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BMC Primary Care
Published in: BMC Primary Care 1/2015

Open Access 01-12-2015 | Research article

Generalized anxiety disorder in primary care: mental health services use and treatment adequacy

Authors: Pasquale Roberge, François Normand-Lauzière, Isabelle Raymond, Mireille Luc, Marie-Michèle Tanguay-Bernard, Arnaud Duhoux, Christian Bocti, Louise Fournier

Published in: BMC Primary Care | Issue 1/2015

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Abstract

Purpose

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.
Literature
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
2.
3.
Wittchen HU, Beesdo K, Bittner A, Goodwin RD. Depressive episodes-evidence for a causal role of primary anxiety disorders? Eur Psychiatry. 2003;18(8):384–93.CrossRefPubMed
4.
Yonkers KA, Dyck IR, Warshaw M, Keller MB. Factors predicting the clinical course of generalised anxiety disorder. Br J Psychiatry. 2000;176:544–9.CrossRefPubMed
5.
Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Borkovec TD, Rickels K, et al. Consensus statement on generalized anxiety disorder from the International Consensus Group on Depression and Anxiety. J Clin Psychiatry. 2001;62 Suppl 11:53–8.PubMed
6.
Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162(6):1179–87.PubMedCentralCrossRefPubMed
7.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.CrossRefPubMed
8.
Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. J Clin Psychiatry. 2002;63 Suppl 8:24–34.PubMed
9.
Munk-Jorgensen P, Allgulander C, Dahl AA, Foldager L, Holm M, Rasmussen I, et al. Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway, and Sweden. Psychiatr Serv. 2006;57(12):1738–44.CrossRefPubMed
10.
Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.CrossRefPubMed
11.
Kessler RC, DuPont RL, Berglund P, Wittchen HU. Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry. 1999;156(12):1915–23.PubMed
12.
Wittchen HU, Carter RM, Pfister H, Montgomery SA, Kessler RC. Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey. Int Clin Psychopharmacol. 2000;15(6):319–28.CrossRefPubMed
13.
Kessler RC, Berglund PA, Dewit DJ, Ustun TB, Wang PS, Wittchen HU. Distinguishing generalized anxiety disorder from major depression: prevalence and impairment from current pure and comorbid disorders in the US and Ontario. Int J Methods Psychiatr Res. 2002;11(3):99–111.CrossRefPubMed
14.
Hunt C, Slade T, Andrews G. Generalized anxiety disorder and major depressive disorder comorbidity in the National Survey of Mental Health and Well-Being. Depress Anxiety. 2004;20(1):23–31.
15.
Revicki DA, Travers K, Wyrwich KW, Svedsater H, Locklear J, Mattera MS, et al. Humanistic and economic burden of generalized anxiety disorder in North America and Europe. J Affect Disord. 2012;140(2):103–12.CrossRefPubMed
16.
Hoffman DL, Dukes EM, Wittchen HU. Human and economic burden of generalized anxiety disorder. Depress Anxiety. 2008;25(1):72–90.CrossRefPubMed
17.
Andrews G, Sanderson K, Slade T, Issakidis C. Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment. Bull World Health Organ. 2000;78(4):446–54.PubMedCentralPubMed
18.
Olfson M, Gameroff MJ. Generalized anxiety disorder, somatic pain and health care costs. Gen Hosp Psychiatry. 2007;29(4):310–6.CrossRefPubMed
19.
Stein DJ. Comorbidity in generalized anxiety disorder: impact and implications. J Clin Psychiatry. 2001;62 Suppl 11:29–36.PubMed
20.
Schoevers RA, Deeg DJ, Van Tilburg W, Beekman AT. Depression and generalized anxiety disorder: co-occurrence and longitudinal patterns in elderly patients. Am J Geriatr Psychiatry. 2005;13(1):31–9.CrossRefPubMed
21.
Wittchen HU, Zhao S, Kessler RC, Eaton WW. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(5):355–64.CrossRefPubMed
22.
Roy-Byrne PP, Davidson KW, Kessler RC, Asmundson GJ, Goodwin RD, Kubzansky L, et al. Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry. 2008;30(3):208–25.CrossRefPubMed
23.
