Screening high-risk patients and assisting in diagnosing anxiety in primary care: the Patient Health Questionnaire evaluated (original) (raw)
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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.
Screening for anxiety disorders
British Journal of Psychiatry, 1998
Background The paper describes the rationale, sensitivity and specificity of the Anxiety Screening Questionnaire (ASQ), a disorder-specific screening instrument for use in primary care.Method Two hundred and fifty subjects sampled from psychiatric, primary care settings and the community, participated in a test-retest reliability as well as a procedural validity study, using the M–CIDI with DSM–IV algorithms as a diagnostic yardstick.Results The ASQ was found to be easy to administer and acceptable and efficient in terms of sensitivity and specificity for generalised anxiety syndromes. The test– retest item reliability was good to excellent with kappa values of 0.6 or above. As compared with the validity standard, the DSM – IV/CIDI diagnoses caseness sensitivity was generally high (above 82%) for all diagnostic domains covered, whereas the specificity was only high for DSM – IV threshold and subthreshold generalised anxiety disorder.Conclusions These preliminary findings demonstrate...
British Journal of General Practice, 2021
Background In the UK between 1998 and 2008, GPs' recording of anxiety symptoms increased, but their recording of anxiety disorders decreased. The reason for this decline is not clear, nor are the treatment implications for primary care patients. Aim To understand GPs' and patients' views on the value of diagnosing anxiety disorders in primary care. Design and Setting In-depth interviews were conducted with 15 GPs and 20 patients, purposively sampled from GP practices in Bristol and the surrounding areas. Method Interviews were held either in person or by telephone. A topic guide was used to ensure consistency across the interviews. The interviews were audio-recorded, transcribed verbatim and analysed thematically. Results GPs reported preferring to use symptom rather than diagnostic codes in order to avoid assigning potentially stigmatising labels, and because they felt diagnostic codes could encourage some patients to adopt a 'sick-role'. In addition, their decision to use a diagnostic code depended on symptom severity and chronicity, and these were hard to establish in a time-limited clinical consultation. In contrast, patients commented that receiving a diagnosis helped them to understand their symptoms, and encouraged them to engage with treatment. Conclusion GPs may be reluctant to diagnose an anxiety disorder, but patients can find a diagnosis helpful in terms of understanding their symptoms and the need for treatment. As limited consultation time can discourage discussions between GPs and patients, follow up appointments and continuity of care may be particularly important for the management of anxiety in primary care.
Screening for anxiety in an epidemiological sample: predictive accuracy of questionnaires
Journal of Anxiety Disorders, 2002
The study examined the predictive accuracy of selected questionnaires when screening for anxiety in a representative epidemiological sample of young female adults (N 1877). All participants were diagnosed using a structured diagnostic interview. Anxiety questionnaires included global as well as speci®c measures (Beck Anxiety Inventory (BAI), Symptom Checklist, Anxiety Sensitivity Index (ASI), Fear Questionnaire (FQ), Mobility Inventory (MI)). Sensitivity, speci®city, positive and negative predictive power were computed for two screening decisions: (1) identifying any anxiety disorder or (2) identifying a speci®c anxiety disorder (agoraphobia) within the total sample and the clinical subsample. Due to naturalistic (low) base rates in epidemiological samples, diagnostic indices were lower than those previously reported. However, questionnaire data proved useful when a speci®c disorder was targeted (agoraphobia) and speci®c symptoms were operationalized. #
Prevention of anxiety disorders in primary care: A feasibility study
BMC Psychiatry, 2012
Background: Anxiety disorders are highly prevalent in primary care and cause a substantial burden of disease. Screening on risk status, followed by preventive interventions in those at risk may prevent the onset of anxiety disorders, and thereby reduce the disease burden. The willingness to participate in screening and interventions is crucial for the scope of preventive strategies, but unknown. This feasibility study, therefore, investigated participation rates of screening and preventive services for anxiety disorders in primary care, and explored reasons to refrain from screening. Methods: In three general practices, screening was offered to individuals visiting their general practitioner (total n = 2454). To assess risk status, a 10-item questionnaire was followed by a telephone interview (including the CIDI) when scoring above a predefined threshold. Preventive services were offered to those at risk. Participation rates for screening and preventive services for anxiety disorders were assessed. Those not willing to be screened were asked for their main reason to refrain from screening. Results: Of all individuals, 17.3% participated in initial screening, and of those with a possible risk status, 56.0% continued screening. In 30.1% of those assessed, a risk status to develop an anxiety disorder was verified. Of these, 22.6% already received some form of mental health treatment and 38.7% of them agreed to participate in a preventive intervention and were referred. The most frequently mentioned reasons to refrain from screening were the emotional burden associated with elevated risk status, the assumption not to be at risk, and a lack of motivation to act upon an elevated risk status by using preventive services. Conclusions: Screening in general practice, followed by offering services to prevent anxiety disorders in those at risk did not appear to be a feasible strategy due to low participation rates. To enable the development of feasible and cost-effective preventive strategies, exploring the reasons of low participation rates, considering involving general practitioners in preventive strategies, and looking at preventive strategies in somatic health care with proven feasibility may be helpful.
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.