Disability and health-related quality of life in outpatients with generalised anxiety disorder treated in psychiatric clinics: is there still room for improvement?

Abstract

ObjectiveWe assessed the impact of generalised anxiety disorder (GAD) on disability and health-related quality of life in outpatients treated in psychiatric clinics via a secondary analysis conducted in 799 patients from a cross-sectional study of prevalence of GAD in psychiatric clinics.MethodsPatients were allocated into two groups: follow-up (15.7%) and newly diagnosed patients (84.3%), and were administered the Hamilton Anxiety Scale (HAM-A), Clinical Global Impressions Scale (CGI), Sheehan Disability Scale (SDS), and 36-item short form structured quality of life questionnaire (SF-36) scales.ResultsThe newly diagnosed group showed higher significant intensity of anxiety (56.9% vs 43.0% (HAM-A >24)), psychiatrist's CGI Severity (CGI-S) scores (4.2 vs 3.7), and perceived stress according to SDS (5.7 vs 5.2). They also showed lower scores in mental health-related quality of life: 25.4 vs 30.8. Statistical differences by gender were not observed. GAD was shown to have a significant impact on patient quality of life and disability, with a substantial portion having persistent, out of control symptoms despite treatment.ConclusionsThese results suggest that there is still room for improvement in the medical management of patients with GAD treated in psychiatric clinics.

Comparison of the course of substance use disorders among individuals with and without generalized anxiety disorder in a nationally representative sample

“…The GAD-SUD group, even after improving from Wave 1 to Wave 2 in mental health-related quality of life, had scores consistently below 50, which was the mean across most scales for the SUD only group. These findings are consistent with other evidence suggesting GAD comorbidity confers increased risk for impairment, poor functioning, and quality of life (Grant et al, 2005), which may be due to the somatic manifestations of GAD and impact on physical discomfort and pain (Bobes et al, 2011), as well as the impact of GAD on numerous areas of one’s life, including work performance (Kessler et al, 1999; Wittchen, 2002) and social functioning (Henning et al, 2007) that often subsists even following treatment for individuals with GAD (Bobes et al, 2011). …”

“…This may be due to the impact of GAD on work productivity, employment status, and overall daily functioning (Bobes et al, 2011; Henning et al, 2007), or the overall higher levels of impairment associated with greater comorbidity.…”

A randomised, double-blind, placebo-controlled, duloxetine-referenced study of the efficacy and tolerability of vortioxetine in the acute treatment of adults with generalised anxiety disorder

“…Despite various treatment options, between 25% and 40% of patients do not respond to treatment in clinical trials , and as many as 32% discontinue study treatment as a result of adverse events (AEs) . Moreover, a recent comparison of newly diagnosed GAD patients and treated patients showed that, despite a significantly lower mean Hamilton Anxiety Scale (HAM‐A) total score (26.8 newly diagnosed vs. 22.4 treated; p < 0.001) in the treated group, scores on patient‐reported functional impairment on the Sheehan Disability Scale (SDS) were not statistically significantly different in the treated vs. newly diagnosed groups . These findings emphasise the need for alternative therapies that can provide efficacy to a larger proportion of patients with GAD and accelerate their functional recovery.…”

Interpersonal Problems, Mindfulness, and Therapy Outcome in an Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder

“…Generalized anxiety disorder (GAD) is a chronic, impairing (Bobes, Caballero, Villardaga, & Rejas, 2011) condition characterized by frequent and persistent worry. Although cognitive behavioral therapy appears efficacious for GAD (Colvin, Ouimet, Seeds, & Dozois, 2008), a quarter (Ladouceur et al, 2000) to three quarters (Waters & Craske, 2005) of patients may not achieve high-end state functioning by treatment completion.…”