of GAD and 95% confidence intervals Academic education
(CI’s) were calculated. A univariate analysis was carried out using Yes 630 9 (1.4) Reference 0.032
v2 test to examine the associations between GAD and the potential No 1,447 44 (3.0) 2.1 (1.1–4.3)
correlates; Fisher’s exact test was applied when appropriate. Prev- Health related factors
alence ratios (PR’s) and 95% CI’s for each potential risk factor were Any chronic disease
also calculated. Multivariate analyses were performed using logistic No 1,354 20 (1.5) Reference <0.001
regression models to examine the independent association between Yes 690 32 (4.6) 3.1 (1.8–5.5)
GAD and the independent variables (e.g. socio-demographic and Regular exercise
health related factors, etc.). Adjusted odds ratios (OR’s) and 95% No 1,369 41 (3.0) Reference 0.071
CI’s for each variable were obtained from the logistic regression Yes 713 12 (1.7) 0.6 (0.3–1.1)
models. The association between GAD and role limitation was Asthma
examined using v2 test. P < 0.05 was considered statistically sig- No 1,950 43 (2.2) Reference <0.001
nificant. Yes 130 10 (7.7) 3.4 (1.8 –6.8)
Hypertension
No 1,709 35 (2.0) Reference 0.001
Yes 358 18 (5.0) 2.5 (1.4 –4.3)
Results High blood lipids
No 1,610 33 (2.0) Reference 0.014
The study included 2,082 participants with a mean age Yes 408 17 (4.2) 2.0 (1.1–3.6)
of 48.3 years (SD 16.6) (range: 21–94 years). Male Rheumatic arthritis
No 1,954 45 (2.3) Reference 0.02
participants comprised 45.4% (n = 945) of the study Yes 112 7 (6.3) 2.7 (1.3 –5.9)
sample. Osteoporosis
Fifty-three subjects met the CIDI diagnosis of 12- No 1,926 36 (1.9) Reference <0.001
month prevalence of GAD, yielding a rate of 2.5% Yes 121 12 (9.9) 5.3 (2.8 –9.9)
Threatening and stressful life events
(95% CI 1.9–3.3). Twenty-one subjects of 53 (39.6%) Life threatening eventsb
who met the CIDI diagnosis of GAD also met CIDI No 1,384 26 (1.9) Reference 0.006
diagnosis of past 12-month major depression. Yes 697 27 (3.9) 2.1 (1.2–3.5)
Injury or severe illness in the past 12 months
No 1,943 46 (2.4) Reference 0.078
j Correlates of GAD Yes 133 7 (5.3) 2.2 (1.0–4.8)
Death of family member in the past 12 months
No 1,791 41 (2.3) Reference 0.053
Univariate analysis Yes 283 12 (4.2) 1.9 (1.0–3.5)

*Linear by linear association

a
Prevalence ratio and 95% confidence interval
Socio-demographic factors: the prevalence of GAD b
Have ever had threatening life events such as a bad accident, a life threat-
was highest in individuals aged 40–59 years (3.6%), as ening illness, being in a terrorist incident, being attacked, or any other trau-
compared with 1.2 and 2.7% among individuals ages matic event?
 901

in the prevalence of GAD according to marital status
(P = 0.75).
Health related factors: participants who reported
on any chronic illness had a three-fold higher prev-
alence of GAD. The prevalence of GAD was signifi-
cantly higher among individuals with asthma, with
hypertension, high blood lipids, rheumatic arthritis
and osteoporosis, as compared with subjects who did
report on such conditions (Table 1). There was no
statistically significant association between GAD and
between history of myocardial infarction (P = 0.28),
congestive heart failure (P = 0.176), malignant
tumors (P = 0.22) and diabetes mellitus (P = 0.26),
this could be due the small numbers of partici-
pants that reported on such illnesses. GAD was
less common among people who regularly exercise
(Table 1).
