Factors predicting the clinical course of generalised anxiety disorder

Background Cross-sectional data show that generalised anxiety disorder (GAD ) is a chronic condition with episodes lasting much longer than the six-mon th minimum required by DSM -III- R and DSM-IV. Although GAD is chronic, lit tle is known about factors influencing illness duration. Aims To investigate variables that influence the clinical course of GAD. Method A total of 167 patients with GAD participated in the Harvard-Brown A nxiety Research Program. Patients were assessed at intake and re-examined a t six- to twelve-month intervals for five years. Kaplan- Meier curves were constructed to assess the likelihood of remission. Regression analysis was used to investigate factors predicting full or partial remission. Results The rate of remission was 0.38 after five years. Diminished likelih ood of remission was associated with low overall life satisfaction, poor sp ousal or family relationships, a concurrent cluster B or C personality diso rder and a low global assessment score. Conclusions Full or partial remissions were less likely to occur in patient s with poor relationships and personality disorders. These patients should be given more intensive and possibly multi-modal therapy. Declaration of interest Practical support from the Upjohn Company and the N ational Institute of Mental Health (see Acknowledgements).