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: Purpose We studied the validity and responsiveness of an item response theory (IRT) scoring method for assessing major depressive episode (MDE) and generalized anxiety disorder (GAD) severity based on direct assessment of DSM-IV-TR symptoms. Methods Prospective cohort study (baseline, 1-month, 3-months assessments) of patients seeking help for incident or aggravated mood or anxiety symptoms from primary, outpatient and inpatient mental health centers (N = 244; 67.81 % active cases − 100 % under psychiatric treatment). The drop-out rate at 3 months was 24.89 %. Patients were assessed at each follow-up for presence/absence of DSM-IV symptoms of MDE (nine symptoms) and GAD (eight symptoms). IRT scores for depression (INS-D) and anxiety (INS-G), based on response patterns, were obtained by means of a 2-parameter model. Diagnostic accuracy was assessed with receiver operating characteristic analysis, using a blinded MINI interview as gold standard. Scores’ construct validity was compared with external clinician-administered (Hamilton Depression Rating Scale, HRSD; Hamilton Anxiety Rating Scale, HAM-A) and self-reported severity measures (PHQ-9; Beck Anxiety Inventory—Subjective Aspects, BAI-Sub). Responsiveness was analyzed based on the evolution of HRSD and HAM-A scores. Results Both severity scores showed excellent reliability (INS-D: 0.92; INS-G: 0.93) and yielded high diagnostic accuracy (INS-D: AUC = 0.96; INS-G: AUC = 0.91) with respect to MINI diagnoses. INS-D and INS-G had higher correlations with clinician-administered measures of the same disorder (INS-D-HRSD: 0.73; INS-G-HAM-A: 0.53) than with self-reported measures (INS-D-PHQ-9: 0.69; INS-G-BAI-Sub: 0.49). Patients who recovered during follow-up showed important decreases in severity (Cohen’s d INS-D:−1.38; INS-G: −1.75). About 90 % variance of INS-D and INS-G score changes over time was associated with changes in clinical status. Conclusions INS-D and INS-G are short reliable, valid, and responsive measures that can be used for diagnostic and severity assessment of mood and anxiety disorders in outpatient care.Quality of Life Research 04/2015; 24(4):979-992. DOI:10.1007/s11136-014-0814-5 · 2.86 Impact Factor
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ABSTRACT: Purpose: No previous study has reported upon comorbid depression and anxiety disorders and their treatment in heart failure (HF), which the current study has sought to document. Materials and methods: Total 29 HF patients under psychiatric management underwent primary depression cognitive behavioral therapy (CBT; n = 15) or primary generalized anxiety disorder (GAD) CBT (n = 14), and participated in a community exercise program and standard physician care. Repeated measures analysis of variance assessed Patient Health Questionnaire (PHQ-9) and GAD-7 symptom change pre- and post-CBT treatment, and assessed the interaction effects of treatment type, exercise, anti-depressant and anxiolytic. Results: There was a significant time and treatment interaction effect that favored the primary GAD CBT group for reduction in PHQ symptoms (F(1, 24) = 4.52, p = 0.04). Analysis of PHQ-somatic symptoms also showed a significant main effect for participation in the exercise program (F(1, 24) = 4.21, p = 0.05) and a significant time and anxiolytic interaction (F(1, 24) = 3.98, p = 0.05). The average number of cardiac hospital readmissions favored the primary GAD CBT group (p = 0.05). Conclusion: The findings support the use of multifaceted interventions in the rehabilitation of HF patients with comorbid psychiatric needs.Implications for Rehabilitation Comorbid depression and anxiety disorders are a clinical and research focus that deserves more attention in the treatment of heart failure patients.Cognitive behavioral therapy, exercise, and anxiolytic use was associated with significant changes in depression and anxiety though discrete effects were evident.Multifaceted interventions are most likely to be successful in the rehabilitation of HF patients with psychiatric needs.Disability and Rehabilitation 07/2014; DOI:10.3109/09638288.2014.935493 · 1.84 Impact Factor
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ABSTRACT: The first pan-European survey of depression in the community (DEPRES I) demonstrated that 17% of the general population suffer from depression (major depression, minor depression, or depressive symptoms). This article describes findings from a second phase of DEPRES (DEPRES II), in which detailed interviews based on a semi-structured questionnaire (78 questions) were conducted with 1884 DEPRES I participants who had suffered from depression and who consulted a healthcare professional about their symptoms during the previous 6 months. The mean time from onset of depression was 45 months, and the most commonly experienced symptoms during the latest period were low mood (76%), tiredness (73%) and sleep problems (63%). During the previous 6 months, respondents had been unable to undertake normal activities because of their depression for a mean of 30 days, and a mean of 20 days of work had been lost to depression by those in paid employment. Approximately one-third of respondents (30%) had received an antidepressant during the latest period of depression. Significantly more respondents given a selective serotonin reputake inhibitor found that their treatment made them feel more like their normal self than those given a tricyclic antidepressant, and fewer reported treatment-related concentration lapses, weight problems, and heavy-headedness (all P < 0.05). Approximately two-thirds of respondents (70%) had received no antidepressant therapy during the latest period of depression, and prescription of benzodiazepines alone, which are not effective against depression, was widespread (17%). There is a need for education of healthcare professionals to encourage appropriate treatment of depression. Int Clin Psychopharmacol 14:139-151 (C) 1999 Lippincott Williams & WilkinsInternational Clinical Psychopharmacology 01/1999; 14(3):139-152. DOI:10.1097/00004850-199905030-00001 · 3.10 Impact Factor