Threatening and stressful life events
Those who reported experiences with life threatening
events such as a severe accident, life threatening
illness, being in a terrorist incident, or have been
attacked, had a two-fold higher prevalence of GAD
compared with those who did not report these expe-
riences (Table 1). Increased prevalence of GAD was
also observed among subjects who reported on injury
or severe illness, and on death of a family member
in the past 12 months (Table 1). No associations
were observed between GAD and other stressful life
events.
Multivariate analysis
GAD without depression co-morbidity
To identify the correlates of GAD beyond the high
co-morbidity with major depression, we performed a
second multivariate analysis in which people with
major depression were excluded (Table 2). This sec-
ond model showed that individuals belonging to the
age group of 40–59 years had a 5.7 fold increased risk
for GAD as compared with the age group of 21–
39 years; adjusted OR 5.7 (95% CI 1.7–19.7). In this
analysis, the associations between GAD and between
asthma and between osteoporosis were weakened
(Table 2); hypertension was no longer associated with
GAD in this model. Regular exercise was still associ-
ated with about 50% decreased risk of GAD; however
this association was no longer statistically significant
(Table 2). In this model threatening life events
were associated with twofold increased risk for GAD
(Table 2). We performed an additional multivariate
analysis on major depression without GAD to exam-
ine the association between exercise and depression.
This analysis revealed a significant reduction in the
odds of major depression in people who regularly
exercise (adjusted OR 0.57, 95% CI 0.35–0.93
P = 0.027).
Treatment
Thirteen subjects (24.5%) of people with GAD
reported using prescribed medications for GAD, while
11.5, 26.4 and 18.9% of them reported seeking psy-
chiatric, psychological, or medical consultation in the

Table 2 Multiple logistic regression adjusted odds ratio (95% CI’s) of the
The variables that were included in the multivariate correlates of generalized anxiety disorder among adults in Israel—INHIS-1
analyses were socio-demographic characteristics (age, GAD without major P
gender, employment status, and academic education), depression N = 1,843
health related factors (certain chronic diseases; Adjusted OR (95%CI)a
asthma, hypertension, high blood lipids, rheumatic
arthritis, osteoporosis and regular exercise) and Age
21–39 Reference
threatening life-events and stressful life-events (severe 40–59 5.7 (1.7–19.7) 0.006
illness or injury, a death of family member in the past 60+ 2.6 (0.63–10.8) 0.18
12 months). Family income was not included in the Asthma
model since data on family income were available No Reference
Yes 3.4 (1.2–9.5) 0.017
only for 76% of the participants. In the first model the Osteoporosis
analysis was carried out using data regarding all No Reference
subjects identified with GAD. In this model the Yes 3.4 (1.2–9.8) 0.022
prevalence of GAD was significantly increased in the Regular exercise
age group of 40–59 years as compared with younger No Reference
Yes 0.47 (0.2–1.14) 0.097
subjects; adjusted OR 2.5 (95% CI 1.08–5.7), in those Life threatening events
with asthma adjusted OR 3.5 (95% CI 1.5–7.8), in No Reference
people with hypertension; adjusted OR 2.6 (95% CI Yes 2.3 (1.1–4.9) 0.028
1.3–5.2), and with osteoporosis; adjusted OR 5.0 (95% a
Adjusted for the variables in the table and for gender, employment status,
CI 2.3–11.1). Regular exercise was associated with a education, certain chronic diseases (hypertension, high blood lipids, rheumatic
decreased prevalence for GAD; adjusted OR 0.46 (95% arthritis) and stressful life event (severe illness or injury, a death of family
CI 0.22–0.95). member in the past 12 months)
902
Table 3 Limitation at work and daily activities in the past 4 weeks among people with GAD as compared with those without GAD or major depression—INHIS-1
Spent less time at work or in
other activities
n/N % P
No GAD and no major depression 54/1920 2.8 <0.001
GAD 18/52 34.6
past 12 months, respectively. Six subjects of those
with GAD (11.3%) reported on seeking religious/
spiritual help in the past 12 months. Six subjects
(11.3%) reported seeking help from non-professional
sources such as naturopath, homeopath or healer, in
the past 12 months, two of these subjects were of
those who reported on seeking religious/spiritual
help. On the other hand, the percentage of partici-
pants with GAD who reported on sharing their wor-
ries and anxieties with a relative or friend was 77.4%.
