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Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection
- Kurt Kroenke, MD;
- Robert L. Spitzer, MD;
- Janet B.W. Williams, DSW;
- Patrick O. Monahan, PhD; and
- Bernd Löwe, MD, PhD
- 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.
Abstract
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.
Article and Author Information
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Acknowledgments: The authors thank Monika Mussell, PhD, and Dieter Schellberg, PhD, University of Heidelberg, Heidelberg, Germany, for their invaluable assistance in some data analyses.
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Grant Support: Pfizer Inc.
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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.).
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Requests for Single Reprints: Kurt Kroenke, MD, Regenstrief Institute, 1050 Wishard Boulevard, Indianapolis, IN 46202; e-mail, kkroenke{at}regenstrief.org.
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Current Author Addresses: Dr. Kroenke: Regenstrief Institute for Health Care, 1050 Wishard Boulevard, Indianapolis, IN 46202.
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Drs. Spitzer and Williams: New York State Psychiatric Institute, Unit 60, 1051 Riverside Drive, New York, NY 10533.
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Dr. Monahan: Division of Biostatistics, Department of Medicine, Indiana University, 1050 Wishard Boulevard, RG4 101, Indianapolis, IN 46202.
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Dr. Löwe: Klinik für Psychosomatische und Allgemeine Klinische Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany.
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Author Contributions: Conception and design: K. Kroenke, R.L. Spitzer, J.B.W. Williams, B. Löwe.
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Analysis and interpretation of the data: K. Kroenke, R.L. Spitzer, J.B.W. Williams, P.O. Monahan, B. Löwe.
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Drafting of the article: K. Kroenke.
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Critical revision of the article for important intellectual content: K. Kroenke, R.L. Spitzer, P.O. Monahan, B. Löwe.
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Final approval of the article: K. Kroenke, R.L. Spitzer, J.B.W. Williams, P.O. Manahan, B. Löwe.
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Statistical expertise: K. Kroenke, R.L. Spitzer, P.O. Monahan.
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Obtaining of funding: K. Kroenke, R.L. Spitzer, B. Löwe.
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Collection and assembly of data: J.B.W. Williams.
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