Generalized Anxiety and Depression in Primary Care: Prevalence, Recognition, and Management
Hans-Ulrich Wittchen, PhD; Ron C. Kessler, PhD; Katja Beesdo, Dipl-Psych; Petra Krause, Dipl-Psych; Michael Hofler, Dipl-Stat; and Jurgen Hoyer, PhD
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Aims: Determine attitudes toward patients with generalized anxiety disorder (GAD) and major depressive episodes (MDE) in primary care; determine prevalence of GAD, MDE, and comorbid
GAD/MDE among primary care patients; assess physician recognition of GAD and MDE; and describe
primary care interventions for these patients. Method: 558 primary care physicians participated in a 1-day survey. Over 20,000 patients completed a diagnostic-screening questionnaire for GAD and
MDE. Physician questionnaires included a standardized clinical appraisal of somatic and psychosocial
symptoms and information on past and current treatments and a prestudy questionnaire assessing
experience with and attitudes toward patients with GAD and MDE. Results: 56.9% of physicians viewed GAD as a genuine mental disorder with clinical management problems and considerable patient
burden; 27.4% treated GAD patients differently from MDE patients. 5.3% of patients met criteria
for GAD, 6.0% for MDE, 3.8% for pure GAD, 4.4% for pure MDE, and 1.6% for comorbid GAD/
MDE. Pure GAD and MDE were associated with disability, high utilization of health care resources,
and suicidality, which were even higher with comorbid GAD/MDE. Physicians recognized clinically
significant emotional problems in 72.5% of patients with pure GAD, 76.5% with pure MDE, and
85.4% with comorbid GAD/MDE. However, correct diagnosis was much lower (64.3% for MDE and
34.4% for GAD). Although the majority of patients with recognized GAD or MDE were treated, only
a small minority with GAD were prescribed medications or referred to specialists. Conclusion: The high proportion of respondents with pure GAD is inconsistent with previous reports that GAD is usually
comorbid with depression. GAD remains poorly recognized and inadequately treated. Improving
the recognition and treatment of GAD in primary care patients is discussed relative to new treatments.
J Clin Psychiatry 2002;63(suppl 8):24-34
© Copyright 2002 Physicians Postgraduate Press, Inc.