Role limitation
Limitation at work and day-to-day activities was sig-
nificantly higher among subjects with GAD as com-
pared with subjects classified as free of GAD or major
depression according to the short form CIDI criteria
(Table 3).
Discussion
This study is based on the mental health module of
the INHIS-1, a telephone interview survey carried out
in the general adult population in Israel. The reli-
ability of telephone surveys of mental illnesses vs.
face-to-face interviews for various mental disorders
have been addressed before [1, 11, 35, 41], suggesting
that although this approach may yield a lower
response rate [45], telephone interviews seem to be a
reliable mode for data collection in areas with a well
developed network of subscribers, and could play an
important role in surveillance of mental illnesses [12,
34].
We found a 12-month prevalence of GAD of 2.5%
among adult Jews in Israel. This rate is similar to the
12-month prevalence reported in population-based
epidemiological studies [13, 21, 46, 47]. The 12-month
prevalence of GAD found in our study among Jews, is
slightly higher than the 12-prevalence of GAD in the
Israeli population (1.8%) in framework of the Israeli
component of the WHO’s WMHS [27].
In common with previous community-based studies
[13, 28, 47], GAD was frequently co-morbid with major
depression. The correlates of GAD have been studied
before in large community samples. In the current
study we aimed to identify the correlates of GAD,
independently of major depression co-morbidity.
Accomplished less than would like Did not perform activities as carefully
as usual
n/N % P N/N % P
96/1910 5.0 <0.001 118/1911 6.2 <0.001
29/52 55.8 25/52 48.1
Mid-adulthood, the presence of certain chronic
diseases and threatening life events independently
increased the risk for GAD. Individuals in mid-adult-
hood (40–59 years) had the highest risk of GAD.
The association between anxiety disorders and
asthma [39] or worse asthma control [24, 43], have
been documented in studies in other countries. The
nature history of asthma and asthmatic attacks gen-
erates much anxiety in asthmatic subjects. Excessive
worrying about asthma symptoms and medical
treatment could have adverse impact asthma control
[43]. This situation may enhance the development of
continuous symptoms of worry and stress and even-
tually of generalized anxiety disorder. We also found
a strong association between osteoporosis and GAD.
Previous studies reported positive associations
between depressive symptoms and osteoporosis
among women [8, 40]. The observed association
between GAD and osteoporosis in our study remained
unchanged even after controlling for gender and
age and excluding people with depression from the
analysis.
Our data demonstrate about 50% reduction in the
prevalence of GAD among people who exercise reg-
ularly. Previous studies reported an association
between physical activity and reduced depressive and
anxiety symptoms among patients with mental illness
[33, 36] and exercise was also related to better mental
wellbeing in the general population [9]. The biological
pathways of the anxiolytic and antidepressant effects
of exercise are not fully understood. Such effects
could be mediated by various neurotransmitters (e.g.
noradrenergic effects) [38]. It should be noted that the
association between regular exercise and GAD was
weakened in the second multivariate analysis, in
which people with co-morbid major depression were
excluded. This may indicate that regular exercise
could be more beneficiary in subjects exhibiting both
depressive and anxiety symptoms. It is also possible
that people with GAD exercise less e.g. due to muscle
tension or fatigue two common symptoms of GAD.
The association between threatening life events
and GAD remained statistically significant, even after
controlling for socio-demographic factors and
chronic diseases. This finding is consistent with data
generated by previous surveys [4, 18, 28].
