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Symptomatic severity of prime-MD diagnosed episodes of panic and generalized anxiety disorder in primary care

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Abstract

BACKGROUND: Panic disorder (PD) and generalized anxiety disorder (GAD) are often unrecognized by primary care physicians (PCPs). The Primary Care Evaluation of Mental Disorders (PRIME-MD) has been used as a case-finding instrument for depression. Yet, little is known on its usefulness as a case-finding tool for anxiety disorders within the context of a clinical trial.

OBJECTIVE: To examine the: (1) completion rate of the PRIME-MD by patients approached to enroll in a treatment study for PD and GAD; (2) distribution of anxiety diagnoses generated; (3) severity of PD and GAD episodes thus identified; and (4) level of PCPs’ agreement with these diagnoses.

DESIGN: Cross-sectional interview.

PATIENTS: Individuals aged 18 to 64 who presented for care at 4 primary care practices.

MEASUREMENTS: The PRIME-MD, Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A), and the Panic Disorder Severity Scale (PDSS).

RESULTS: Of the 6,700 patients who completed the PRIME-MD Patient Questionnaire (PQ), 2,926 (44%) screened positive for an anxiety disorder, and 1,216 (42%) met preliminary study eligibility and consented to the PRIME-MD Anxiety Module. Of these, 619 (51%) had either GAD (308), PD (94), or both (217) disorders. Later, 329 completed a telephone interview. Of these, 59% with GAD and 68% with PD reported moderate or greater levels of anxiety symptoms on the SIGH-A and PDSS, respectively, and PCPs agreed with the PRIME-MD diagnosis for 98% of these patients.

CONCLUSIONS: The PRIME-MD can efficiently screen patients for PD and GAD. Although patients thus identified endorse a wide range of anxiety symptoms, PCPs often agree with the diagnosis.

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Authors and Affiliations

  1. Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pa, USA

    Bruce L. Rollman MD, MPH & Bea Herbeck Belnap Biol. Hum

  2. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa, USA

    Sati Mazumdar PhD & Fang Zhu MS

  3. Department of Medicine, Regenstrief Institute, Indiana University, Indianapolis, Ind, USA

    Kurt Kroenke MD

  4. Department of Psychiatry, Weill Medical College, Cornell University, White Plains, NY, USA

    Herbert C. Schulberg PhD

  5. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pa, USA

    M. Katherine Shear MD

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  1. Bruce L. Rollman MD, MPH
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  2. Bea Herbeck Belnap Biol. Hum
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  3. Sati Mazumdar PhD
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  4. Fang Zhu MS
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  5. Kurt Kroenke MD
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  7. M. Katherine Shear MD
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Correspondence to Bruce L. Rollman MD, MPH.

Additional information

This work was supported by NIMH grant R01 MH59395.

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Rollman, B.L., Belnap, B.H., Mazumdar, S. et al. Symptomatic severity of prime-MD diagnosed episodes of panic and generalized anxiety disorder in primary care. J GEN INTERN MED 20, 623–628 (2005). https://doi.org/10.1007/s11606-005-0108-2

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  • DOI: https://doi.org/10.1007/s11606-005-0108-2

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