Abstract
OBJECTIVE: To determine the number of physician office visits by adults in which an anxiety disorder diagnosis was recorded and rates of treatment during these visits.
DESIGN: We used data from the 1985, 1993, 1994, 1997, and 1998 National Ambulatory Medical Care Surveys, which is a nationally representative series of surveys of office-based practice employing clustered sampling.
SETTING: Office-based physician practices in the United States.
PARTICIPANTS: A systematically sampled group of office-based physicians.
RESULTS: The number of office visits with a recorded anxiety disorder diagnosis increased from 9.5 million in 1985 to 11.2 million per year in 1993–1994 and 12.3 million per year in 1997–1998, representing 1.9%, 1.6%, and 1.5% of all office visits in 1985, 1993–1994, and 1997–1998, respectively. The majority of recorded anxiety disorder diagnoses were not for specific disorders, with 70% of anxiety disorder visits to primary care physicians coded as “anxiety state, unspecified.” Visits to primary care physicians accounted for 48% of all anxiety disorder visits in 1985 and 1997–1998. Treatment for anxiety was offered in over 95% of visits to psychiatrists but in only 60% of visits to primary care physicians. Primary care physicians were less likely to offer treatment for anxiety when specific anxiety disorders were diagnosed than when “anxiety state, unspecified” was diagnosed (54% vs 62% in 1997–1998). Prescriptions for medications to treat anxiety disorders increased between 1985 and 1997–1998 while use of psychotherapy decreased over the same time period in visits to both primary care physicians and psychiatrists.
CONCLUSIONS: Although there is a large number of office visits with a recorded anxiety disorder diagnosis, under-recognition and under-treatment appear to be a continuing problem, especially in the primary care sector. Medication is being substituted for psychotherapy in visits to both psychiatrists and primary care physicians over time.
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References
Regier DA, Boyd JH, Burke J, et al. One month prevalence of mental disorders in the United States. Arch Gen Psychiatry. 1988;45:977–86.
Kessler R, McGonagle K, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.
Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157:669–82.
Johnson J, Weissman M, Klerman G. Panic disorder, comorbidity, and suicide attempts. Arch Gen Psychiatry. 1990;47:805–8.
Leon A, Olfson M, Broadhead W, et al. Prevalence of mental disorders in primary care: implications for screening. Arch Fam Med. 1995;4:857–61.
Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Coronary heart disease/myocardial infarction: symptoms of anxiety and risk of coronary heart disease: the normative aging study. Circulation. 1994;90:2225–9.
Fifer SK, Mathias SD, Patrick DL, Mazonson PD, Lubeck DP, Buesching DP. Untreated anxiety among adult primary care patients in a health maintenance organization. Arch Gen Psychiatry. 1994;51:740–50.
DuPont RL, Rice DP, Miller LS, Shiraki SS, Rowland CR, Harwood HJ. Economic costs of anxiety disorders. Anxiety. 1996;2:167–72.
Greenberg P, Sisitsky T, Kessler Rea. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60:427–35.
Costa E, Silva JA. The public health impact of anxiety disorders: a WHO perspective. Acta Psychiatrica Scandinavica. 1998;98:2S-5S.
Skaer TL, Robison LM, Sclar DA, Galin RS. Trend in complaint, diagnosis, use of pharmacotherapy and diagnosis of comorbid depression. Clin Drug Invest. 2000;20:237–44.
Bryant E, Shimizu I. Sampling design, sampling variance, and estimation procedures for the National Ambulatory Medical Care Survey. Vital Health Stat. 1988;108:1–39.
U.S. Department of Health and Human Services PHS. Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical Modification, Third Edition. Washington DC: U.S. Department of Health and Human Services; 1989.
Potthoff R, Woodbury M, Manton K. “Equivalent sample size” and “equivalent degrees of freedom” refinements for inference using survey weights under superpopulation models. J Am Stat Assoc. 1992;87:383–96.
Leaf P, Myers J, McEvoy L. Procedures used in the epidemiologic catchment area study. New York, NY: The Free Press; 1991.
Barrett JE, Barrett HA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry. 1988;45:1100–6.
Nisenson LG, Pepper CM, Schwenk TL, Coyne JC. The nature and prevalence of anxiety disorders in primary care. Gen Hosp Psychiatry. 1998;20:21–8.
Olfson M, Shea S, Feder A, et al. Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med. 2000;9:876–83.
Harman JS, Mulsant BH, Kelleher KJ, Schulberg HC, Kupfer DJ, Reynolds CF. Narrowing the gap in treatment of depression. Int J Psychiatry Med. 2001;31:255–69.
Shear MK, Greeno C, Kang J, et al. Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry. 2000;157:581–7.
Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58:55–61.
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This research was partially funded through National Institute of Mental Health grants P30 MH52247, P30 MH30915, and R25 MH60473.
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Harman, J.S., Rollman, B.L., Hanusa, B.H. et al. Physician office visits of adults for anxiety disorders in the United States, 1985–1998. J GEN INTERN MED 17, 165–172 (2002). https://doi.org/10.1046/j.1525-1497.2002.10409.x
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DOI: https://doi.org/10.1046/j.1525-1497.2002.10409.x