Our study indicates that only a small portion of
people with GAD seek professional help i.e. psychi-
atric, psychological or medical counseling. Previous
reports estimated that the probability of first contact

treatment in GAD patients within five years since the
onset of the disease is about 50% [20, 26, 32]. Barriers
related to the health care system towards professional
help seems less likely to explain the low rate of help-
seeking in people with GAD which was found in our
study, since in Israel the health care system has a
direct access to specialty psychiatric services. The
issue of help—seeking behaviors for mental illness is
complex and might involve socio-demographic fac-
tors such as education, living in non-rural areas, [44],
age at onset of illness and cohort effect [20]. The
attitudes and health beliefs could also play a role in
help-seeking behaviors for mental health problems
[22]. In common with previous studies [47] we found
a high degree of functional limitation, among people
with GAD.
Although consistent with other studies, the gener-
alizability of our findings is limited to households
who choose to list their phone numbers in the
national lists. The low response rate of 54% in the
survey could be considered as a drawback of the study
and this could potentially limit generalizability of the
results.
In summary, the current study indicates that the
correlates of GAD include demographic and health
related factors and experience of life threatening
events. The rates of seeking professional treatment are
low and the levels of limitation are high in people with
GAD. These findings highlight the importance of early
detection of people at high risk of GAD.
References
1. Aneshensel CS, Frerichs RR, Clark VA, Yokopenic PA (1982)
Measuring depression in the community: a comparison
of telephone and personal interviews. Public Opin Q 46:
110–121
2. Baron-Epel O, Garty N, Green MS (2007) Inequalities in use of
health services among Jews and Arabs in Israel. Health Serv Res
42:1008–1019
3. Bélanger L, Ladouceur R, Morin CM (2005) Generalized anxiety
disorder and health care use. Can Fam Physician 51:1362–1363
4. Blazer D, Hughes D, George LK (1987) Stressful life events and
the onset of a generalized anxiety syndrome. Am J Psychiatry
144:1178–1183
5. Bonnewyn A, Bruffaerts R, Vilagut G, Almansa J, Demyttenaere
K (2007) Lifetime risk and age-of-onset of mental disorders in
the Belgian general population. Soc Psychiatry Psychiatr Epi-
demiol 42:522–529
6. Bromet EJ, Gluzman SF, Paniotto VI, Webb CP, Tintle NL,
Zakhozha V, Havenaar JM, Gutkovich Z, Kostyuchenko S,
Schwartz JE (2005) Epidemiology of psychiatric and alcohol
disorders in Ukraine: findings from the Ukraine world mental
health survey. Soc Psychiatry Psychiatr Epidemiol 40:681–690
7. Central Bureau of Statistics 2004. Statistical abstract of Israeli
2004. Publication No. 54. Jerusalem. State of Israel
8. Coelho R, Silva C, Maia A, Prata J, Barros H (1999) Bone
mineral density and depression: a community study in women.
J Psychosom Res 46:29–35
9. Cramer SR, Nieman DC, Lee JW (1991) The effects of moderate
exercise training on psychological well-being and mood state in
women. J Psychosom Res 35:437–449
903
10. Cramer V, Torgersen S, Kringlen E (2005) Quality of life and
anxiety disorders: a population study. J Nerv Ment Dis 193:196–
202
11. Fenig S, Levav I, Kohn R, Yelin N (1993) Telephone vs. face-to-
face interviewing in a community psychiatric survey. Am J Pub
Health 83:896–898
12. Fournier L, Lesage A, Toupin J, Cre M (1997) Telephone sur-
veys as an alternative for estimating prevalence of mental dis-
orders and service utilization: a montreal catchment area study.
