title: Screening high-risk patients and assisting in diagnosing anxiety in primary care: the Patient Health Questionnaire evaluated.
abstract: BACKGROUND
  Questionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders.
  
  
  METHODS
  A cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible 'anxiety case' by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ.
  
  
  RESULTS
  Using only the screening questions of the PHQ, the area under the curve was 83% in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77%. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio = 23.4; 95% confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio = 13.9; 95% confidence interval 3.8 to 50.6).
  
  
  CONCLUSIONS
  The PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident.
authors.affiliation: Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO box 725, Utrecht 3500AS, The Netherlands. a.muntingh@ggzingeest.nl
authors.forename: Anna D T
authors.initials: AD
authors.lastname: Muntingh
authors.forename: Eric W
authors.initials: EW
authors.lastname: De Heer
authors.forename: Harm W J
authors.initials: HW
authors.lastname: Van Marwijk
authors.forename: Herman J
authors.initials: HJ
authors.lastname: Adèr
authors.forename: Anton J L M
authors.initials: AJ
authors.lastname: Van Balkom
authors.forename: Philip
authors.initials: P
authors.lastname: Spinhoven
authors.forename: Christina M
authors.initials: CM
authors.lastname: Van der Feltz-Cornelis
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis*; D001008:Anxiety Disorders / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care; D011594:Psychometrics; D012307:Risk Factors; D011795:Surveys and Questionnaires