title: Why do people with an anxiety disorder utilize more nonmental health care than those without?
abstract: OBJECTIVE
  It is unclear why nonmental healthcare utilization is greater among those with psychological problems. The authors examined healthcare utilization in HMO patients to determine whether greater utilization in anxiety disorder (AD) patients was explained by anxiety symptoms (increasing sensitivity to physical symptoms) or comorbid illness (causing greater need for services).
  
  
  METHODS
  Patients were randomly selected from the database of a multi-specialty practice and 1,041 completed a survey assessing psychological symptoms, health behaviors, and demographics. Anxiety symptoms were assessed by questionnaire and the presence of an AD was determined from the medical chart. Healthcare encounters and medication use were abstracted from medical charts and HMO claims data.
  
  
  METHODS
  Healthcare utilization.
  
  
  RESULTS
  Both AD and anxiety symptoms predicted utilization, but symptoms were not associated with utilization in a model that also included AD. Comorbid illness was significantly associated with utilization independent of AD and somewhat reduced the strength of the AD-utilization association. The results were replicated in comparison of those with any psychiatric disorder to those without.
  
  
  CONCLUSIONS
  Among those with AD, greater utilization is not explained by anxiety symptoms but is partly explained by greater comorbid illness. Further study is needed to understand excess healthcare utilization among AD patients.
authors.affiliation: Dana-Farber Cancer Institute, Bston, MA 02115, USA. andrea_gurmankin@dfci.harvard.edu
authors.forename: Andrea
authors.initials: A
authors.lastname: Gurmankin Levy
authors.forename: Joanna
authors.initials: J
authors.lastname: Maselko
authors.forename: Mark
authors.initials: M
authors.lastname: Bauer
authors.forename: Laura
authors.initials: L
authors.lastname: Richman
authors.forename: Laura
authors.initials: L
authors.lastname: Kubzansky
mesh_terms: D000368:Aged; D001008:Anxiety Disorders; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D014481:United States