title: Diagnostic indicators of anxiety and depression in older dizzy patients in primary care.
abstract: BACKGROUND
  Dizzy patients with both psychological and physical symptoms tend to have high levels of disability and are at risk of remaining symptomatic and disabled. The objective of this study was to develop a prediction model for the presence of anxiety and/or depression in older dizzy patients in primary care.
  
  
  METHODS
  We performed a cross-sectional study among 415 older patients consulting their primary care physician for persistent dizziness. Participants underwent a standardized, comprehensive evaluation and completed self-administered questionnaires regarding anxiety and depression (PRIME-MD Patient Health Questionnaire [PHQ]) and dizziness-related disability (Dizziness Handicap Inventory). To determine the diagnostic indicators of anxiety and/or depression, we used multiple logistic regression analysis with ''presence of Panic Disorder, Other Anxiety Disorder, or Major Depressive Disorder'' as dependent variable. Potential diagnostic indicators included dizziness-related disability, patient characteristics (age, sex, history of anxiety, and history of depression), and dizziness characteristics (description of dizziness, provoking circumstances, associated symptoms, onset, frequency, duration, and avoidance of activities because of dizziness).
  
  
  RESULTS
  According to the PHQ, an anxiety and/or depressive disorder was present in 90 patients (22%), of whom 35 reported no medical history of anxiety or depression, nor current pharmacological treatment for these disorders. In the final model, dizziness-related disability, a history of depression, and accompanying fear were associated with an increased odd of anxiety and/or depression, whereas tinnitus and rotational dizziness were associated with a decreased odd of anxiety and/or depression. The model showed good calibration (Hosmer-Lemeshow P value of .46) and discrimination (adjusted area under the receiver operating characteristic curve [AUC] after bootstrapping of .82).
  
  
  CONCLUSIONS
  Primary care physicians should consider the existence of anxiety and depression in older patients presenting with dizziness. After external validation, our model may contribute to better recognition and hence better management of anxiety and depression in older patients with dizziness in primary care.
authors.affiliation: Department of Family Practice and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands. o.maarsingh@vumc.nl
authors.forename: Otto R
authors.initials: OR
authors.lastname: Maarsingh
authors.forename: Jacquelien
authors.initials: J
authors.lastname: Dros
authors.forename: Daniëlle A
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Gerben
authors.initials: G
authors.lastname: ter Riet
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Henk C
authors.initials: HC
authors.lastname: van Weert
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
mesh_terms: D001007:Anxiety / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D001008:Anxiety Disorders / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D004244:Dizziness / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D058007:Physicians, Primary Care; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires