Untreated Anxiety Among Adult Primary Care Patients in a Health Maintenance Organization

doi:10.1001/archpsyc.1994.03950090072010

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Vol. 51 No. 9, September 1994

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Untreated Anxiety Among Adult Primary Care Patients in a Health Maintenance Organization

Sheila K. Fifer, PhD; Susan D. Mathias, MPH; Donald L. Patrick, PhD, MSPH; Peter D. Mazonson, MD, MBA; Deborah P. Lubeck, PhD; Don P. Buesching, PhD

Arch Gen Psychiatry. 1994;51(9):740-750.

Abstract

Background
Untreated anxiety may be particularly difficult for primarycare physicians to recognize and diagnose because there areno reliable demographic or medical profiles for patients withthis condition and because these patients present with a highrate of comorbid psychological conditions that complicate selectionof treatment.

Method
A prospective assessment of untreated anxiety symptoms and disordersamong primary care patients.

Results
Approximately 10% of eligible patients screened in clinic waitingrooms of a mixed-model health maintenance organization reportedelevated symptoms and/or disorders of anxiety that were unrecognizedand untreated. These patients with untreated anxiety reportedsignificantly worse functioning on both physical and emotionalmeasures than "not anxious" comparison patients; in fact thesepatients reported reduced functioning levels within ranges thatwould be expected for patients with chronic physical diseases,such as diabetes and congestive heart failure. The most severereductions in functioning were reported by untreated patientswhose anxiety was mixed with depression symptoms or disorders.

Conclusion
Primary care physicians may benefit from screening tools andconsultations by mental health specialists to assist in recognitionand diagnosis of anxiety symptoms and disorders alone and mixedwith depression.

Author Affiliations

From the Technology Assessment Group Inc, San Francisco, Calif (Drs Fifer, Mazonson, and Lubeck and Ms Mathias); the Department of Health Services, University of Washington School of Public Health, Seattle (Dr Patrick); the Department of Medicine, Stanford University, Palo Alto, Calif (Dr Lubeck); and the Upjohn Co, Kalamazoo, Mich (Dr Buesching). Dr Buesching is now with Eli Lilly & Co, Indianapolis, Ind. Dr Buesching is a former employee of the Upjohn Co but owns no stock or options to purchase further stock in that company. The other authors own no stock or options in the Upjohn Co.

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