Can J psychiatry 42:737–743
13. Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W,
Goldstein RB, Smith SM, Saha TD, Huang B (2005) Prevalence,
correlates, co-morbidity, and comparative disability of DSM-IV
generalized anxiety disorder in the USA: results from the
national epidemiologic survey on alcohol and related condi-
tions. Psychol Med 35:1747–1759
14. Hunt C, Issakidis C, Andrews G (2002) DSM-IV generalized
anxiety disorder in the Australian national survey of mental
health and well-being. Psychol Med 32:649–659
15. Hunt C, Slade T, Andrews G (2004) Generalized anxiety
disorder and major depressive disorder co-morbidity in the
national survey of mental health and well-being. Depress
Anxiety 20:23–31
16. Jones GN, Ames SC, Jeffries SK, Scarinci IC, Brantley PJ (2001)
Utilization of medical services and quality of life among low-
income patients with generalized anxiety disorder attending
primary care clinics. Int J Psychiatry Med 31:183–198
17. Karam EG, Mneimneh ZN, Karam AN, Fayyad JA, Nasser SC,
Chatterji S, Kessler RC (2006) Prevalence and treatment of
mental disorders in Lebanon: a national epidemiological sur-
vey. Lancet 367(9515):1000–1006
18. Kendler KS, Hettema JM, Butera F, Gardner CO, Prescott CA
(2003) Life event dimensions of loss, humiliation, entrapment,
and danger in the prediction of onsets of major depression and
generalized anxiety. Arch Gen Psychiatry 60:789–796
19. Kessler RC, Angermeyer M, Anthony JC, DE Graaf R,
Demyttenaere K, Gasquet I, DE Girolamo G, Gluzman S,
Gureje O, Haro JM, Kawakami N, Karam A, Levinson D,
Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ,
Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S,
Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S,
Ustün TB (2007) Lifetime prevalence and age-of-onset distribu-
tions of mental disorders in the World Health Organization’s
world mental health survey initiative. World Psychiatry 6:168–176
20. Kessler RC, Olfson M, Berglund PA (1998) Patterns and pre-
dictors of treatment contact after first onset of psychiatric
disorders. Am J Psychiatry 155:62–69
21. Kessler RC, Wittchen HU (2002) Patterns and correlates of
generalized anxiety disorder in community samples. J Clin
Psychiatry 63(Suppl 8):4–10
22. Komiti A, Judd F, Jackson H (2006) The influence of stigma and
attitudes on seeking help from a GP for mental health problems:
a rural context. Soc Psychiatry Psychiatr Epidemiol 41:738–745
23. Kroenke K, Spitzer RL, Williams JBW, Mohanan PO, Lowe B
(2007) Anxiety disorders in primary care: prevalence, impair-
ment, comorbidity and detection. Ann Intern Med 146:317–325
24. Lavoie KL, Cartier A, Labrecque M, Bacon SL, Lemiere C, Malo
JL, Lacoste G, Barone S, Verrier P, Ditto B (2005) Are psychi-
atric disorders associated with worse asthma control and
quality of life in asthma patients? Respir Med 99:1249–1257
25. Lee S, Tsang A, Zhang MY, Huang YQ, He YL, Liu ZR, Shen YC,
Kessler RC (2007) Lifetime prevalence and inter-cohort varia-
tion in DSM-IV disorders in metropolitan China. Psychol Med
37:61–71
26. Levinson D, Lerner Y, Zilber N, Grinshpoon A, Levav I (2007)
Twelve-month service utilization rates for mental health rea-
sons: data from the Israel national health survey. Isr J Psychi-
atry Relat Sci 44:114–125
27. Levinson D, Zilber N, Lerner Y, Grinshpoon A, Levav I (2007)
Prevalence of mood and anxiety disorders in the community:
results from the Israel national health survey. Isr J Psychiatry
Relat Sci 44:94–103
904
28. Lim L, Ng TP, Chua HC, Chiam PC, Won V, Lee T, Fones C,
Kua EH (2005) Generalised anxiety disorder in Singapore:
prevalence, co-morbidity and risk factors in a multi-ethnic
population. Soc Psychiatry Psychiatr Epidemiol 40:972–979
29. Marciniak MD, Lage MJ, Dunayevich E, Russell JM, Bowman L,
