Prevalence of comorbid anxiety disorders in primary care outpatients.
OBJECTIVE
To estimate the extent to which anxiety disorders (eg, panic disorder, phobia, and generalized anxiety disorder [GAD]) co-occur in patients with major medical and psychiatric conditions.


METHODS
Observational study.


METHODS
Offices of primary care providers in three US cities, with mental health specialty providers included for comparative purposes.


METHODS
Adult patients (N = 2494) with hypertension, diabetes, heart disease (congestive heart failure or myocardial infarction), current depressive disorder, or subthreshold depression.


METHODS
Current (past 12 months) and lifetime panic disorder, phobia, GAD, perceived need for help for emotional or family problems, and unmet need (ie, failure to get help that was needed).


METHODS
Comparisons of the prevalence of anxiety comorbidity in medically ill nondepressed patients of primary care providers and in depressed patients of both primary care and mental health specialty providers.


RESULTS
Among primary care patients, those with chronic medical illnesses or subthreshold depression had low rates of lifetime (1.5% to 3.5%) and current (1.0% to 1.7%) panic disorder, but those with current depressive disorder had much higher rates (10.9% lifetime and 9.4% current panic disorder). Concurrent phobia and GAD were more common (10.4% to 12.4% current GAD), especially among depressed patients (25% to 54% current GAD). Depending on the type of medical illness or depression, 14% to 66% of primary care patients had at least one concurrent anxiety disorder. Patient-perceived unmet need for care for personal or emotional problems was high among all primary care patients (54.6% to 72.9%).


CONCLUSIONS
Primary care clinicians should be aware of the possible coexistence of anxiety disorders (especially GAD) among their patients with chronic medical conditions, but especially among those with current depressive disorder.
Sherbourne
C D
CD
RAND, Santa Monica, Calif., USA.
Jackson
C A
CA
Meredith
L S
LS
Camp
P
P
Wells
K B
KB
D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006301:Health Services Needs and Demand; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology