Generalized anxiety and depression in primary care: prevalence, recognition, and management.
OBJECTIVE
Determine attitudes toward patients with generalized anxiety disorder (GAD) and major depressive episodes (MDE) in primary care; determine prevalence of GAD, MDE, and comorbid GAD/MDE among primary care patients; assess physician recognition of GAD and MDE; and describe primary care interventions for these patients.


METHODS
558 primary care physicians participated in a 1-day survey. Over 20,000 patients completed a diagnostic-screening questionnaire for GAD and MDE. Physician questionnaires included a standardized clinical appraisal of somatic and psychosocial symptoms and information on past and current treatments and a prestudy questionnaire assessing experience with and attitudes toward patients with GAD and MDE.


RESULTS
56.9% of physicians viewed GAD as a genuine mental disorder with clinical management problems and considerable patient burden; 27.4% treated GAD patients differently from MDE patients. 5.3% of patients met criteria for GAD, 6.0% for MDE, 3.8% for pure GAD, 4.4% for pure MDE, and 1.6% for comorbid GAD/MDE. Pure GAD and MDE were associated with disability, high utilization of health care resources, and suicidality, which were even higher with comorbid GAD/MDE. Physicians recognized clinically significant emotional problems in 72.5% of patients with pure GAD, 76.5% with pure MDE, and 85.4% with comorbid GAD/MDE. However, correct diagnosis was much lower (64.3% for MDE and 34.4% for GAD). Although the majority of patients with recognized GAD or MDE were treated, only a small minority with GAD were prescribed medications or referred to specialists.


CONCLUSIONS
The high proportion of respondents with pure GAD is inconsistent with previous reports that GAD is usually comorbid with depression. GAD remains poorly recognized and inadequately treated. Improving the recognition and treatment of GAD in primary care patients is discussed relative to new treatments.
Wittchen
Hans-Ulrich
HU
Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany. wittchen@mpipsykl.mpg.de
Kessler
Ron C
RC
Beesdo
Katja
K
Krause
Petra
P
Höfler
Michael
M
Hoyer
Jürgen
J
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D001291:Attitude of Health Personnel; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany / Q000453:epidemiology; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents