Human and Economic Burden of GAD, Subthreshold GAD, and Worry in a Primary Care Sample

Abstract

Generalized anxiety disorder (GAD) has been associated with significant impairment and estimates of human and economic burden associated with the disorder are substantial. Little has been done, however, to examine impairment associated with subthreshold presentations of the disorder in medically underserved populations. This study compared primary care patients with GAD (n = 30), subthreshold GAD (n = 21), worry (n = 79), and no worry (n = 199) on measures of human and economic burden. On measures of human burden, all three symptomatic groups reported poorer perceived physical health, greater stress, and sleep difficulty. Worried and subthreshold groups also reported lower social support. For economic burden, GAD and worry groups reported a greater number of prescription medications. However, when co-morbid depression was accounted for the effect was no longer significant. Groups did not differ on employment status, number of visits to the clinic in the last 90 days, or physical health. Results are discussed in terms of identification, prevention, and intervention for GAD in primary care settings.

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References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. (text revision).

    Google Scholar 

  2. Andrews, V. H., & Borkovec, T. D. (1988). The differential effects of inductions of worry, somatic anxiety, and depression on emotional experience. Journal of Behavior Therapy and Experimental Psychiatry, 19, 21–26.

    PubMed  Article  CAS  Google Scholar 

  3. Ansseau, M., Fischler, B., Dierick, M., Albert, A., Leyman, S., & Mignon, A. (2008). Socioeconomic correlates of generalized anxiety disorder and major depression in primary care: The GADIS II study (generalized anxiety and depression impact survey II). Depression and Anxiety, 25, 506–513.

    PubMed  Article  Google Scholar 

  4. Ansseau, M., Fischler, B., Dierick, M., Mignon, A., & Leyman, S. (2005). Prevalence and impact of generalized anxiety disorder and major depression in primary care in Belgium and Luxemburg: The GADIS study. European Psychiatry, 20, 229–235.

    PubMed  Article  Google Scholar 

  5. Bakker, I. M., Terluin, B., van Marwjk, H. W., van Mechelen, W., & Stalmna, W. A. B. (2009). Test-retest reliability of the PRIME-MD: Limitations in diagnosing mental disorders in primary care. Eupropean Journal of Public Health, 19, 303–307.

    Article  Google Scholar 

  6. Boyer, P., Bsserbe, J., & Weller, E. (1998). How efficient is a screener? A comparison of the PRIME-MD patient questionnaire with the SDDS-PC screen. International Journal of Methods in Psychiatric Research, 7, 27–32.

    Article  Google Scholar 

  7. Brenes, G. A., Knudson, M., McCall, W. V., Williamson, J. D., Miller, M. E., & Stanley, M. A. (2008). Age and racial differences in the presentation and treatment of generalized anxiety disorder in primary care. Journal of Anxiety Disorders, 22, 1128–1136.

    PubMed  Article  Google Scholar 

  8. Carter, R. M., Wittchen, H. U., Pfister, H., & Kessler, R. C. (2001). One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety, 13, 78–88.

    PubMed  Article  CAS  Google Scholar 

  9. De Gruy, F. V., & Pincus, H. A. (1996). The DSM-IV-PC: A manual for diagnosing mental disorders in the primary care setting. Journal of the American Board of Family Practice, 9, 271–281.

    Google Scholar 

  10. Eng, W., & Heimberg, R. G. (2006). Interpersonal correlates of generalized anxiety disorder: Self versus other perception. Journal of Anxiety Disorders, 20, 380–387.

    PubMed  Article  Google Scholar 

  11. Grant, B. F., Hasin, D. S., Stinson, F. S., Dawson, D. A., Ruan, W. J., Goldstein, R. B., et al. (2005). Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results from the national epidemiologic survey on alcohol and related conditions. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 35, 1747–1759.

    Google Scholar 

  12. Hoffman, D. L., Dukes, E. M., & Wittchen, H. U. (2008). Human and economic burden of generalized anxiety disorder. Depression and Anxiety, 25, 72–90.

    PubMed  Article  Google Scholar 

  13. Johnson, J., Weissman, M. M., & Klerman, G. L. (1992). Service utilization and social morbidity associated with depressive symptoms in the community. JAMA, 267, 1478–1483.

    PubMed  Article  CAS  Google Scholar 

  14. Jones, G. N., Ames, S. C., Jeffries, S. K., Scarinci, I. C., & Brantley, P. J. (2001). Utilization of medical services and quality of life among low-income patients with generalized anxiety disorder attending primary care clinics. International Journal of Psychiatry in Medicine, 31, 183–198.

    PubMed  Article  CAS  Google Scholar 

  15. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 617–627.

    PubMed  Article  Google Scholar 

  16. Kessler, R. C., DuPont, R. L., Berglund, P., & Wittchen, H. U. (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. American Journal of Psychiatry, 156, 1915–1923.

    PubMed  CAS  Google Scholar 

  17. Leon, A. C., Portera, L., & Weissman, M. M. (1995). The social costs of anxiety disorders. British Journal of Psychiatry, 166, 19–22.

    Article  Google Scholar 

  18. Loerch, B., Szegedi, A., Kohnen, R., & Benkert, O. (2000). The Primary Care Evaluation of Mental Disorders (PRIME-MD), German version: A comparison with the CIDI. Journal of Psychiatric Research, 34, 211–220.

    PubMed  Article  CAS  Google Scholar 

  19. Maier, W., Gänsicke, M., Freyberger, H. J., Linz, M., Heun, R., & Lecrubier, Y. (2000). Generalized anxiety disorder (ICD-10) in primary care from a cross-cultural perspective: A valid diagnostic entity? Acta Psychiatrica Scandinavica, 101, 29–36.

