Comorbid Anxiety Disorder and the Functioning and Well-being of Chronically Ill Patients of General Medical Providers

doi:10.1001/archpsyc.1996.01830100035005

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Vol. 53 No. 10, October 1996

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Comorbid Anxiety Disorder and the Functioning and Well-being of Chronically Ill Patients of General Medical Providers

Cathy Donald Sherbourne, PhD; Kenneth B. Wells, MD; Lisa S. Meredith, PhD; Catherine A. Jackson, PhD; Patti Camp, MA

Arch Gen Psychiatry. 1996;53(10):889-895.

Abstract

Background
The comorbidity of psychiatric disorders with chronic healthconditions has emerged as a topic of considerable clinical andpolicy interest, in part owing to the evidence that anxietydisorders themselves are associated with morbidity. However,the implications for health-related quality of life that resultfrom anxiety disorders, which are comorbid to chronic medicalor psychiatric illness, are not well understood, especiallyin primary care samples.

Methods
A 2-year observational study of 875 adult patients with hypertension,diabetes, heart disease, and current depressive disorder orsubthreshold depression receiving care from general medicalproviders was conducted. The unique effect of any comorbid anxietydisorder on functioning and well-being (determined with theuse of the 36-Item Short-Form Health Survey [SF-36]) was estimated,as well as the differential impact at baseline, 2-year follow-up,and change over time, of any comorbid anxiety disorder for patientswith chronic medical conditions or depression.

Results
Patients with comorbid anxiety who received general medicalcare had lower levels of functioning and well-being than thosewithout comorbid anxiety. These differences were most pronouncedin mental health—related quality-of-life measures andwhen anxiety was comorbid with chronic medical conditions ratherthan with depression. Hypertensive and diabetic patients withcomorbid anxiety were as debilitated as patients with depressionor heart disease, and this low health-related quality of lifepersisted over time. Comorbid anxiety had less of an effecton patients with heart disease who already had a low health-relatedquality of life.

Conclusion
The finding of substantial differences in the quality of lifebetween hypertensive and diabetic patients with and withoutcomorbid anxiety disorder highlights the clinical and societalimportance of identifying comorbid anxiety in these patients.

Author Affiliations

From RAND, Santa Monica, Calif (Drs Sherbourne, Meredith, and Jackson and Ms Camp), and the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Dr Wells).

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