title: DETECTION OF ANXIETY DISORDERS IN PRIMARY CARE: A META-ANALYSIS OF ASSISTED AND UNASSISTED DIAGNOSES.
abstract: BACKGROUND
  Evidence suggests that general practitioners (GPs) fail to diagnose up to half of common mental disorder cases. Yet no previous research has systematically summarized the evidence in the case of anxiety disorders. The aim of this review was to systematically assess and meta-analyze the diagnostic accuracy of GPs' assisted (i.e., using severity scales/diagnostic instruments) and unassisted (without such tools) diagnoses of anxiety disorders.
  
  
  METHODS
  Systematic review (PROSPERO registry CRD42013006736) was conducted. Embase, Ovid Journals--Ovid SP Medline, Pubmed, PsycINFO, Scopus, Web of Science, and Science Direct were searched from January 1980 through June 2014. Seven investigators, working in pairs, evaluated studies for eligibility. The quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2). The main outcome measures were sensitivity and specificity of clinical diagnoses of any anxiety disorder. We pooled sensitivity and specificity levels from included studies using bivariate meta-analyses.
  
  
  RESULTS
  Twenty-four studies were included in the meta-analysis with a total sample of 34,902 patients. Pooled sensitivity and specificity were estimated at 44.5% (95% CI 33.7-55.9%) and 90.8% (95% CI 87-93.5%). GPs' sensitivity was higher when diagnoses were assisted (63.6%, 95% CI 50.3-75.1%) than when unassisted (30.5%, 95% CI 20.7-42.5%) to the expense of some specificity loss (87.9%, 95% CI 81.3-92.4% vs. 91.4%, 95% CI 86.6-94.6%, respectively). Identification rates remained constant over time (P-value = .998).
  
  
  CONCLUSIONS
  The use of diagnostic tools might improve detection of anxiety disorders in "primary care."
authors.affiliation: Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.|Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Olariu
authors.affiliation: Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Forero
authors.affiliation: Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.|Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.|Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain.
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Castro-Rodriguez
authors.affiliation: Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Rodrigo-Calvo
authors.affiliation: Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Álvarez
authors.affiliation: Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Martín-López
authors.affiliation: Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Sánchez-Toto
authors.affiliation: Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
authors.forename: Núria D
authors.initials: ND
authors.lastname: Adroher
authors.affiliation: Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Blasco-Cubedo
authors.affiliation: Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.|Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.affiliation: Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain.
authors.forename: Miquel A
authors.initials: MA
authors.lastname: Fullana
authors.affiliation: Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.|Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis*; D005260:Female; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012680:Sensitivity and Specificity
keywords: anxiety disorders; assessment/diagnosis; primary care; sensitivity; specificity