title: Classification models for subthreshold generalized anxiety disorder in a college population: Implications for prevention.
abstract: Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders on college campuses and often goes unidentified and untreated. We propose a combined prevention and treatment model composed of evidence-based self-help (SH) and guided self-help (GSH) interventions to address this issue. To inform the development of this stepped-care model of intervention delivery, we evaluated results from a population-based anxiety screening of college students. A primary model was developed to illustrate how increasing levels of symptomatology could be linked to prevention/treatment interventions. We used screening data to propose four models of classification for populations at risk for GAD. We then explored the cost considerations of implementing this prevention/treatment stepped-care model. Among 2489 college students (mean age 19.1 years; 67% female), 8.0% (198/2489) met DSM-5 clinical criteria for GAD, in line with expected clinical rates for this population. At-risk Model 1 (subthreshold, but considerable symptoms of anxiety) identified 13.7% of students as potentially at risk for developing GAD. Model 2 (subthreshold, but high GAD symptom severity) identified 13.7%. Model 3 (subthreshold, but symptoms were distressing) identified 12.3%. Model 4 (subthreshold, but considerable worry) identified 17.4%. There was little overlap among these models, with a combined at-risk population of 39.4%. The efficiency of these models in identifying those truly at risk and the cost and efficacy of preventive interventions will determine if prevention is viable. Using Model 1 data and conservative cost estimates, we found that a preventive intervention effect size of even 0.2 could make a prevention/treatment model more cost-effective than existing models of "wait-and-treat."
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States. Electronic address: nkanuri@stanford.edu.
authors.forename: Nitya
authors.initials: N
authors.lastname: Kanuri
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States; Palo Alto University, United States.
authors.forename: C Barr
authors.initials: CB
authors.lastname: Taylor
authors.affiliation: PGSP-Stanford PsyD Consortium, United States.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Cohen
authors.affiliation: The Pennsylvania State University, Department of Psychology, United States.
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Newman
mesh_terms: D001007:Anxiety / Q000523:psychology; D001008:Anxiety Disorders / Q000145:classification* / Q000191:economics / Q000517:prevention & control; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013334:Students / Q000523:psychology; D057832:Watchful Waiting / Q000191:economics; D055815:Young Adult
keywords: College health; Generalized anxiety disorder; Prevention; Screening; Self-help interventions; Stepped-care models; e-Health