The burden of anxiety among a nationally representative US adult population

Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, and specific phobias, are the most prevalent psychiatric disorders and are associated with significant health care costs and a high burden of illness (Bandelow and Michaelis, 2015). The prevalence of anxiety symptoms has risen significantly in recent years as a result of the COVID-19, from 31.4 % to 36.9 % (Vahratian et al., 2021). Recent reports estimate that approximately 40 million United States (US) adults are affected by anxiety disorders (Mental health - Household Pulse Survey - COVID-19, 2022). Additionally, anxiety disorders place a significant economic impact on the US healthcare system. The global annual direct cost of anxiety disorders has been estimated to be up to $6.5 trillion, or 2.08 % of all healthcare-related expenditures (Konnopka and König, 2020). Even more compelling is that the total cost estimate for anxiety disorders comprises >30 % of the total expenditures for psychiatric disorders in the United States (Arikian and Gorman, 2001; DuPont et al., 1996).

In addition to the economic burden, anxiety disorders place a significant humanistic burden on individuals. Compared to non-anxious individuals, those with anxiety disorders are more likely to have reduced psycho-social functioning and life satisfaction; relationship, role and social impairment; greater stress, and sleep difficulty (Henning et al., 2007; Kertz and Woodruff-Borden, 2011; Wittchen, 2002). These factors contribute to lower overall health-related quality of life (HRQoL). Further, severity of anxiety symptoms is significantly associated with these outcomes, with worse anxiety symptoms predicting lower HRQoL (Brenes, 2007). Anxiety disorders are also often comorbid with other psychiatric disorders, the most common being depression (Hoffman et al., 2008). Some estimates show that 60 % of individuals with anxiety also have concurrent symptoms of depression (Salcedo, 2018). Comorbidities typically increase the severity of prognosis, symptoms, and impairment, leading to lower work productivity and greater health service utilization, thereby increasing costs further (Kessler et al., 2002; Wittchen, 2002).

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