Treatment adequacy for social anxiety disorder in primary care patients

Abstract

ObjectivesThere is a gap between clinical practice guidelines for social anxiety disorder and clinical practice that needs to be addressed to ensure the delivery of evidence-based treatments. The objectives of this study were: 1) to describe mental health service utilization in a cohort of primary care patients with social anxiety disorder; 2) to examine treatment adequacy for pharmacotherapy and psychotherapy according to indicators based on clinical practice guidelines; and 3) to explore correlates of treatment adequacy.MethodThe “Dialogue” project (Quebec, Canada) is a large study conducted in 67 primary care clinics. After a mental health screening in primary care (n = 14 833), participants with anxiety or depressive symptoms took part in a telephone/web structured interview on mental health symptoms and service utilization (n = 1956). This study included 289 participants meeting DSM-IV criteria for social anxiety disorder.ResultsOverall, 86.2% of participants reported consulting for mental health reasons over the past 12 months. Only 23.6% of our sample reported the detection of social anxiety disorder by a healthcare professional in the past 12 months. Approximately 2 in 5 respondents with social anxiety disorder reported receiving pharmacotherapy or psychotherapy meeting our treatment adequacy indicators. Antidepressant medication was the most common treatment. Logistic regression models showed that the detection of major depression (OR = 4.651; 95% CI: 2.559–8.453) or other anxiety disorder(s) (OR = 2.957; 95% CI: 1.555–5.625) were associated with receiving any adequate treatment, but the detection of social anxiety disorder itself was not (OR = 1.420; 95% CI: 0.696–2.899).ConclusionLow rates of detection and treatment adequacy based on our indicators demonstrate that efforts must be made to ensure the quality of care for individuals with social anxiety disorder in primary care.

Social Anxiety and Theory of Mind: A Comparison of Self-Report and Objective Measures

“…This disagrees with fundamental features of SAD models in the key characteristics of SAD outlined, such as over-mentalization (Heimberg et al, 2010), and negative self-evaluation (Clark & Wells, 1995), and thus the subsequent CBTs based on these approaches. The disparity between the findings and current treatment for SAD is consistent with recent criticisms of the treatment options available (Chapdelaine et al, 2018) and highlights the necessity for updated recommendations. However, SOCIAL ANXIETY AND THEORY OF MIND 38 the findings regarding ToM deficits in SAD have not been unanimous with some, like this study, not finding an association with social anxiety (Lenton-Brym et al, 2018), and others finding an association (Washburn, 2012;Hezel & McNally, 2014;Washburn et al, 2016).…”

“…Finally, a comparison of the effectiveness of different treatments of SAD is crucial given the stark differences in CBT approaches (Clark & Wells, 1995;Heimberg et al, 2010) and criticisms of the effectiveness of current interventions (Carpenter et al, 2018;Chapdelaine et al, 2018). Exploration of CBT for SAD based on different theoretical models may aid the understanding of SAD in a bottom-up fashion by indicating which strategies are most effective, thus providing insight into the underlying mechanisms.…”

“…Quality of life is lower in individuals with SAD than those without (Eng, Coles, Heimberg, & Safren, 2005). However, despite a heightened awareness of the severity of the impact SAD can have on individuals' functioning and quality of life, SAD is under-detected by clinicians and treatment is insufficient (Chapdelaine, Carrier, Fournier, Duhoux, & Roberge, 2018). Quality of life for individuals after receiving treatment for SAD increases relative to before treatment, however, this is still reported to be lower than that of healthy controls (Eng, Coles, Heimberg, & Safren, 2001).…”

Abordagem Comparativa: Intervenções Terapêuticas Em Saúde Mental Na Atenção Primária Do Brasil Em Relação Ao Canadá / Comparative Approach: Mental Health Terapeutic Interventions in Brazil's Primary Care in Respect of Canadá

“…São 5 artigos canadenses pertinentes ao tema no total. Quanto aos anos de publicações, o ano de maior número de publicações foi 2015 com três (60%) estudos 6,16,17 , seguido de 2018 com dois (40%) 5,20 . Todos os trabalhos são escritos exclusivamente em inglês e todos pertenciam a base de dados da MEDLINE 5,6,16,17,20 .…”

“…Quanto aos anos de publicações, o ano de maior número de publicações foi 2015 com três (60%) estudos 6,16,17 , seguido de 2018 com dois (40%) 5,20 . Todos os trabalhos são escritos exclusivamente em inglês e todos pertenciam a base de dados da MEDLINE 5,6,16,17,20 . Com relação ao método de estudo das pesquisas, encontram-se 2 estudos de prevalência 5,16 , 1 estudos fenomenológico 20 , 1 estudo transversal 6 e 1 estudo qualitativo 17 .…”