Identifying Depressed Patients With a High Risk of Comorbid Anxiety in Primary Care

Background: Depressive and anxiety disorders are highly prevalent in the primary care setting. There is evidence that patients with depression and comorbid anxiety are more severely impaired than patients with depression alone and require aggressive mental health treatment. The goal of this study was to assess the impact of comorbid anxiety in a primary care population of depressed patients.

Method: 342 subjects diagnosed with a DSM-IV-defined major depressive episode, dysthymia, or both were asked 2 questions about the presence of comorbid anxiety symptoms (history of panic attacks and/or flashbacks). Patient groups included depression only (N = 119), depression and panic attacks (N = 51), depression and flashbacks (N = 97), and depression and both panic attacks and flashbacks (N = 75). Groups were compared on demographics, mental health histories, and health-related quality-of-life variables. Data were gathered from January 1998 to March 1999.

Results: Those patients with depression, panic attacks, and flashback symptoms as compared with those with depression alone were more likely to be younger, unmarried, and female. The group with depression, panic attacks, and flashbacks was also more likely to have more depressive symptoms, more impaired health status, worse disability, and a more complicated and persistent history of mental illness. Regression analysis revealed that the greatest impact on disability, presence of depressive symptoms, and mental health outcomes was associated with panic attacks.

Conclusion: By asking 2 questions about comorbid anxiety symptoms, primary care providers evaluating depressed patients may be able to identify a group of significantly impaired patients at high risk of anxiety disorders who might benefit from collaboration with or referral to a mental health specialist.