Generalized anxiety disorder, with or without co-morbid major depressive disorder, in primary care: prevalence of painful somatic symptoms, functioning and health status.
BACKGROUND
Painful physical symptoms (PPS) have received little attention in patients with generalized anxiety disorder (GAD). The objective of the present study was to assess the prevalence of PPS in patients with GAD vs patients with GAD and co-morbid major depressive disorder (MDD) and a control group (patients neither with GAD nor MDD).


METHODS
This is a cross-sectional, multi-center, epidemiological study, in primary care. Patients were screened for GAD (HADS-A), followed by a diagnosis confirmation (MINI). Patients were considered to have PPS when VAS overall pain score >30. Functioning and health status was assessed (SDS, EUROQoL-5D). Relationships between the presence of PPS and functioning and health status was analyzed (ANCOVA models). Results were adjusted for confounding factors.


RESULTS
Of 7152 patients, 1546 (22%) screened positive for GAD, 981 (14%) had confirmed GAD diagnosis, of whom 559 (8%) had GAD with co-morbid MDD and 422 (6%) had GAD alone. Of the 5292 (74%) patients screened negative for GAD, 336 (5%) were confirmed as controls. PPS in patients with GAD were twice as prevalent as in the control group: 59.0% vs. 28.3%; p<0.001. The presence of co-morbid MDD was associated with a significantly higher prevalence of PPS: 78.0% vs. 59.0%; p<0.001. PPS were significantly associated with functioning and health status impairment (p<0.001) both in GAD alone and in GAD and co-morbid MDD compared with controls.


CONCLUSIONS
Results do not prove causal relationships.


CONCLUSIONS
Our results support the clinical relevance of PPS in patients suffering from GAD; therefore they need to be considered when evaluating the patient.
Romera
Irene
I
Clinical Research Department, Lilly Spain, Madrid, Spain. romera_irene@lilly.com
Fernández-Pérez
Sabela
S
Montejo
Angel Luis
AL
Caballero
Fernando
F
Caballero
Luis
L
Arbesú
José Ángel
JÁ
Delgado-Cohen
Helena
H
Desaiah
Durisala
D
Polavieja
Pepa
P
Gilaberte
Inmaculada
I
D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011320:Primary Health Care / Q000706:statistics & numerical data; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013030:Spain