مقالات اختلال اضطراب فراگیر: یک دهه بعد کجا ایستاده ایم؟

The purpose of this study was to extend previous work examining publication rates for the anxiety disorders and publication topics for generalized anxiety disorder (GAD). Specifically, we examined anxiety disorder publication rates in MEDLINE and PsycINFO from 1998 to 2008. The results show: (1) that with the exception of panic disorder, there was a significant increase in the annual rate of publications for every anxiety disorder; (2) that GAD had the second lowest annual rate of publications in every year – with no more than 8% of anxiety disorder publications devoted to GAD in any given year; and (3) that GAD publications focused more often on treatment (44%) than on descriptive issues (26%), process issues (22%), and general reviews (8%). Given that citation analysis appears to be a valid indicator of research progress, the current findings suggest that research on GAD continues to lag behind research on most other anxiety disorders.

The number of anxiety disorder publications has increased in both absolute and relative terms over the past 25 years (Boschen, 2008). Like most other anxiety disorders, generalized anxiety disorder (GAD) appears to have received increased research attention – at least in absolute terms – since its introduction in DSM-III (American Psychiatric Association [APA], 1980). However, the growth of GAD publications relative to other anxiety disorder publications remains unclear. More importantly, a systematic review of the topics that are addressed in GAD publications (i.e., descriptive issues, process issues, treatment issues, and general reviews) has not been undertaken since 1997. The goal of this study is to examine GAD publication rates and topics from 1998 to 2008. Given that we investigated similar issues from 1980 to 1997 (Dugas, 2000), the current study will provide information on changes that have taken place in the decade following the time period covered by our previous study. A number of researchers have examined anxiety disorder publication rates over the past 15 years. For example, Norton, Cox, Asmundson, and Maser (1995) found that the number of anxiety disorder publications increased dramatically from 1981 to 1990. They also found that panic disorder, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) were the most frequently published anxiety disorders. This latter finding was also reported by Cox, Wessel, Norton, Swinson, and Direnfeld (1995), who examined publication rates from 1990 to 1992. Findings from our previous study (Dugas, 2000) looking at publication rates from 1980 to 1997 were consistent with those of Norton et al. and Cox et al. in that they showed that GAD, social phobia and specific phobia were by far the least published anxiety disorders. More recently, Boschen (2008) examined anxiety disorder publications from 1980 to 2005 and found that the number of publications has steadily grown over the 25-year period. His findings also show that PTSD (and to a lesser degree, OCD) had the most dramatic increase in publication rates over the period covered by his study. In all studies reviewed above, the number of GAD publications was considerably lower than the ones for panic disorder, PTSD, and OCD. In fact, Boschen (2008) found that, relative to all other anxiety disorders (with the exception of acute stress disorder), GAD had the lowest number of publications from 1980 to 2005. GAD publications were almost nine times less frequent than PTSD publications and about four times less frequent than panic disorder and OCD publications over the 25-year period. In our previous study (Dugas, 2000), we found that the absolute number of GAD publications had generally increased from year to year from 1980 to 1997. However, although the relative number of GAD publications (relative to other anxiety disorder publications) had increased in the 1980s, it had remained fairly stable in the 1990s. In fact, we found that the percentage of anxiety disorder publications devoted to GAD in the 1990s did not exceed 8.5% in any given year. Thus, data from independent researchers indicate that the number of publications devoted to GAD relative to other anxiety disorders has been modest in the two decades following the inception of GAD in DSM-III (APA, 1980). In terms of the topics covered by GAD publications from 1980 to 1997, the data show that 57% of GAD publications dealt with descriptive issues (e.g., epidemiology, diagnosis, comorbidity), 31% with treatment issues (e.g., clinical trials, meta-analyses, treatment algorithms), 10% with process issues (e.g., biological substrates, cognitive vulnerability, interpersonal functioning), and 2% presented general reviews (Dugas, 2000). It appears that although we are just beginning to understand the biological, psychological and social factors involved in the etiology of GAD, relatively few publications were devoted to the processes or risk factors implicated in the development and maintenance of GAD. One could argue that research on the etiology of a condition should normally precede research into its treatment – this does not seem to have been the case for GAD as only 1 of 10 publications addressed process issues whereas 3 of 10 publications dealt with treatment. The review presented above suggests that GAD has received modest research attention compared to other anxiety disorders. In addition, within the GAD literature, studies of the biological, psychological and social factors involved in the etiology of the disorder are under-represented (at least from 1980 to 1997). Although publication output is only one indicator of research activity, it can be used as a stand-alone marker of research interest. For example, publication rates have been used to measure research interest in the areas of addictions (Zurián, Aleixandre, & Castellano, 2004), personality disorders (Blashfield & Intoccia, 2000), and clinical medicine (Fava, Guidi, & Sonino, 2004). Given that publication rates appear to be a valid indicator of research interest, GAD (and in particular the etiology of GAD) has been under-studied from 1980 to 1997. Considering that GAD is highly prevalent, distressing for the individual, and costly to society (see e.g., Wittchen, 2002), the relative lack of research interest in GAD in previous decades is surprising. The goal of the present study is to extend previous work examining publication rates for the anxiety disorders and publication topics for GAD. Specifically, we will examine anxiety disorder publication rates and investigate the frequency of GAD publications devoted to descriptive, process, and treatment issues, as well as general reviews from 1998 to 2008. It is predicted that: (1) the number of GAD publications will be among the lowest of the anxiety disorders; (2) GAD publications will show increases in absolute terms (the actual number of GAD publications), but not in relative terms (the number of GAD publications relative to other anxiety disorder publications); and (3) most GAD publications will be devoted to descriptive and treatment issues.