(311) Generalized anxiety disorder: Epidemiology, burden, and comorbid depression.

Background: Generalized anxiety disorder (GAD) is characterized by excessive and persistent out-of-control worry, and anxiety and causes clinically significant distress or impairment in social, occupational, or other important areas of functioning for at least 6 months. Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are highly comorbid. The burden of GAD is high and associated risk factors are not well documented in the general population.
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Objectives: This study aims to provide an overview of epidemiology, risk factors and overlap of depression in Generalized Anxiety disorders (GAD).

Methods: This is an observational retrospective study of patients identified using the Optum CDM database. Adult patients diagnosed with GAD between January 1, 2008, and December 31, 2022, were identified from claims data.
The primary study endpoint was the estimated incidence and prevalence of GAD in the US adult population. Secondary study endpoints included the identification of risk factors for developing GAD and an assessment of any overlap of GAD with a diagnosis of MDD.
Adults with GAD were matched with a control general population. All recorded baseline patient characteristics and SARS-CoV-2 infection were considered as potential risk factors for developing a GAD episode, with a logistic regression performed to select the most important risk factors.

Results: A total of 1 086 618 GAD patients were included, most were women (66.5%), and average age was of 49.4 ±19.12. The incidence and 1- year prevalence of GAD increased (from 0.8% in 2012 to 2.4% in 2022 and from 2.1% in 2012 to 7.4% in 2022) among patients aged 18 and over. In the year preceding a GAD diagnosis, the primary risk factor for developing GAD was a pre-existing major depression disorder (MDD)(OR=5.06 95%CI [5.03, 5.08]; p< 0.001). The patients with employment difficulties (OR 2.48; 95% CI: [2.36, 2.60]; p< 0.01), family problems (OR 2.83 95% CI: [2.76, 2.89]; p< 0.001) and pre-existing attention deficit hyperactivity disorder (ADHD) (OR=2.19 95%CI [2.17, 2.21]; p< 0.001) were also more likely to have GAD. SARS-CoV-2 infection was higher among individuals with GAD than general population (6.3% versus 3.3%, OR= 2.53 95%CI [2.48, 2.57], p< 0.001). Of those individuals with GAD, 40.5% reported MDD prior to GAD diagnosis and 23.7% reported MDD after GAD diagnosis. An association between MDD and GAD was identified, with a RR of 4.14 (95% CI: 4.12, 4.17) if MDD occurred before GAD and a RR of 2.11 (95% CI: 2.08, 2.13) if it occurred after GAD.

Conclusions: In summary, the incidence and prevalence of GAD in the USA has continued to increase. The most associated risk factors to GAD were a pre-existing depression, employment difficulties, an ADHD, a SARS-CoV-2 infection. The results indicate that GAD and MDD had a significant overlap.