    PubMed  Article  CAS  Google Scholar 

  20. Marciniak, M. D., Lage, M. J., Dunayevich, E., Russell, J. M., Bowman, L., Landbloom, R. P., et al. (2005). The cost of treating anxiety: The medical and demographic correlates that impact total medical costs. Depression and Anxiety, 21, 178–184.

    PubMed  Article  Google Scholar 

  21. Massion, A. O., Warshaw, M. G., & Keller, M. B. (1993). Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. American Journal of Psychiatry, 150, 600–607.

    PubMed  CAS  Google Scholar 

  22. Mennin, D. S., Heimberg, R. G., Fresco, D. M., & Ritter, M. R. (2008). Is generalized anxiety disorder an anxiety or mood disorder? Considering multiple factors as we ponder the fate of GAD. Depression and Anxiety, 25, 289–299.

    PubMed  Article  Google Scholar 

  23. Miller, G. A., & Chapman, J. P. (2001). Misunderstanding analyses of covariance. Journal of Abnormal Psychology, 110, 40–48.

    PubMed  Article  CAS  Google Scholar 

  24. Murray, C. J. L., & Lopez, A. D. (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press.

    Google Scholar 

  25. Olfson, M. (2000). Impairment in generalized anxiety disorder. American Journal of Psychiatry, 157, 2060–2061.

    PubMed  Article  CAS  Google Scholar 

  26. Olfson, M., Broadband, E. W., Weissman, M. M., Leon, A. C., Farber, L., Hoven, C., et al. (1996). Subthreshold psychiatric symptoms in a primary care group practice. Archives of General Psychiatry, 53, 880–886.

    PubMed  CAS  Google Scholar 

  27. Olfson, M., Fireman, B., Weissman, M., Leon, A. C., Sheehan, D. V., Kathol, R. G., et al. (1997). Mental disorders and disability among patients in a primary care group practice. American Journal of Psychiatry, 154, 1734–1740.

    PubMed  CAS  Google Scholar 

  28. Olfson, M., & Gameroff, M. J. (2007). Generalized anxiety disorder, somatic pain and health care costs. General Hospital Psychiatry, 29, 310–316.

    PubMed  Article  Google Scholar 

  29. Pini, S., Perkonnig, A., Tansella, M., & Wittchen, H. U. (1999). Prevalence and 12-month outcome of threshold and subthreshold mental disorders in primary care. Journal of Affective Disorders, 56, 37–48.

    PubMed  Article  CAS  Google Scholar 

  30. Roemer, L., Molina, S., & Borkovec, T. D. (1997). An investigation of worry content among generally anxious individuals. Journal of Nervous and Mental Disease, 185, 314–319.

    PubMed  Article  CAS  Google Scholar 

  31. Roy-Byrne, P. P., & Wagner, A. (2004). Primary care perspectives on generalized anxiety disorder. Journal of Clinical Psychiatry, 65, 20–26.

    PubMed  Google Scholar 

  32. Rucci, P., Gherardi, S., Tansella, M., Piccinelli, M., Berardi, D., Bisoffi, G., et al. (2003). Subthreshold psychiatric disorders in primary care: Prevalence and associated characteristics. Journal of Affective Disorders, 76, 171–181.

    PubMed  Article  Google Scholar 

  33. Spitzer, R. L., Williams, J. B. W., Kroenke, K., & Linzer, M. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. JAMA, 272, 1749–1756.

    PubMed  Article  CAS  Google Scholar 

  34. Stein, M. B., & Heimberg, R. G. (2004). Well-being and life satisfaction in generalized anxiety disorder: Comparison to major depressive disorder in a community sample. Journal of Affective Disorders, 79(1), 161–166.

    PubMed  Article  Google Scholar 

  35. Wells, K. B., Burnham, M. A., Rogers, W., Hays, R., & Camp, P. (1992). The course of depression in adult outpatients. Archives of General Psychiatry, 489, 788–794.

    Google Scholar 

  36. Williams, R. B., Barefoot, H. C., Califf, R. M., Haney, T. L., Saunders, W. B., Pryor, D. B., et al. (1992). Prognostic importance of social and economic resources among medically under treated patients with angiographically documented coronary artery disease. JAMA, 267, 520–524.

    PubMed  Article  CAS  Google Scholar 

  37. Wittchen, H. U. (2002). Generalized anxiety disorder: Prevalence, burden, and cost to society. Depression and Anxiety, 16, 162–171.

    PubMed  Article  Google Scholar 

  38. Wittchen, H. U., & Hoyer, J. (2001). Generalized anxiety disorder: Nature and course. Journal of Clinical Psychiatry, 62, 15–19.

    PubMed  Google Scholar 

  39. World Health Organization. (1990). Global burden of disease 1990 disability weights. Retrieved August 26, 2005, from http://www.who.int/healthinfo/bodreferencesdisabilityweights.xls .

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Acknowledgment

This research was supported by a Health Resources and Services Administration, Department of Health and Human Services GPE Grant #1D40HP00001.

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Correspondence to Sarah J. Kertz.

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Kertz, S.J., Woodruff-Borden, J. Human and Economic Burden of GAD, Subthreshold GAD, and Worry in a Primary Care Sample. J Clin Psychol Med Settings 18, 281–290 (2011). https://doi.org/10.1007/s10880-011-9248-1

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Keywords

  • Generalized anxiety disorder
  • Worry
  • Primary care
  • Burden