GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study (original) (raw)
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BMC Family Practice, 2019
Background: Anxiety is under-recorded and under-treated in the UK and is under-represented in research compared with depression. Detecting anxiety can be difficult because of co-existing conditions. GPs can be reluctant to medicalise anxiety symptoms and patients can be reluctant to disclose them, for a variety of reasons. This research addresses the gap in evidence of real-life consultations of patients with anxiety and explores how physical and psychological symptoms are discussed and prioritised by patients and GPs in primary care consultations. Methods: A mixed methods study using a baseline questionnaire, video-recorded primary care consultations and interview data with patients and GPs. Results: Seventeen patients with anxiety symptoms (GAD-7 score ≥ 10) completed a questionnaire, had their consultation video-recorded and took part in a semi-structured interview. Four GPs were interviewed. The main themes that emerged from GP and patients accounts as barriers and facilitators to discussing anxiety mostly mirrored each other. The GP/patient relationship and continuity of care was the main facilitator for the discussion of anxiety in the consultation. The main barriers were: attribution of or unacknowledged symptoms; co-morbidities; and time constraints. GPs overcame these barriers by making repeat appointments and employing prioritising techniques; patients by choosing an empathetic GP. Conclusions: The findings add to the evidence base concerning the management of anxiety in primary care. The findings suggest that the discussion around anxiety is a process negotiated between the patient and the GP influenced by a range of barriers and facilitators. Co-existing depression and health anxieties can mask anxiety symptoms in patients. Good practice techniques such as bringing back patients for appointments to foster continuity of care and understanding can help disclosure and detection of anxiety symptoms. Future research could investigate this longitudinally and should include a wider range of GPs practices and GPs.
Trends in the recording of anxiety in UK primary care: a multi-method approach
Social Psychiatry and Psychiatric Epidemiology, 2021
Purpose Anxiety disorders are common. Between 1998 and 2008, in the UK, GP recording of anxiety symptoms increased, but the recording of anxiety disorders decreased. We do not know whether such trends have continued. This study examined recent trends in the recording of anxiety and explored factors that may influence GPs’ coding of anxiety. Methods We used data from adults (n = 2,569,153) registered with UK general practices (n = 176) that contributed to the Clinical Practice Research Datalink between 2003 and 2018. Incidence rates and 95% confidence intervals were calculated for recorded anxiety symptoms and diagnoses and were stratified by age and gender. Joinpoint regression was used to estimate the years trends changed. In addition, in-depth interviews were conducted with 15 GPs to explore their views and management of anxiety. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results The incidence of anxiety symptoms rose from 6.2/1000 person-years...
BACKGROUND: Questionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders. METHODS: A cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible 'anxiety case' by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regress...
Recognition of anxiety disorders by the general practitioner: results from the DASMAP Study
General Hospital Psychiatry, 2012
Objectives: The objectives were to determine the levels of general practitioner (GP) recognition of anxiety disorders and examine associated factors. Methods: An epidemiological survey was carried out in 77 primary care centers representative of Catalonia. A total of 3815 patients were assessed. Results: GPs identified 185 of the 666 individuals diagnosed as meeting the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) criteria for any anxiety disorder (sensitivity 0.28). Regarding specific anxiety disorders, panic disorder was registered in just three of the patients who, according to the SCID-I, did not meet the criteria for this condition .Generalized anxiety disorder was recorded by the GP in 46 cases, 4 of them being concordant with the SCID-I (sensitivity 0.03). The presence of comorbid hypertension was associated with an increased probability of recognition. Emotional problems as the patients' main complaint and additional appointments with a mental health specialist were associated with both adequate and erroneous recognition. Being female, having more frequent appointments with the GP and having higher levels of self-perceived stress were related to false positives. As disability increased, the probability of being erroneously detected decreased. Conclusion: GPs recognized anxiety disorders in some sufferers but still failed with respect to differentiating between anxiety disorder subtypes and disability assessment.
BMJ, 1999
Objectives To examine the effect of patients' causal attributions of common somatic symptoms on recognition by general practitioners of cases of depression and anxiety and to test the hypothesis that normalising attributions make recognition less likely. Design Cross sectional survey. Setting One general practice of eight doctors in Bristol. Subjects 305 general practice attenders. Main outcome measure The rate of detection by general practitioners of cases of depression and anxiety as defined by the general health questionnaire. Results Consecutive attenders completed the general health questionnaire and the symptom interpretation questionnaire, which scores style of symptom attribution along the dimensions of psychologising, somatising, and normalising. General practitioners detected depression or anxiety in 56 (36%; 95% confidence interval 28% to 44%) of the 157 patients who scored highly on the general health questionnaire. Subjects with a normalising attributional style were less likely to be detected as cases; doctors did not make any psychological diagnosis in 46 (85%; 73% to 93%) of 54 patients who had high questionnaire and high normalising scores. Those with a psychologising style were more likely to be detected; doctors did not detect 21 (38%; 25% to 52%) of 55 patients who had high questionnaire and high psychologising scores. The somatisation scale was not associated with low detection rates. This pattern of results persisted after adjustment for age, sex, general health questionnaire score, and general practitioner. Conclusions Normalising attributions minimise symptoms and are non-pathological in character. The normalising attributional style is predominant in general practice attenders and is an important cause of low rates of detection of depression and anxiety.
