The Burden of Generalized Anxiety Disorder in Germany

Objective: To review studies quantifying the burden of generalized anxiety disorder (GAD) in Germany. Methods: A review of 17 original English-language studies on the human, health care and economic burden of GAD in Germany, identified in electronic databases (MEDLINE/ EMBASE: 1990-2008) and published bibliographies. Results: Nationally representative data indicate that GAD is more prevalent in primary care (5.3%, 4-week point prevalence) than in the community (1.5%, 12-month prevalence). Although GAD commonly co-occurs with depression, the burden of GAD was not satisfactorily explained by comorbidity. Functional impairments and high rates of medical resource use observed for pure GAD were at least similar in magnitude compared with that of pure major depressive disorder (MDD). The per-patient cost of GAD in Germany (€2728, adjusted for purchase power parity in 2004) was higher than the corresponding cost of other anxiety disorders. Direct medical costs were nearly four times higher than indirect costs of sick leave. Although both disorders are burdensome in primary care, GAD was less likely than MDD to be accurately recognized and adequately treated. Conclusions: Results from Germany underscore that GAD is a distinct, clinically relevant and costly disorder. Strategies to improve recognition and treatment of GAD have the potential to reduce the serious burden of illness (German J Psychiatry 2008; 11: 159-167).