Prevalence of comorbid anxiety disorders in primary care outpatients
ABSTRACT 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.
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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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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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 · 1.85 Impact Factor
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ABSTRACT: ÖZET Amaç: Bu çal›flman›n amac› psikiyatrik tan› düflünülen ve/veya tedavi önerilen hastalar›n s›kl›¤›n› belirlemektir. Ayr›ca, psikiyatrik bozukluklar›n yafl ve cinsiyetle iliflkisini ve hekimleri taraf›ndan psikiyatrik tan› düflünülen hastalara önerilen tedavileri araflt›rmak amaçlanmaktad›r. Yöntem: Poliklinik defterlerindeki kay›tlar›n taranmas›n› içeren bu çal›flmada, Eskiflehir il merkezinde bulunan bü- tün sal›k ocaklar›na 1 y›lda baflvuran 313.139 hasta ile il- gili veriler incelendi. Bulgular: Sal›k Ocaklar›na psikiyatrik bir hastal›k nede- niyle 1'den fazla baflvuran hastalar olarak belirlenen en az bir kez baflvuran hastalarda ruhsal hastal›k oran› %2.34 idi. Bir kez baflvuranlarda ise bu oran %1.04 idi. Kad›nlar- da baflvuru s›kl›¤› erkeklere göre daha s›k bulunurken, en s›k konulan tan›lar depresyon ve anksiyete bozukluklar› idi. Her iki bozukluk, kad›nlarda daha fazla saptan›rken, en s›k kullan›lan ilaçlar ise antidepresanlar ve anksiyolitikler idi. Sonuç: Bu çal›flmada, gösterildii gibi Eskiflehir ilindeki sal›k ocaklar›nda ruhsal hastal›k teflhislerinin düflük oran- da konmas› ve tedavisinin düflük oranda yap›lmas› ile ilgili olarak afla¤›daki nedenleri düflünmekteyiz. Hekimlerin ruh- sal hastal›klar› yeterince teflhis edememesi, ruhsal deer- lendirme ölçekleri kullan›lmamas›, hastalar›n hastal›klar›- n›n fark›nda olmamas› ve ruhsal semptomlar› hakk›nda ye- terli bilgi vermemesi, fiziksel hastal›klara s›kl›kla ruhsal be- lirtilerin efllik etmesi, hekimlerin hastalara olumsuz yakla- fl›mlar› ve hekimlerin ilaç ya da t›bbi kay›tlara önem verme- me eilimleri.