Treatment of anxiety disorders in primary care practice: a randomised controlled trial
The British journal of general practice : the journal of the Royal College of General Practitioners, 2005
Anxiety disorders are prevalent in primary care. Psychological treatment is effective but time-consuming, and there are waiting lists for secondary care. Interest has therefore grown in developing guidelines for treatment that would be feasible in primary care. To compare the effectiveness and feasibility of guided self-help, the Anxiety Disorder Guidelines of the Netherlands College of General Practitioners and cognitive behavioural therapy (CBT). Randomised controlled study lasting 12 weeks with follow-up at 3 and 9 months for primary care patients with panic disorder and/or generalised anxiety disorder. The first two forms of treatment were carried out by 46 GPs who were randomly assigned to one or the other form. CBT was carried out by cognitive behaviour therapists in a psychiatric outpatient clinic. Participants (n = 154) were randomly assigned to one of the three forms of treatment. The main outcome measure used was the state subscale of the Spielberger Anxiety Inventory. All...
Cross-sectional 7-year follow-up of anxiety in primary care patients
Depression and Anxiety, 2004
We describe the longitudinal patterns of anxiety symptoms and mental health treatment among patients recruited from a primary care clinic, and provide a naturalistic view of anxiety symptoms, disorders, and treatment at two time periods 7 years apart. Study participants were originally identified in a primary care setting in 1992 as positive but untreated for the presence of anxiety and/or depressive symptoms and disorders. Data were collected through telephone interviews assessing current psychological status for anxiety and depression symptoms, disorders, and general functioning and well being. There were no planned interventions. Participants were re-interviewed after 7 years. Two hundred seventy-one of the identified 1992 population of 784 patients were followed up by interview in 1999. Comparisons of the scores demonstrated that respondents were less symptomatic in 1999 than in 1992, with 45% of respondents reporting no symptoms whatsoever at follow-up. Severity of symptom status in 1992 was indicative of follow-up symptom severity. Most respondents (68%) had not received mental health treatment over the 7 years, largely because they wanted to handle problems on their own. This study demonstrates the tendency of anxiety to remain or reappear years after originally identified, with 55% of patients reporting symptoms after 7 years. Initially untreated and underdiagnosed anxiety is associated with continued impairment in functional status and quality of life and continued underrecognition and undertreatment.
Anxiety and depression: a model for assessment and therapy in primary care
Primary Care Mental …, 2004
Patients who feel anxious and depressed often turn to primary care for initial professional help. However, systematic service evaluations allege poor standards of diagnosis and treatment, resulting in disappointing clinical outcomes. All the same, special educational and quality improvement initiatives have not raised standards significantly. Why this should be so and possible remedies are suggested by this article, on the basis that the empirical evidence base for criticising primary care standards is weaker than commonly acknowledged. Systematic clinical trials are often premised by assumptions that are not relevant to primary care, they tend to select subject populations unrepresentative of those typically seen by general practitioners and results are often compromised by a series of methodological flaws. This article proposes an alternative conceptualisation of anxiety and depression apposite to primary care assessment and therapy. It draws on an emergent evidence base within psychobiology that recognises that these reactions have two adaptive functions. Firstly, they are responses evoked by actual personal adversity, secondly they have the function of prompting communication to self and to others of the need for practical remedial action to be taken independently, or with assistance, to improve the quality of the recovery environment. A table summarises the phased stages of anxiety and depression and lists their adaptive and communicative functions along with some phase-appropriate primary care interventions. This new model of assessment and therapy is offered to stimulate discussion and inspire future research that is appropriate for primary care service improvement.
Patients' experiences of GP consultations for psychological problems: a qualitative study
The British Journal of General Practice the Journal of the Royal College of General Practitioners, 2006
Twenty-five to forty per cent of general practice consultations have a significant psychological component. 1 Some involve relatively minor or selflimiting episodes of anxiety, depression and adjustment reactions. However, a substantial number involve more severe and chronic problems, with associated medical, social and psychological morbidity. 2 Ninety to ninety-five per cent of patients with psychological problems are seen solely by their GP or by primary care counsellors, psychologists or community psychiatric nurses, with a small minority referred to secondary care psychiatric services. 3 In addition to prescribing medication, such as antidepressants, GPs use a variety of consultation skills in trying to understand and help such patients. This qualitative study examines patients' experiences of GP consultations in which the patient presents explicitly with a psychological problem. The importance of obtaining patients' views on services has been emphasised 4 and there are some indications that patients' views may at times diverge from professionals' perspectives. 5,6 The current study aimed to investigate which aspects of routine GP consultations patients considered helpful or unhelpful, and what impact the doctor's communication had on