What predicts persistence of anxiety disorders across the lifespan? : A systematic review

Despite the impressive disease burden of anxiety disorders, we have a poor understanding of factors that predict their typical persistent course. This systematic review of predictors of persistent anxiety disorders covered 48 studies with 29.690 subjects diagnosed with an anxiety disorder that were published in PubMed, PsycINFO, and Web of Science between 1980 (introduction of DSM-III) and December 2019. We also compared predictors between children, adolescents, adults, and elderly. A persistent course was primarily predicted by clinical and psychological characteristics including having panic attacks, co-occurring personality disorders, treatment seeking, poor clinical status after treatment, higher severity and longer duration of avoidance behavior, low extraversion, higher anxiety sensitivity, and higher behavioral inhibition. Unlike disorder onset, sociodemographic characteristics did not predict persistence. Our results outline a profile of subjects with specific clinical and psychological characteristics who are particularly vulnerable for anxiety disorder persistence. Clinically, these patients likely deserve additional or more intensive treatment to prevent development of chronicity.