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Generalized Anxiety Disorder in Older Medical Patients: Diagnostic Recognition, Mental Health Management and Service Utilization

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Abstract

Background Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. Methods Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. Results Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, χ2 (2, N = 225) = 4.75, p < .05. Conclusions Most patients with anxiety do not have anxiety or symptoms documented in their medical records.

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References

  • Allgulander, C. (2006). Generalized anxiety disorder: What are we missing? European Neuropsychopharmacology, 16, 5101–5108. doi:10.1016/j.euroneuro.2006.04.001.

    Article  Google Scholar 

  • Ansseau, M., Dierick, M., Butinkx, F., Cnockaert, P., De Smedt, J., van den Haute, M., et al. (2004). High prevalence of mental disorders in primary care. Journal of Affective Disorders, 78, 49–55. doi:10.1016/S0165-0327(02)00219-7.

    Article  PubMed  Google Scholar 

  • Bebbington, P. E., Brugha, T. A., Meltzer, H., Jenkins, R., Ceresa, C., Farrell, M., et al. (2000). Neurotic disorders and the receipt of psychiatric treatment. Psychiatric Medicine, 30, 1369–1376. doi:10.1017/S0033291799002974.

    Article  Google Scholar 

  • Belanger, L., Ladouceur, R., & Morin, C. M. (2005). Generalized anxiety disorder and health care use. Canadian Family Physician Medecin de Famille Canadien, 51, 1362–1363.

    PubMed  Google Scholar 

  • Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Chronic Disease, 4, 373–383. doi:10.1016/0021-9681(87)90171-8.

    Article  Google Scholar 

  • Culpepper, L. (2002). Generalized anxiety disorder in primary care: Emerging issues in management and treatment. The Journal of Clinical Psychiatry, 63(suppl 8), 35–42.

    PubMed  Google Scholar 

  • deBeurs, E., Beekman, A. T. F., van Balkom, A. J. L. M., Deeg, D. J. H., van Dyck, R., & van Tilburg, W. (1999). Consequences of anxiety in older persons: Its effect on disability, well-being and use of health services. Psychological Medicine, 29, 583–593.

    Article  Google Scholar 

  • Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45, 613–619.

    Article  PubMed  Google Scholar 

  • Gurmankin Levy, A., Maselko, J., Bauer, M., Richaman, L., & Kubzansky, L. (2007). Why do people with an anxiety disorder utilize more nonmental health care than those without? Health Psychology, 26, 545. 533.

    Article  PubMed  Google Scholar 

  • Hoehn-Saric, R. (2005). Generalized anxiety disorder in medical practice. Primary Psychiatry, 12, 30–34.

    Google Scholar 

  • Klap, R., Unroe, K. T., & Unutzer, J. (2003). Caring for mental illness in the United States: A focus on older adults. American Journal of Geriatric Psychiatry, 11, 517–524.

    PubMed  Google Scholar 

  • Lenze, E. J., Karp, J. F., Mulsant, B. H., Blank, S., Shear, M. K., Houck, P. R., et al. (2005). Somatic symptoms in late-life anxiety: Treatment issues. Journal of Geriatric Psychiatry and Neurology, 18, 89–96.

    Article  PubMed  Google Scholar 

  • Logue, M. B., Thomas, A. M., Barbee, J. G., Hoehn-Saric, R., Maddock, R. J., Schwab, J., et al. (1993). Generalized anxiety disorder patients seek evaluation for cardiological symptoms at the same frequency as patients with panic disorder. Journal of Psychiatric Residency, 27, 55–59.

    Article  Google Scholar 

  • Marciniak, M. D., Lage, M. J., Dunayevich, E., Russell, M. M., Bowman, L., Landbloom, R. P., et al. (2005). The costs of treating anxiety: The medical and demographic correlates that impact total medical costs. Depression and Anxiety, 21, 178–184.

    Article  PubMed  Google Scholar 

  • Pollack, M. H., Meoni, P., Otto, M. W., & Hackett, D. (2003). Predictors of outcome following venlafaxine extended-release treatment of DSM-IV generalized anxiety disorder: A pooled analysis of short- and long-term studies. Journal of Clinical Psychopharmacology, 23, 250–259.

    Article  PubMed  Google Scholar 

  • Rollman, B. L., Belnap, B. H., Mazumdar, S., Zhu, F., Kroenke, K., Schulberg, H. C., et al. (2005). Symptomatic severity of PRIME-MD diagnosed panic and generalized anxiety disorder in primary care. Journal of General Internal Medicine, 20, 623–628.

