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Probability and Predictors of First Treatment Contact for Anxiety Disorders in the United States: Analysis of Data From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Miren Iza, MD; Mark Olfson, MD, MPH; Donna Vermes, NP; Marcela Hoffer, LCSW; Shuai Wang, PhD; and Carlos Blanco, MD, PhD

Published: November 15, 2013

Article Abstract

Background: Despite the high prevalence of anxiety disorders and the demonstrated efficacy of their treatment, most individuals with anxiety disorders never utilize mental health services.

Objective: To identify predictors of treatment-seeking for DSM-IV anxiety disorders from a range of sociodemographic factors and comorbid mental disorders.

Design: Survival analysis with time-varying covariates was performed using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Setting: Face-to-face interviews conducted in the United States.

Participants: 34,653 respondents, aged 18 years and older, from the 2004-2005 Wave 2 NESARC.

Main Outcome Measure: The cumulative probability of treatment-seeking (assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version, Wave 2 version) across the anxiety disorders in 1 year, 10 years, and lifetime and the median delay to the first treatment contact.

Results: Most individuals with panic disorder sought treatment within the same year of disorder onset, whereas the median delays to first treatment contact for generalized anxiety disorder, specific phobia, and social anxiety disorder were 1 year, 13 years, and 16 years, respectively. Several personality disorders and earlier age at anxiety disorder onset decreased the probability of treatment contact. By contrast, younger cohort membership, a recent change in marital status, treatment for a psychiatric disorder other than substance use disorder, and comorbid anxiety disorders increased the lifetime probability of treatment contact.

Conclusions: Treatment-seeking rates for most anxiety disorders are low, are associated with long delays, and sometimes are hindered by co-occurrence of other psychopathology. These patterns highlight the complex interplay of personal characteristics, individual psychopathology, and social variables in the treatment-seeking process.

J Clin Psychiatry 2013;74(11):1093-1100

Submitted: January 9, 2013; accepted May 21, 2013 (doi:10.4088/JCP.13m08361).

Corresponding author: Miren Iza, MD, New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032 (

Volume: 74

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