Generalized anxiety disorder in primary care: mental health services use and treatment adequacy.
OBJECTIVE
Generalized Anxiety Disorder (GAD) is a common mental disorder in the primary care setting, marked by persistent anxiety and worries. The aims of this study were to: 1) examine mental health services utilisation in a large sample of primary care patients; 2) explore detection of GAD and minimal standards for pharmacological and psychological treatment adequacy based on recommendation from clinical practice guidelines; 3) examine correlates of treatment adequacy, i.e. predisposing, enabling and needs factors according to the Behavioural Model of Health Care Use.


METHODS
A sample of 373 adults meeting DSM-IV criteria for Generalized Anxiety Disorder in the past 12 months took part in this study. Data were drawn from the "Dialogue" project, a large primary care study conducted in 67 primary care clinics in Quebec, Canada. Following a mental health screening in medical clinics (n = 14833), patients at risk of anxiety or depression completed the Composite International Diagnostic Interview-Simplified (CIDIS). Multilevel logistic regression models were developed to examine correlates of treatment adequacy for pharmacological and psychological treatments.


RESULTS
Results indicate that 52.5 % of participants were recognized as having GAD by a healthcare professional in the past 12 months, and 36.2 % of the sample received a pharmacological (24.4 %) and/or psychological treatment (19.2 %) meeting indicators based on clinical practice guidelines recommendations. The detection of GAD by a health professional and the presence of comorbid depression were associated with overall treatment adequacy.


CONCLUSIONS
This study suggests that further efforts towards GAD detection could lead to an increase in the delivery of evidence-based treatments. Key targets for improvement in treatment adequacy include regular follow up of patients with a GAD medication and access to psychotherapy from the primary care setting.
Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada. pasquale.roberge@usherbrooke.ca.
Pasquale
P
Roberge
Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada. Francois.Normand.Lauziere@USherbrooke.ca.
François
F
Normand-Lauzière
Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada. Isabelle.Raymond2@USherbrooke.ca.
Isabelle
I
Raymond
Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada. mireille.luc@USherbrooke.ca.
Mireille
M
Luc
Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada. Marie-Michele.Tanguay.Bernard@USherbrooke.ca.
Marie-Michèle
MM
Tanguay-Bernard
Division of Neurology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001,12th Avenue North, Sherbrooke, QC, J1H 5 N4, Canada. arnaud.duhoux@umontreal.ca.
Arnaud
A
Duhoux
Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montreal, QC, H3C 3 J7, Canada. Christian.Bocti@USherbrooke.ca.
Christian
C
Bocti
CRCHUM (Centre de recherche du Centre Hospitalier de l'Université de Montréal), Université de Montréal, Pavillon Édouard-Asselin, 264, boul. René-Lévesque Est, Montréal, QC, H2X 1P1, Canada. louise.fournier@umontreal.ca.
Louise
L
Fournier
D000293:Adolescent; D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D011792:Quebec / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
D014151:Anti-Anxiety Agents