Anxiety Disorders in Primary Care Patients

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

The summary below is from the full report titled "Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection." It is in the 6 March 2007 issue of Annals of Internal Medicine (volume 146, pages 317-325). The authors are K. Kroenke, R.L. Spitzer, J.B.W. Williams, P.O. Monahan, and B. Löwe.

What is the problem and what is known about it so far?

Anxiety and depression are common disorders in patients who receive their medical care from a primary care physician. Because depression causes so much misery and even death from suicide, it has received much attention in research and care that focus on mental health disorders in primary care patients. Anxiety disorders are also common but have attracted much less attention from doctors and researchers.

Why did the researchers do this particular study?

To learn more about anxiety disorders and their effects and to test a short questionnaire to detect anxiety disorders.

Who was studied?

965 patients who had an appointment with their primary care physician.

How was the study done?

The patients completed a 4-page questionnaire about symptoms of anxiety, their ability to function in daily life, the number of days when they were disabled, and the number of visits to the doctor. Within 1 week, each person was interviewed by a mental health professional to find out whether the patient had an anxiety disorder. The interviewer inquired about symptoms of 4 types of anxiety disorders: generalized anxiety disorder, panic disorder, social anxiety disorder, and posttraumatic stress disorder.

What did the researchers find?

Of the 965 patients, 19.5% of the patients had at least 1 anxiety disorder and many had more than 1 anxiety disorder. People with anxiety disorders could not function as well as people without anxiety disorders, and they had more disability days and more doctor visits. These problems were all worse in patients with more than 1 anxiety disorder and with worse anxiety. Surprisingly, 41% of the patients with an anxiety disorder were not receiving treatment. The authors found that both a 7-item questionnaire and a 2-item questionnaire detected most patients with anxiety, regardless of the type of anxiety that the patients had.

What were the limitations of the study?

The authors did not inquire about other medical conditions. Although the study results suggest that anxiety was causing the patients' disability, poor function, and doctor visits, patients may have had anxiety because they had serious diseases that were interfering with their lives.

What are the implications of the study?

Anxiety disorders are very common and interfere with people's lives, yet they often go unrecognized or untreated. Screening for depression is becoming more common in primary care practice. Screening for anxiety should also become more common. The authors' anxiety questionnaire does a good job of detecting anxiety.

Read all Rapid Responses

Untitled

Alan L. Fine

Annals Online, 19 Mar 2007 [Full text]