Anxiety disorders are among the most common mental health disorders and impose a substantial burden on affected individuals, their relatives, and society. Often, these disorders are persistent, i.e. chronic or recurring, and patients can struggle with them for a large part of their lives. It is therefore important to identify patients with a less favourable prognosis at an early stage in order to increase the chance of recovery and reduce the disease burden. An overview of all predictors of a persistent course is essential in this regard but has been missed so far.
The aim of this study was to provide a comprehensive overview of all known predictors of persistent anxiety disorders. To this end, 5,389 studies of anxiety disorders were perused and screened for predictors of persistent anxiety. 48 studies including a total of 29,690 patients provided information on one or more predictors. The relevance of each predictor for persistent anxiety disorders was determined and the findings in studies of children, adolescents, adults, and older adults (i.e., ≥55 years) were combined to create the most complete overview of predictors.
The main outcome was that clinical and psychological characteristics, such as having panic attacks, having a co-occurring personality disorder, and more severe avoidance behaviour, are predictive of a persistent course of anxiety disorders. Sociodemographic characteristics such as level of education, income, and occupation were not predictive of such an unfavourable course. No clear difference was found between the different age groups. These results might be of importance to clinical practice. The predictors found might help identify patients at risk of a poor prognosis, in order to provide them with a more targeted or more intensive treatment at an early stage, both to prevent adverse outcome and to optimize current care.
Predictors of persistence of anxiety disorders across the lifespan: a systematic review. Hovenkamp-Hermelink JHM, Jeronimus BF, Myroniuk S, Riese H, Schoevers RA. The Lancet Psychiatry (2021).
