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Subsyndromal (“Mixed”) anxiety-depression in primary care

Journal of General Internal Medicine volume 9, pages 507–512 (1994)Cite this article

Abstract

Objective: To determine in primary care settings the prevalence, clinical characteristics, and functional status of patients who have anxious and depressive symptoms who did not meet diagnostic criteria for major mood and anxiety diagnoses.

Design: Patients were screened with the General Health Questionnaire and interviewed if they exceeded the cutoff score of 5. Also, one patient whose score was below the cutoff was interviewed for every two patients whose scores were above the cutoff.

Setting: Five primary care sites in the United States, France, and Australia.

Patient: Two hundred sixty-seven patients presenting to their primary care physicians for general medical care and follow-up.

Methods: Structured diagnostic interviews were conducted and ratings of anxiety, depression, and functional impairment were obtained by trained interviewers.

Results: After adjustments for sampling, 5% of the patients had symptoms of anxiety, depression, and functional impairment, without meeting formal criteria for a major DSM-III-R mood or anxiety disorder. This was comparable to the prevalence of diagnosable DSM-III-R mood disorders but only one-fourth the prevalence of diagnosable anxiety disorders. These patients who had subsyndromal symptoms had rates of lifetime psychiatric disorders and prior psychiatric treatment comparable to those of patients meeting criteria for major mood and anxiety disorders.

Conclusion: The comparable rates of symptomatic distress, functional impairment, and prior psychiatric illness and treatment suggest that patients with subsyndromal anxiety and depressive symptoms warrant clinical recognition and possibly specific treatment.

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Author information

Affiliations

  1. Professor and Vice-Chairman, the University of Washington School of Medicine, Seattle, Washington

    Peter Roy-Byrne MD, Wayne Katon MD & Jeff Richards PhD

  2. Duke University School of Medicine, Durham, North Carolina

    W. Eugene Broadhead MD, PhD

  3. Groupe Hospitalier Bichat-Claude-Bernard, Paris, France

    Jean-Pierre Lepine MD

  4. Curtin University of Technology, Perth, West Australia

    Joan Russo PhD

  5. Louisiana State University School of Medicine, Baton Rouge, Louisiana

    Phillip J. Brantley PhD

  6. Department of Psychology, the University of Oregon, Eugene, Oregon

    Richard Zinbarg PhD

  7. the Center for Stress and Anxiety, Albany, New York

    David Barlow PhD

  8. Columbia University School of Medicine, New York, New York

    Michael Liebowitz MD

Authors
  1. Peter Roy-Byrne MD
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  2. Wayne Katon MD
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  3. W. Eugene Broadhead MD, PhD
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  4. Jean-Pierre Lepine MD
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  5. Jeff Richards PhD
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  6. Phillip J. Brantley PhD
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  7. Joan Russo PhD
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  8. Richard Zinbarg PhD
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  9. David Barlow PhD
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  10. Michael Liebowitz MD
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Additional information

Supported in part by a grant from the American Psychiatric Association.

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Roy-Byrne, P., Katon, W., Broadhead, W.E. et al. Subsyndromal (“Mixed”) anxiety-depression in primary care. J Gen Intern Med 9, 507–512 (1994). https://doi.org/10.1007/BF02599221

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  • DOI: https://doi.org/10.1007/BF02599221

Key words

  • anxiety
  • depression
  • subsyndromal
  • primary care
  • mood disorders