Article

Anxiety disordes 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: 16.1). 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.

Download full-text

Full-text

Available from: Bernd Löwe, May 23, 2014
4 Followers
 · 
232 Views
  • Source
    • "Despite robust evidence showing that anxiety symptoms are common and have a significant impact on the functioning of individuals with chronic pain, to date research on primary care screening has focused on depression. The recently developed ultra-brief anxiety instrument (the two-item Generalized Anxiety Disorder scale [36]) has opened up the possibility of anxiety screening in primary care. Management guidance for depression in primary care typically focuses on identifying individuals whose depressive symptoms meet diagnostic criteria of symptoms count, frequency of episodes, duration and impairment indicating depressive disorders [20] [42] [52]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Distinguishing transient from persistent anxiety and depression symptoms in older people presenting to general practice with musculoskeletal pain is potentially important for effective management. This study sought to identify distinct post-consultation depression and anxiety symptom trajectories in adults aged over 50years consulting general practice for non-inflammatory musculoskeletal pain. Self-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1week of the consultation and at 3, 6 and 12months. Latent class growth analysis was used to identify anxiety and depression symptoms trajectories, which were ascertained with cut-off score ≥8 on Hospital Anxiety and Depression Scale subscales. Associations between baseline characteristics and cluster membership were examined using multivariate multinomial logistic regression analysis (the 3-step approach). Latent class growth analyses determined a 3-cluster anxiety model (n=499) and a 3-cluster depression model (n=501). Clusters identified were: no anxiety problem (44.1%), persistent anxiety problem (33.9%) and transient anxiety symptoms (22.2%); no depression problem (74.1%), persistent depression problem (22.0%) and gradual depression symptom recovery (4.0%). Widespread pain, interference with valued activities, coping by increased behavioral activities, catastrophizing, perceived lack of instrumental support, age ≥70years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters. Older people with non-inflammatory musculoskeletal pain are at high risk of persistent anxiety and/or depression problems. Biopsychosocial factors, such as pain status, coping strategies, instrumental support, performing manual/routine work, being female and age ≥70years, may help identify patients with persistent anxiety and/or depression. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Psychosomatic Research 06/2015; DOI:10.1016/j.jpsychores.2015.05.016
  • Source
    • "An important clinical application of the MASQ and the theoretical foundation on which it is founded is to readily identify depression and anxiety disorder cases in primary care settings. Depression prevalence is approximately 28% in primary care (Spitzer et al., 1999) whereas anxiety disorder prevalence is estimated at 20% in primary care (Kroenke et al., 2007). Rapid identification of depression and anxiety disorders in primary care may identify individuals for further evaluation and initiation of treatment strategies. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The receiver operating characteristics (ROC) of anhedonic depression and anxious arousal to detect the distress- (major depression, dysthymia, generalized anxiety disorder) and fear-disorder clusters (i.e. panic disorder, agoraphobia, social phobia) have not been reported in a large sample. Methods A sample of 2981 persons underwent structured psychiatric interview; n=652 were without lifetime depression and anxiety disorder history. Participants also completed a neuroticism scale (Revised NEO Five Factor Inventory [NEO-FFI]), and the 30-item short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ-D30) measuring anhedonic depression, anxious arousal and general distress. Maximal sensitivity and specificity was determined by the Youden Index and the area-under-the-curve (AUC) in ROC analysis. Results A total of 2624 completed all measures (age M=42.4 years±13.1, 1760 females [67.1%]), including 1060 (40.4%) persons who met criteria for a distress-disorder, and 973 (37.1%) who met criteria for a fear-disorder. The general distress dimension provided the highest ROC values in the detection of the distress-disorders (AUC=.814, sensitivity=71.95%, specificity=76.34%, positive predictive value=67.33, negative predictive value=80.07). None of the measures provided suitable operating characteristics in the detection of the fear-disorders with specificity values <75%. Limitations Over sampling of depression and anxiety disorders may lead to inflated positive- and negative predictive values. Conclusions The MASQ-D30 general distress dimension showed clinically suitable operating characteristics in the detection of distress-disorders. Neither neuroticism nor the MASQ-D30 dimensions provided suitable operating characteristics in the detection of the fear-disorders.
    Journal of Affective Disorders 03/2015; 174:611–618. DOI:10.1016/j.jad.2014.12.045
  • Source
    • "Exclusion criteria included a primary diagnosis of a psychotic disorder, current suicidal ideation, or comorbid Axis II disorders. Clinical participants were not excluded based on Axis I comorbidity (n¼ 11), as this is typical of community-based clinical samples (Kroenke et al., 2007; Clarke et al., 2012a, 2012b). 35.29% met criteria for another anxiety disorder, 29.41% with a mood disorder, and 5.88% with a substance dependence disorder. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Social anxiety disorder (SAD) is a debilitating mental illness which is thought to be maintained in part by the aberrant attentional processing of socially relevant information. Critically however, research has not assessed whether such aberrant attentional processing occurs during social-evaluative contexts characteristically feared in SAD. The current study presents a novel approach for the assessment of the visuocognitive biases operating in SAD during a social-evaluative stressor. For this task, clinically socially anxious participants and controls were required to give a brief impromptu speech in front of a pre-recorded audience who intermittently displayed socially positive or threatening gestures. Participant gaze at the audience display was recorded throughout the speech. Socially anxious participants exhibited a significantly longer visual scanpath, relative to controls. In addition, socially anxious participants spent relatively longer time fixating at the non-social regions in between and around the confederates. The findings of the present study suggest that SAD is associated with hyperscanning and the attentional avoidance of social stimuli. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 11/2014; 225(3). DOI:10.1016/j.psychres.2014.11.025
Show more