Prevalence of comorbid anxiety disorders in primary care outpatients

Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, Los Ángeles, California, United States
Archives of Family Medicine 02/1996; 5(1):27-34; discussion 35. DOI: 10.1001/archfami.5.1.27
Source: PubMed


To estimate the extent to which anxiety disorders (eg, panic disorder, phobia, and generalized anxiety disorder [GAD]) co-occur in patients with major medical and psychiatric conditions.
Observational study.
Offices of primary care providers in three US cities, with mental health specialty providers included for comparative purposes.
Adult patients (N = 2494) with hypertension, diabetes, heart disease (congestive heart failure or myocardial infarction), current depressive disorder, or subthreshold depression.
Current (past 12 months) and lifetime panic disorder, phobia, GAD, perceived need for help for emotional or family problems, and unmet need (ie, failure to get help that was needed).
Comparisons of the prevalence of anxiety comorbidity in medically ill nondepressed patients of primary care providers and in depressed patients of both primary care and mental health specialty providers.
Among primary care patients, those with chronic medical illnesses or subthreshold depression had low rates of lifetime (1.5% to 3.5%) and current (1.0% to 1.7%) panic disorder, but those with current depressive disorder had much higher rates (10.9% lifetime and 9.4% current panic disorder). Concurrent phobia and GAD were more common (10.4% to 12.4% current GAD), especially among depressed patients (25% to 54% current GAD). Depending on the type of medical illness or depression, 14% to 66% of primary care patients had at least one concurrent anxiety disorder. Patient-perceived unmet need for care for personal or emotional problems was high among all primary care patients (54.6% to 72.9%).
Primary care clinicians should be aware of the possible coexistence of anxiety disorders (especially GAD) among their patients with chronic medical conditions, but especially among those with current depressive disorder.

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    • "Among all psychiatric disorders, generalized anxiety disorder (GAD) is the most commonly comorbid disorder with MDD, both concurrently and across the lifespan, among individuals primarily free from CHD (Krueger, 1999; Sherbourne et al., 1996; Watson, 2009). In fact, in primary care settings over half of unipolar MDD, cases are comorbid with GAD (Sherbourne et al., 1996), so much so that scholars have long debated whether these even form separate diagnostic and clinical disorders (Mennin et al., 2008). Explanations for high comorbidity between GAD and MDD include shared diagnostic criteria (i.e. "
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    ABSTRACT: Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease patients remain unquantified. Systematic searching of Medline, Embase, SCOPUS and PsycINFO databases revealed 1025 unique citations. Aggregate generalized anxiety disorder prevalence (12 studies, N = 3485) was 10.94 per cent (95% confidence interval: 7.8-13.99) and 13.52 per cent (95% confidence interval: 8.39-18.66) employing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (random effects). Lifetime generalized anxiety disorder prevalence was 25.80 per cent (95% confidence interval: 20.84-30.77). In seven studies, modest correlation was evident between generalized anxiety disorder and depression, Fisher's Z = .30 (95% confidence interval: .19-.42), suggesting that each psychiatric disorder is best conceptualized as contributing unique variance to coronary heart disease prognosis.
    Journal of Health Psychology 01/2013; 18(12). DOI:10.1177/1359105312467390 · 1.88 Impact Factor
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    • "There is a high prevalence of GAD and MDD in patients with unexplained somatic complaints (Brown et al., 1990; Maier and Falkai, 1999). GAD appears to be commonly associated with chest pain (Carter and Maddock, 1992; Logue et al., 1993), chronic fatigue syndrome (Fischler et al., 1997), irritable bowel syndrome (Lydiard et al., 1993), and chronic medical illnesses (hypertension, diabetes, and heart disease) (Maier and Falkai, 1999; Sherbourne et al., 1996). As most GAD patients present with somatic complaints in primary care (Hidalgo and Davidson, 2001), there is a Figure 2. Early Developmental Stages of Psychopathology study: proportion of representative study population (n=3021) with pure and comorbid anxiety disorders at (a) baseline and (b) 5-year follow-up. "
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    ABSTRACT: Generalized anxiety disorder (GAD) is a severe and chronic anxiety disorder characterized by uncontrollable worrying and somatic anxiety (tension, insomnia and hypervigilance). It is a common condition, with lifetime prevalence rates for DSM-IV GAD in the general population of approx. 5-6% being reported. In addition, like other anxiety disorders, GAD also shows comorbidity with depression and most of the other anxiety disorders. This article reviews data on the prevalence of GAD, its comorbidity with depression, and its social and economic impact. Proposed neurobiological mechanisms for GAD are discussed, since an understanding of these may help in the development of future therapies. Finally, current pharmacological and non-pharmacological treatment options for GAD are reviewed, with particular attention being paid to published clinical-trial data.
    The International Journal of Neuropsychopharmacology 01/2003; 5(4):315-25. DOI:10.1017/S1461145702003048 · 4.01 Impact Factor
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    • "Comorbid anxiety and depression not only increase cost but also increase medical risks and impair the quality of life of patients with diabetes mellitus or cardiovascular disease (HaÈ llstroÈ m et al., 1986; Helz and Templeton, 1990; Kawachi et al., 1994a, 1994b; Hayward, 1995; Ladwig et al., 1994; Wheatley, 1980; Merlo et al., 1996; Everson et al., 1996; Lespe rance et al., 1995; Henk et al., 1996; Sherbourne et al., 1996b). In the Medical Outcomes Study, 55±73 per cent of primary care patients reported unmet needs for care for personal or emotional problems (Sherbourne et al., 1996c). Moreover, patients with generalised anxiety and panic disorder may be more susceptible to upper respiratory infections due to stress-induced immunodepression (La Via et al., 1996; Wells et al., 1998a). "
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    ABSTRACT: The purpose of this review is to broaden the base for informed policy and to identify research issues to improve the utility of anti-anxiety agents. Data quality is discussed and the prevalence of morbid anxiety and the exposure to treatment with, and abuse of, anti-anxiety agents in different populations is presented. Findings concerning under-treatment, quality of life and misdiagnosing are also discussed. Based on the findings of this review, controlled studies of anti-anxiety treatments in anxious patients with cardiovascular disease, diabetes mellitus or other chronic somatic conditions should be prioritised. These are likely to show substantial and vital benefits by not only controlling symptoms and improving coping capacity, but also by improving social functioning and somatic disease management. Investing in improved detection and management of patients with anxious and/or depressive disorders in many forms of care will pay rapid direct and indirect dividends. Copyright © 1999 John Wiley & Sons, Ltd.
    Human Psychopharmacology Clinical and Experimental 04/1999; 14(3):149 - 160. DOI:10.1002/(SICI)1099-1077(199904)14:3<149::AID-HUP78>3.0.CO;2-M · 2.19 Impact Factor
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