Landbloom RP, Levine LR (2005) The cost of treating anxiety:
the medical and demographic correlates that impact total
medical costs. Depress Anxiety 21:178–184
30. Nosikov A, Gudex C (eds) (2003) EUROHIS developing com-
mon instruments for health surveys. WHO EUROPE. IOS Press,
Amsterdam
31. Oakley Browne MA, Wells JE, Scott KM, McGee MA; New
Zealand Mental Health Survey Research Team (2006) Lifetime
prevalence and projected lifetime risk of DSM-IV disorders in
Te Rau Hinengaro: the New Zealand mental health survey. Aust
NZ J Psychiatry 40:865–874
32. Olfson M, Kessler RC, Berglund PA, Lin E (1998) Psychiatric
disorder onset and first treatment contact in the United States
and Ontario. Am J Psychiatry 155:1415–1422
33. Paluska SA, Schwenk TL (2000) Physical activity and mental
health: current concepts. Sports Med 29:167–180
34. Patten SB, Adair CE, Williams JA, Brant R, Wang JL, Casebeer
A, Beausejour P (2006) Assessment of mental health illness by
telephone survey: experience with an Alberta mental health
survey. Chronic Dis Can 27: 99–109
35. Paulsen AS, Crowe RR, Noyes R, Pfohl B (1988) Reliability of
the telephone interview in diagnosing anxiety disorders. Arch
Gen Psychiatry 45:62–63
36. Richardson CR, Faulkner G, McDevitt J, Skrinar GS,
Hutchinson DS, Piette JD (2005) Integrating physical activity
into mental health services for persons with serious mental
illness. Psychiatr Serv 56:324–331
37. Roy-Byrne PP, Wagner A (2004) Primary care perspectives on
generalized anxiety disorder. J Clin Psychiatry 65(Suppl 13):
20–26
38. Salmon P (2001) Effects of physical exercise on anxiety,
depression, and sensitivity to stress: a unifying theory. Clin
Psychol Rev 21:33–61
39. Scott KM, Von Korff M, Ormel J, Zhang MY, Bruffaerts R,
Alonso J, Kessler RC, Tachimori H, Karam E, Levinson D,
Bromet EJ, Posada-Villa J, Gasquet I, Angermeyer MC, Borges
G, de Girolamo G, Herman A, Haro JM (2007) Mental disorders
among adults with asthma: results from the world mental
health survey. Gen Hosp Psychiatry 29:123–133
40. Silverman SL, Shen W, Minshall ME, Xie S, Moses KH (2007)
Prevalence of depressive symptoms in postmenopausal women
with low bone mineral density and/or prevalent vertebral
fracture: results from the multiple outcomes of raloxifene
evaluation (MORE) study. J Rheumatol 34:140–144
41. Simon GE, Revicki D, VonKorff M (1993) Telephone assess-
ment of depression severity. J Psychiatric Res 27:247–252
42. Stein DJ, Seedat S, Herman A, Moomal H, Heeringa SG, Kessler
RC, Williams DR (2008) Lifetime prevalence of psychiatric
disorders in South Africa. Br J Psychiatry 192:112–117
43. ten Thoren C, Petermann F (2000) Reviewing asthma and
anxiety. Respir Med 94:409–415
44. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC
(2005) Twelve-month use of mental health services in the
United States: results from the national comorbidity survey
replication. Arch Gen Psychiatry 62:629–640
45. Weeks MF, Kulka RA, Lessler JT, Whitmore RW (1983) Per-
sonal versus telephone surveys for collecting household health
data at the local level. Am J Pub Health 73:1389–1394
46. Wells JE, Browne MA, Scott KM, McGee MA, Baxter J, Kokaua
J; New Zealand Mental Health Survey Research Team (2006)
Prevalence, interference with life and severity of 12 month
DSM-IV disorders in Te Rau Hinengaro: the New Zealand
mental health survey. Aust NZ J Psychiatry 40:845–854
47. Wittchen HU (2002) Generalized anxiety disorder: prevalence,
burden, and cost to society. Depress Anxiety 16:162–171
48. Wittchen HU, Hoyer J (2001) Generalized anxiety disorder:
nature and course. J Clin Psychiatry 62(Suppl 11):15–19
49. Wittchen HU, Kessler RC, Beesdo K, Krause P, Höfler M, Hoyer
J (2002) Generalized anxiety and depression in primary care:
prevalence, recognition, and management. J Clin Psychiatry
63(Suppl 8):24–34