title: Predictors of anxiety recurrence in the Coordinated Anxiety Learning and Management (CALM) trial.
abstract: Few studies have examined anxiety recurrence after symptom remission in the primary care setting. We examined anxiety recurrence in the Coordinated Anxiety Learning and Management (CALM) trial. From 2006 to 2009, CALM randomized adults with anxiety disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder) in primary care clinics to usual care (UC) or a collaborative care (CC) intervention of pharmacotherapy and/or cognitive behavioral therapy. We examined 274 patients who met criteria for anxiety remission (Brief Symptom Inventory for anxiety and somatization (BSI-12) < 6) after 6 months of randomized treatment and completed a follow-up of 18 months. Logistic regression and receiver operating characteristics (ROC) were used to identify predictors of anxiety recurrence (BSI-12 ≥ 6 and 50% increase from 6-month ratings) during the year following remission. Recurrence was lower in CC (29%) compared to UC (41%) (p = 0.04). Patients with comorbid depression or lower self-perceived socioeconomic status particularly benefited (in terms of reduced recurrence) if assigned to CC instead of UC. In the multivariable logistic regression model, smoking, being single, Anxiety Sensitivity Index score, functional impairment at month 6 due to residual anxiety (measured with the Sheehan Disability Scale), and treatment with benzodiazepines were associated with subsequent anxiety recurrence. ROC identified prognostic subgroups based on the risk of recurrence. Our study was exploratory, and our findings require replication. Future studies should also examine the effectiveness of relapse prevention programs in patients at highest risk for recurrence.
authors.affiliation: Yale Child Study Center, New Haven, CT, USA; Yale University Department of Psychiatry, New Haven, CT, USA. Electronic address: jerome.taylor@yale.edu.
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Taylor
authors.affiliation: Yale Child Study Center, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA. Electronic address: ewgeni.jakubovski@yale.edu.
authors.forename: Ewgeni
authors.initials: E
authors.lastname: Jakubovski
authors.affiliation: Yale Child Study Center, New Haven, CT, USA; Yale University Department of Psychiatry, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA. Electronic address: michael.bloch@yale.edu.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bloch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000628:therapy*; D003299:Cooperative Behavior; D019468:Disease Management; D005260:Female; D006801:Humans; D007858:Learning; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anxiety disorders; Collaborative care; Integrated health care; Primary care; Relapse; Risk factors