Ustun TB, Sartorius N. Eds: Mental Illness in General Health Care: an International Study. Chichester (England): John Wiley; 1995.
24.
Harman JS, Rollman BL, Hanusa BH, Lenze EJ, Shear MK. Physician office visits of adults for anxiety disorders in the United States, 1985–1998. J Gen Intern Med. 2002;17(3):165–72.PubMedCentralCrossRefPubMed
25.
Rickels K, Rynn MA. What is generalized anxiety disorder? J Clin Psychiatry. 2001;62 Suppl 11:4–12. discussion 13–14.PubMed
26.
Calleo J, Stanley MA, Greisinger A, Wehmanen O, Johnson M, Novy D, et al. Generalized anxiety disorder in older medical patients: diagnostic recognition, mental health management and service utilization. J Clin Psychol Med Settings. 2009;16(2):178–85.PubMedCentralCrossRefPubMed
27.
Olsson I, Mykletun A, Dahl AA. Recognition and treatment recommendations for generalized anxiety disorder and major depressive episode: a cross-sectional study among general practitioners in Norway. Prim Care Companion J Clin Psychiatry. 2006;8(6):340–7.PubMedCentralCrossRefPubMed
28.
Janssen EH, van de Ven PM, Terluin B, Verhaak PF, Van Marwijk HW, Smolders M, et al. Recognition of anxiety disorders by family physicians after rigorous medical record case extraction: results of the Netherlands Study of Depression and Anxiety. Gen Hosp Psychiatry. 2012;34(5):460–7.CrossRefPubMed
29.
Hoehn-Saric R. Generalized anxiety disorder in medical practice. Prim Psychiatry. 2005;12:30–4.
30.
Barbee JG, Todorov AA, Kuczmierczyk AR, Mancuso DM, Schwab JJ, Maddock RJ, et al. Explained and unexplained medical symptoms in generalized anxiety and panic disorder: relationship to the somatoform disorders. Ann Clin Psychiatry. 1997;9(3):149–55.CrossRefPubMed
31.
Klap R, Unroe KT, Unutzer J. Caring for mental illness in the United States: a focus on older adults. Am J Geriatr Psychiatry. 2003;11(5):517–24.CrossRefPubMed
32.
Judd LL, Kessler RC, Paulus MP, Zeller PV, Wittchen HU, Kunovac JL. Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatr Scand Suppl. 1998;393:6–11.CrossRefPubMed
33.
Antony MM, Stein MB. Oxford handbook of anxiety and related disorders. New York: Oxford University Press; 2009.
34.
Swinson RP, Antony M, Bleau P, Chokka P, Craven M, Fallu A, et al.. Clinical practice guidelines: Management of anxiety disorders. Can J Psychiatr. 2006;51 Suppl 2:1–92.
35.
National Institute for Health and Care Excellence Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults. In: Management in primary care, secondary care and community care. London, UK: National Institute for Health and Clinical Excellence; 2011.
36.
Fernandez A, Haro JM, Codony M, Vilagut G, Martinez-Alonso M, Autonell J, et al. Treatment adequacy of anxiety and depressive disorders: primary versus specialised care in Spain. J Affect Disord. 2006;96(1–2):9–20.CrossRefPubMed
37.
Wang PS, Berglund P, Kessler RC. Recent care of common mental disorders in the United States : prevalence and conformance with evidence-based recommendations. J Gen Intern Med. 2000;15(5):284–92.PubMedCentralCrossRefPubMed
38.
Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):629–40.CrossRefPubMed
39.
Stein MB, Roy-Byrne PP, Craske MG, Campbell-Sills L, Lang AJ, Golinelli D, et al. Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry. 2011;72(7):970–6.PubMedCentralCrossRefPubMed
40.
Stein MB, Sherbourne CD, Craske MG, Means-Christensen A, Bystritsky A, Katon W, et al. Quality of care for primary care patients with anxiety disorders. Am J Psychiatry. 2004;161(12):2230–7.CrossRefPubMed
41.
Prins MA, Verhaak PF, Smolders M, Laurant MG, van der Meer K, Spreeuwenberg P, et al. Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care. J Gen Intern Med. 2010;25(7):648–55.PubMedCentralCrossRefPubMed
42.
Roberge P, Fournier L, Duhoux A, Nguyen CT, Smolders M. Mental health service use and treatment adequacy for anxiety disorders in Canada. Soc Psychiatry Psychiatr Epidemiol. 2011;46(4):321–30.CrossRefPubMed
43.