    Article  PubMed  Google Scholar 

  • Roundy, K., Culley, J. A., Stanley, M. A., Veazey, C., Souchek, J., Wray, N. P., et al. (2005). Are anxiety and depression addressed in primary care patients with chronic obstructive pulmonary disease? A chart review. Primary Care Companion to the Journal of Clinical Psychiatry, 7, 213–218.

    PubMed  Google Scholar 

  • Roy-Byrne, P. P., & Wagner, A. (2004). Primary care perspective on generalized anxiety disorder. Journal of Clinical Psychiatry, 65(Suppl 13), 20–26.

    PubMed  Google Scholar 

  • Schulz, J., Gotto, J. G., & Rapaport, M. H. (2005). The diagnosis and treatment of generalized anxiety disorder. Primary Psychiatry, 12, 58–67.

    Google Scholar 

  • Skopp, N. A., Novy, D., Kunik, M., Daza, P., Adams, J. H., Senior, A., et al. (2006). Investigation of cognitive behavior therapy. American Journal of Geriatric Psychiatry, 14, 292.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., de Gruy, F. V., Hahn, S. R., I. I. I., et al. (1994). Utility of new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. Journal of the American Medical Association, 272, 1749–1756.

    Article  PubMed  Google Scholar 

  • Stanley, M. A., Diefenbach, G. J., Hopko, D. R., Novy, D., Kunik, M. E., Wilson, N., et al. (2003). The nature of generalized anxiety in older primary care patients: Preliminary findings. Journal of Psychopathology and Behavioral Assessment, 25, 273–280.

    Article  Google Scholar 

  • Stein, M. B., Sherbourne, C. D., Craske, M. G., Means-Christensen, A., Bystritsky, A., Katon, W., et al. (2004). Quality of care for primary care patients with anxiety disorders. American Journal of Psychiatry, 161, 2230–2237.

    Article  PubMed  Google Scholar 

  • Weiller, E., Bisserbe, J. C., Maier, W., & Lecrubier, Y. (1998). Prevalence and recognition of anxiety syndromes in five European primary care settings: A report from the WHO study on psychological problems in general health care. British Journal of Psychiatry, 173, 18–23.

    Google Scholar 

  • Wittchen, H. U. (2002). Generalized anxiety disorder: Prevalence burden, and cost to society. Depression and Anxiety, 16, 162–171.

    Article  PubMed  Google Scholar 

  • Wittchen, H. U., Kessler, R. C., Beesko, K., Krause, P., Hofler, M., & Hoyer, J. (2002). Generalized anxiety and depression in primary care: Prevalence, recognition, and management. Journal of Clinical Psychiatry, 63(suppl 8), 24–34.

    PubMed  Google Scholar 

  • Wulsin, L. R., Arnold, L. M., & Hillard, J. R. (1991). Axis I disorders in ER patients with atypical chest pain. International Journal of Psychiatry in Medicine, 21, 37–46.

    PubMed  Google Scholar 

  • Young, A. S., Klap, R., Sherbourne, C. D., & Wells, K. B. (2001). The quality of care and depressive and anxiety disorders in the United States. Archives of General Psychiatry, 58, 55–61.

    Article  PubMed  Google Scholar 

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Acknowledgments

This project was supported by Grant Number R01MH053932 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

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Authors and Affiliations

  1. Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    Jessica Calleo, Melinda A. Stanley, Nancy Wilson & Mark Kunik

  2. Houston Center for Quality of Care & Utilization Studies, Michael E DeBakey VAMC (152), 2002 Holcombe, Houston, TX, 77030, USA

    Melinda A. Stanley, Michael Johnson, Nancy Wilson & Mark Kunik

  3. Kelsey Research Foundation, Houston, TX, USA

    Anthony Greisinger & Oscar Wehmanen

  4. Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, TX, USA

    Michael Johnson

  5. Department of Anesthesiology and Pain Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Diane Novy

  6. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Mark Kunik

  7. VA South Central Mental Illness Research, Education and Clinical Center, North Little Rock, AR, USA

    Mark Kunik

  8. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Mark Kunik

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  1. Jessica Calleo
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  2. Melinda A. Stanley
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  3. Anthony Greisinger
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  4. Oscar Wehmanen
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  5. Michael Johnson
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  6. Diane Novy
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  7. Nancy Wilson
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  8. Mark Kunik
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Correspondence to Mark Kunik.

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Calleo, J., Stanley, M.A., Greisinger, A. et al. Generalized Anxiety Disorder in Older Medical Patients: Diagnostic Recognition, Mental Health Management and Service Utilization. J Clin Psychol Med Settings 16, 178–185 (2009). https://doi.org/10.1007/s10880-008-9144-5

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  • DOI: https://doi.org/10.1007/s10880-008-9144-5

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