Detection of Anxiety Disorders in Primary Care: A Meta-Analysis of Assisted and Unassisted Diagnoses

Olariu, Elena; Forero, Carlos G.; Castro-Rodríguez, José Ignacio; Rodrigo-Calvo, María Teresa; Álvarez, Pilar; Martín-López, Luis Miguel; Sánchez-Toto, Alicia; Adroher, Núria Duran; Blasco, María Jesús; Vilagut, Gemma; Fullana, Miquel À.; Alonso, Jordi

doi:10.1002/da.22360

Cited by 53 publications

(43 citation statements)

References 81 publications

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“…Low recognition rates for anxiety disorders have been described at the primary care level (Olariu et al, 2015). Also, the low level of perceived need for care among individuals with anxiety disorders may be due to low levels of mental health literacy (Wang et al, 2007b; Ho et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…Recognition rates in primary care may be lower than 50% (Culpepper, 2003). Using standardized case detection methods has been recommended to improve their recognition in primary settings (Culpepper, 2003; Olariu et al, 2015). Structural and health system weaknesses, including scarce mental health and human services (World Health Organization, 2010) as well as lack of awareness and costs of treatment (Ho, Hunt, & Li, 2008) and stigma perceived by the people who experience anxiety disorders, further limit their treatment (Clement et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries

et al. 2018

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Background Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV anxiety disorder in 21 countries, the proportion who: i) perceived a need for treatment; ii) received any treatment; and (iii) received possibly adequate treatment. Methods Data from 24 community surveys in 21 countries of the WMH surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included PTSD among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or non-medical professional) for “problems with emotions, nerves, mental health, or use of alcohol or drugs”. Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, CAM or non-medical care (8+ visits). Results Of 51,547 respondents (response=71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. 41.3% of those with 12-month anxiety perceived a need for care. Lower treatment levels were found for lower income countries. Conclusions Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries

et al. 2018

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“…al., 1999;Leape, 1994). For example, there is broad and consistent evidence that primary care clinicians routinely do not detect anxiety and depressive disorders (Wittchen & Jacobi, 2005;Olariu et. al., 2015;Simon, Ormel, VonKorff, & Barlow, 1995).…”

Section: Introductionmentioning

confidence: 97%

Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care

Zvolensky

Paulus

Bakhshaie

et al. 2016

Psychiatry Research

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“…[15][16][17][18][19][20] Although around 70% of children and adolescents consult their GP more than twice a year, [21][22][23][24] studies in primary healthcare indicate that over two-thirds of children with ADs go unnoticed. [25][26][27][28] Recognition is especially problematic in early onset, less severe and less explicit disorders. [28][29][30][31] Interestingly, those factors are inherent to anxiety, including the covert nature of its core symptoms, its gradual development, fluctuating course and the wide variety of accompanying symptoms that are not prototypic for anxiety.…”

Section: Introductionmentioning

confidence: 99%

Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners

Aydın¹,

Crone

Siebelink³

et al. 2020

BMJ Open

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ObjectiveTo quantify general practitioners’ (GPs) sensitivity to anxiety disorders (ADs) when confronted with the range of symptoms common to children with ADs. Also, to explore GPs’ conscious preferences and implicit tendencies for referral of children with ADs to mental healthcare.Design and settingIn a cross-sectional vignette-based survey, all attendees of a Dutch continuing medical education conference for primary care physicians were presented with subtitled audio fragments of five vignettes that we constructed to mimic symptom presentation of children with ADs in general practice. We asked attendees to select per vignette the most plausible diagnoses and most adequate referral option, and for their general referral preferences when they suspect each of the most common mental health problems.ParticipantsA sample of 229 GPs, resulting in a total of 1128 vignette evaluations.Main outcome measureGPs’ selection rate of ADs in the five vignettes compared with a benchmark provided by mental health professionals (MHPs).ResultsOverall, recognition of ADs was less likely in GPs compared with MHPs (OR=0.26, 95% CI 0.15 to 0.46). GPs varied in their recognition of anxiety, with 44.1% not once selecting anxiety as the probable presenting problem. When asked explicitly, 63.9% of the GPs reported that they would refer a child to mental healthcare when they suspect probable ADs. By contrast, only 12.0% of the GPs who recognised anxiety in the vignettes actually selected that referral option.ConclusionA significant fraction of GPs did not notice the depicted symptoms as anxiety. Despite the widespread prevalence of ADs, GPs seem to overlook anxiety already in their early diagnostic opinion. Improving GPs’ familiarity with initial symptom presentation, ADs’ base-rate, relevance and impact yields potential for timely recognition.

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Detection of Anxiety Disorders in Primary Care: A Meta-Analysis of Assisted and Unassisted Diagnoses

Abstract: The use of diagnostic tools might improve detection of anxiety disorders in "primary care."

Cited by 53 publications

References 81 publications

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries

Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care

Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners

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