title: Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The predictA-Spain study.
abstract: BACKGROUND
  There are no risk algorithms for the onset of anxiety syndromes at 12 months in primary care. We aimed to develop and validate internally a risk algorithm to predict the onset of anxiety syndromes at 12 months.
  
  
  METHODS
  A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multilevel logistic regression and inverse probability weighting to build the risk algorithm. Our main outcome was generalized anxiety, panic and other non-specific anxiety syndromes as measured by the Primary Care Evaluation of Mental Disorders, Patient Health Questionnaire (PRIME-MD-PHQ). We recruited 3,564 adult primary care attendees without anxiety syndromes from 174 family physicians and 32 health centers in 6 Spanish provinces.
  
  
  RESULTS
  The cumulative 12-month incidence of anxiety syndromes was 12.2%. The predictA-Spain risk algorithm included the following predictors of anxiety syndromes: province; sex (female); younger age; taking medicines for anxiety, depression or stress; worse physical and mental quality of life (SF-12); dissatisfaction with paid and unpaid work; perception of financial strain; and the interactions sex*age, sex*perception of financial strain, and age*dissatisfaction with paid work. The C-index was 0.80 (95% confidence interval=0.78-0.83) and the Hedges' g=1.17 (95% confidence interval=1.04-1.29). The Copas shrinkage factor was 0.98 and calibration plots showed an accurate goodness of fit.
  
  
  CONCLUSIONS
  The predictA-Spain risk algorithm is valid to predict anxiety syndromes at 12 months. Although external validation is required, the predictA-Spain is available for use as a predictive tool in the prevention of anxiety syndromes in primary care.
authors.affiliation: Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Moreno-Peral
authors.affiliation: Departamento de Bioestadística, Universidad de Granada, Granada, Spain.
authors.forename: Juan de Dios
authors.initials: Jde D
authors.lastname: Luna
authors.affiliation: Department of Primary care and Population Health, University College London, London, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: Marston
authors.affiliation: Mental Health Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.affiliation: Department of Primary care and Population Health, University College London, London, United Kingdom.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Universidad Loyola Andalucía, Sevilla, Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Motrico
authors.affiliation: Unidad Docente de Medicina Familiar y Comunitaria de La Rioja, Servicio Riojano de la Salud, Logroño, La Rioja, Spain.
authors.forename: María Josefa
authors.initials: MJ
authors.lastname: GildeGómez-Barragán
authors.affiliation: Centro de Investigación Biomédica en Red de Salud Mental, Universidad de Granada, Granada, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Torres-González
authors.affiliation: Centro de Salud Casablanca, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Montón-Franco
authors.affiliation: Directora Continuidad Asistencial Hospital Universitario Infanta Sofía, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sánchez-Celaya
authors.affiliation: Centro de Salud Vecindario, Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Díaz-Barreiros
authors.affiliation: Centro de Salud son Serra-La Vileta, Unidad Docente de Medicina Familiar y Comunitaria de Mallorca, Instituto Balear de la Salud, Palma de Mallorca, Illes Balears, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Vicens
authors.affiliation: Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Muñoz-Bravo
authors.affiliation: Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain; Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain; Centro de Salud El Palo, Servicio Andaluz de Salud, Málaga, Spain.
authors.forename: Juan Ángel
authors.initials: JÁ
authors.lastname: Bellón
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011788:Quality of Life; D012307:Risk Factors; D013030:Spain; D013315:Stress, Psychological