Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection

Regenstrief Institute for Health Care and Indiana University, Indianapolis, Indiana 46202, USA.
Annals of internal medicine (Impact Factor: 17.81). 04/2007; 146(5):317-25.
Source: PubMed

ABSTRACT Anxiety, although as common as depression, has received less attention and is often undetected and undertreated.
To determine the current prevalence, impairment, and comorbidity of anxiety disorders in primary care and to evaluate a brief measure for detecting these disorders.
Criterion-standard study performed between November 2004 and June 2005.
15 U.S. primary care clinics.
965 randomly sampled patients from consecutive clinic patients who completed a self-report questionnaire and agreed to a follow-up telephone interview.
7-item anxiety measure (Generalized Anxiety Disorder [GAD]-7 scale) in the clinic, followed by a telephone-administered, structured psychiatric interview by a mental health professional who was blinded to the GAD-7 results. Functional status (Medical Outcomes Study Short Form-20), depressive and somatic symptoms, and self-reported disability days and physician visits were also assessed.
Of the 965 patients, 19.5% (95% CI, 17.0% to 22.1%) had at least 1 anxiety disorder, 8.6% (CI, 6.9% to 10.6%) had posttraumatic stress disorder, 7.6% (CI, 5.9% to 9.4%) had a generalized anxiety disorder, 6.8% (CI, 5.3% to 8.6%) had a panic disorder, and 6.2% (CI, 4.7% to 7.9%) had a social anxiety disorder. Each disorder was associated with substantial impairment that increased significantly (P < 0.001) as the number of anxiety disorders increased. Many patients (41%) with an anxiety disorder reported no current treatment. Receiver-operating characteristic curve analysis showed that both the GAD-7 scale and its 2 core items (GAD-2) performed well (area under the curve, 0.80 to 0.91) as screening tools for all 4 anxiety disorders.
The study included a nonrandom sample of selected primary care practices.
Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.

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Available from: Bernd Löwe, May 23, 2014
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    • "The total possible range of scores is from zero to 21, where higher scores indicate greater severity and/or duration of anxiety symptoms. The GAD-7 has demonstrated good reliability and construct validity (Kroenke et al., 2007; Löwe et al., 2008; Spitzer et al., 2006) and is a valid measure of general anxiety in our partial hospital population (Beard and Björgvinsson, 2014). The GAD-7 had good internal consistency in this study (α = .86). "
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    ABSTRACT: Deficits in attentional control have been hypothesized to cause rumination, suggesting that the relationships between attentional control and clinical symptoms may be mediated in part by rumination. However, to date, no clinical study has examined these constructs transdiagnostically in a path analysis model. Fifty-one adults presenting for treatment completed measures of self-reported attentional control, rumination, and depression and anxiety symptoms. A bias-corrected path analysis-based approach was employed to test whether indirect (i.e., mediating) effects of rumination were significantly associated with the direct effects of attentional control on depression and anxiety symptoms. Separate models for depression and anxiety symptoms were tested along with reverse models using attentional control as a proposed mediator. The relationship between attentional control and clinical symptomatology (i.e., both depression and anxiety symptoms) was mediated by rumination. Poor attentional control was associated with more rumination and consequently more severe symptoms of depression and anxiety. The reverse relationship (i.e., attentional control mediating the relationship between rumination and depression or anxiety symptoms) was not significant. Study design did not allow testing of temporal precedence for the mediation models. All constructs were assessed via self-report. Attentional control appears to impact depression and anxiety symptoms through rumination. The pathway between poor attentional control and emotion dysregulation via rumination suggests that interventions targeting attentional control may decrease maladaptive ruminative processes, leading to improved emotion regulation and reduced clinical symptomatology. Future studies should examine the stability of this mediational relationship over time (and in the face of targeted interventions). Copyright © 2015. Published by Elsevier B.V.
    Journal of Affective Disorders 08/2015; 188:22-27. DOI:10.1016/j.jad.2015.08.008 · 3.38 Impact Factor
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    • "The anxiety prevalences we found were low compared to previous population surveys and screening programmes that showed anxiety disorder prevalences ranging from 7%–20% [2] [5] [8] [14] [19] [22]. Since such studies are research question-driven rather than based on patients consulting the GP, the lower prevalences in our study seem expected. "
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    ABSTRACT: The mental health burden on primary care is substantial and increasing. Anxiety is a major contributor. Stepped collaborative care (SCC) is implemented worldwide to improve patient outcomes, but long term real-world evaluations of SCC do not exist. Using routinely used electronic medical records from more than a decade, we investigated changes in anxiety prevalences, whether physicians made distinction between non-severe and severe anxiety, and whether these groups were referred and treated differently, both non-pharmacologically and pharmacologically. Retrospective assessment of anxiety care parameters recorded by 54 general practitioners between 2003 and 2014, in the electronic medical records of a dynamic population of 49,841-69,413 primary care patients. Substantial shifts in anxiety care parameters have occurred. The prevalence of anxiety symptoms doubled to 0.9% and of anxiety disorders almost tripled to 1.1%. Use of ICPC codes seemed comprehensive and use of instruments to support in anxiety level differentiation increased to 13% of anxiety symptom and 7% of anxiety disorder patients in 2014. Minimal interventions were used more frequently, especially for anxiety symptoms (OR 21 [95% CI 5.1-85]). The antidepressant prescription rates decreased significantly for anxiety symptoms (OR 0.5 [95% CI 0.4-0.8]) and anxiety disorders (OR 0.6 [95% CI 0.4-0.8]). More patients were referred to psychologists and psychiatrists. We found shifts in anxiety care parameters that follow the principles of SCC. Future primary care research should comprehensively assess the use of the SCC range of therapeutic options, tailored to patients with all different anxiety severity levels. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 07/2015; 30(6). DOI:10.1016/j.eurpsy.2015.06.002 · 3.44 Impact Factor
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    • "Studies from other countries revealed roughly similar figures (Bijl et al., 1998; Faravelli et al., 1989; Hunt et al., 2002; Jenkins et al., 1997). GAD patients typically present in primary care settings, where the reported prevalence is up to 8% (Kroenke et al., 2007; Roy-Byrne & Wagner, 2004). "
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    ABSTRACT: Generalized Anxiety Disorder (GAD) is typically considered a chronic condition characterised by excessive worry. Lifetime prevalence is 4.3-5.9%, yet a small percentage seek treatment. GAD can be treated and in recent years online-delivered treatment interventions have shown promise. The paper aimed to systematically search for literature on online-delivered psychological interventions for the treatment of GAD and conduct a meta-analysis to examine their efficacy. The purpose of the paper is to inform the community of researchers in internet delivered interventions of the current state of the art and research gaps that require attention. A systematic search of the literature was conducted to find all studies for online-delivered treatments for GAD (N=20). Using Review Manager 5 all Randomized Controlled trials (RCTs; n = 11) that met our established eligibility criteria were included into a meta-analysis that calculated effect sizes via the standardised mean difference. Compared to the waiting-list controls, the results demonstrate positive outcomes for GAD symptoms (d = -0.91) and its central construct of pathological worry (d = -0.74). The meta-analysis supports the efficacy of online-delivered treatments for GAD including the use of disorder-specific (4 studies) and transdiagnostic treatment protocols (7 studies) delivered online. Caution is advised regarding the results as the data is limited and highly heterogeneous, but revealing of what future research might be needed.
    Internet Interventions 07/2015; In Press. DOI:10.1016/j.invent.2015.07.003
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