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, et al. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841–50.PubMedCentralCrossRefPubMed
44.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10.CrossRefPubMed
45.
Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14 Suppl 1:S1–S83.PubMedCentralCrossRefPubMed
46.
Duhoux A, Fournier L, Gauvin L, Roberge P. Quality of care for major depression and its determinants: a multilevel analysis. BMC Psychiatry. 2012;12(1):142.PubMedCentralCrossRefPubMed
47.
Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMed
48.
Roberge P, Dore I, Menear M, Chartrand E, Ciampi A, Duhoux A, et al. A psychometric evaluation of the French Canadian version of the Hospital Anxiety and Depression Scale in a large primary care population. J Affect Disord. 2013;147(1–3):171–9.CrossRefPubMed
49.
Kovess V, Fournier L, Lesage AD, Lebigre FA, Caria A. Two validation studies of the CIDIS: a simplified version of the composite international diagnostic interview. Psychiatric Networks. 2001;4(1–2):10–24.
50.
Fernandez A, Haro JM, Martinez-Alonso M, Demyttenaere K, Brugha TS, Autonell J, et al. Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry. 2007;190:172–3.CrossRefPubMed
51.
Smolders M, Laurant M, Verhaak P, Prins M, Van Marwijk H, Penninx B, et al. Adherence to evidence-based guidelines for depression and anxiety disorders is associated with recording of the diagnosis. Gen Hosp Psychiatry. 2009;31(5):460–9.CrossRefPubMed
52.
Prins MA, Verhaak PF, Hilbink-Smolders M, Spreeuwenberg P, Laurant MG, van der Meer K, et al. Outcomes for depression and anxiety in primary care and details of treatment: a naturalistic longitudinal study. BMC Psychiatry. 2011;11:180.PubMedCentralCrossRefPubMed
53.
Diez-Roux AV. Multilevel analysis in public health research. Annu Rev Public Health. 2000;21:171–92.CrossRefPubMed
54.
Thompson A, Hunt C, Issakidis C. Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample. Soc Psychiatry Psychiatr Epidemiol. 2004;39(10):810–7.PubMed
55.
Culpepper L. Generalized anxiety disorder in primary care: emerging issues in management and treatment. J Clin Psychiatry. 2002;63 Suppl 8:35–42.PubMed
56.
Allgulander C. Generalized anxiety disorder: What are we missing? Eur Neuropsychopharmacol. 2006;16 Suppl 2:S101–8.CrossRefPubMed
57.
Smolders M, Laurant M, Van Rijswijk E, Mulder J, Braspenning J, Verhaak P, et al. The impact of co-morbidity on GPs’ pharmacological treatment decisions for patients with an anxiety disorder. Fam Pract. 2007;24(6):538–46.CrossRefPubMed
58.
Drapeau A, Boyer R, Diallo FB. Discrepancies between survey and administrative data on the use of mental health services in the general population: findings from a study conducted in Quebec. BMC Public Health. 2011;11:837.PubMedCentralCrossRefPubMed
59.
Palin JL, Goldner EM, Koehoorn M, Hertzman C. Prevalence and frequency of mental health care provided by general practitioners: differences between 2 national data sources for the same population. Can J Psychiatry. 2012;57(6):366–74.PubMed
60.
Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.PubMedCentralCrossRefPubMed
61.
Dezetter A, Duhoux A, Menear M, Roberge P, Chartrand E, Fournier L. Reasons and determinants for perceiving unmet needs for mental health in primary care in Quebec. Can J Psychiatry. 2015;60(6):284–93.
62.
Bennett-Levy J, Richards DA, Farrand P, Christensen H, Griffiths KM, Kavanagh DJ, et al. Oxford guide to low intensity CBT interventions. New York: Oxford University Press; 2010.CrossRef
Metadata
Title
Generalized anxiety disorder in primary care: mental health services use and treatment adequacy
Authors
Pasquale Roberge
François Normand-Lauzière
Isabelle Raymond
Mireille Luc
Marie-Michèle Tanguay-Bernard
Arnaud Duhoux
Christian Bocti
Louise Fournier
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2015
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-015-0358-y

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