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

6 March 2007 | Volume 146 Issue 5 | Pages 317-325

Background: Anxiety, although as common as depression, has received less attention and is often undetected and undertreated.

Objective: To determine the current prevalence, impairment, and comorbidity of anxiety disorders in primary care and to evaluate a brief measure for detecting these disorders.

Design: Criterion-standard study performed between November 2004 and June 2005.

Setting: 15 U.S. primary care clinics.

Participants: 965 randomly sampled patients from consecutive clinic patients who completed a self-report questionnaire and agreed to a follow-up telephone interview.

Measurements: 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.

Results: 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.

Limitation: The study included a nonrandom sample of selected primary care practices.

Conclusions: Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.

Editors' Notes Context Anxiety and depression are both common in primary care patients, but much less attention has been paid to anxiety. Contribution The authors administered a 7-item anxiety scale (Generalized Anxiety Disorder [GAD]-7) to 965 primary care patients, who also had a structured interview, to detect an anxiety disorder. Of these patients, 19.5% had at least 1 anxiety disorder. Patients with anxiety had worse functional status, more disability days, and more physician visits, but 41% were not being treated for any anxiety disorder. The GAD-7 had high sensitivity and good specificity for detecting a generalized anxiety disorder, panic disorder, social anxiety disorder, and posttraumatic stress disorder. Implications Anxiety disorders are common, underrecognized, and undertreated, but they are easy to detect with a brief questionnaire. —The Editors

 

Author and Article Information

From Regenstrief Institute for Health Care and Indiana University, Indianapolis, Indiana; New York State Psychiatric Institute and Columbia University, New York, New York; and University of Heidelberg, Heidelberg, Germany.

Acknowledgments: The authors thank Monika Mussell, PhD, and Dieter Schellberg, PhD, University of Heidelberg, Heidelberg, Germany, for their invaluable assistance in some data analyses.

Grant Support: Pfizer Inc.

Potential Financial Conflicts of Interest: Consultancies: K. Kroenke (Eli Lilly Inc., Pfizer Inc.), J.B.W. Williams (Eli Lilly Inc., GlaxoSmithKline); Honoraria: K. Kroenke (Eli Lilly Inc., Wyeth); Grants received: K. Kroenke (Eli Lilly Inc., Pfizer Inc., Wyeth), R.L. Spitzer (Pfizer Inc.), J.B.W. Williams (Pfizer Inc.), B. Löwe (Pfizer Inc.).

Requests for Single Reprints: Kurt Kroenke, MD, Regenstrief Institute, 1050 Wishard Boulevard, Indianapolis, IN 46202; e-mail, kkroenke{at}regenstrief.org.

Current Author Addresses: Dr. Kroenke: Regenstrief Institute for Health Care, 1050 Wishard Boulevard, Indianapolis, IN 46202.

Drs. Spitzer and Williams: New York State Psychiatric Institute, Unit 60, 1051 Riverside Drive, New York, NY 10533.

Dr. Monahan: Division of Biostatistics, Department of Medicine, Indiana University, 1050 Wishard Boulevard, RG4 101, Indianapolis, IN 46202.

Dr. Löwe: Klinik für Psychosomatische und Allgemeine Klinische Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.

Author Contributions: Conception and design: K. Kroenke, R.L. Spitzer, J.B.W. Williams, B. Löwe.

Analysis and interpretation of the data: K. Kroenke, R.L. Spitzer, J.B.W. Williams, P.O. Monahan, B. Löwe.

Drafting of the article: K. Kroenke.

Critical revision of the article for important intellectual content: K. Kroenke, R.L. Spitzer, P.O. Monahan, B. Löwe.

Final approval of the article: K. Kroenke, R.L. Spitzer, J.B.W. Williams, P.O. Manahan, B. Löwe.

Statistical expertise: K. Kroenke, R.L. Spitzer, P.O. Monahan.

Obtaining of funding: K. Kroenke, R.L. Spitzer, B. Löwe.

Collection and assembly of data: J.B.W. Williams.

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Alan L. Fine

Annals Online, 19 Mar 2007 [Full text]