Journal of General Internal Medicine

, Volume 17, Issue 3, pp 165–172 | Cite as

Physician office visits of adults for anxiety disorders in the United States, 1985–1998

  • Jeffrey S. Harman
  • Bruce L. Rollman
  • Barbara H. Hanusa
  • Eric J. Lenze
  • M. Katherine Shear
Original Articles

Abstract

OBJECTIVE: To determine the number of physician office visits by adults in which an anxiety disorder diagnosis was recorded and rates of treatment during these visits.

DESIGN: We used data from the 1985, 1993, 1994, 1997, and 1998 National Ambulatory Medical Care Surveys, which is a nationally representative series of surveys of office-based practice employing clustered sampling.

SETTING: Office-based physician practices in the United States.

PARTICIPANTS: A systematically sampled group of office-based physicians.

RESULTS: The number of office visits with a recorded anxiety disorder diagnosis increased from 9.5 million in 1985 to 11.2 million per year in 1993–1994 and 12.3 million per year in 1997–1998, representing 1.9%, 1.6%, and 1.5% of all office visits in 1985, 1993–1994, and 1997–1998, respectively. The majority of recorded anxiety disorder diagnoses were not for specific disorders, with 70% of anxiety disorder visits to primary care physicians coded as “anxiety state, unspecified.” Visits to primary care physicians accounted for 48% of all anxiety disorder visits in 1985 and 1997–1998. Treatment for anxiety was offered in over 95% of visits to psychiatrists but in only 60% of visits to primary care physicians. Primary care physicians were less likely to offer treatment for anxiety when specific anxiety disorders were diagnosed than when “anxiety state, unspecified” was diagnosed (54% vs 62% in 1997–1998). Prescriptions for medications to treat anxiety disorders increased between 1985 and 1997–1998 while use of psychotherapy decreased over the same time period in visits to both primary care physicians and psychiatrists.

CONCLUSIONS: Although there is a large number of office visits with a recorded anxiety disorder diagnosis, under-recognition and under-treatment appear to be a continuing problem, especially in the primary care sector. Medication is being substituted for psychotherapy in visits to both psychiatrists and primary care physicians over time.

Key words

anxiety disorders primary care treatment rates 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Regier DA, Boyd JH, Burke J, et al. One month prevalence of mental disorders in the United States. Arch Gen Psychiatry. 1988;45:977–86.PubMedGoogle Scholar
  2. 2.
    Kessler R, McGonagle K, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.PubMedGoogle Scholar
  3. 3.
    Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry. 2000;157:669–82.PubMedCrossRefGoogle Scholar
  4. 4.
    Johnson J, Weissman M, Klerman G. Panic disorder, comorbidity, and suicide attempts. Arch Gen Psychiatry. 1990;47:805–8.PubMedGoogle Scholar
  5. 5.
    Leon A, Olfson M, Broadhead W, et al. Prevalence of mental disorders in primary care: implications for screening. Arch Fam Med. 1995;4:857–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Coronary heart disease/myocardial infarction: symptoms of anxiety and risk of coronary heart disease: the normative aging study. Circulation. 1994;90:2225–9.PubMedGoogle Scholar
  7. 7.
    Fifer SK, Mathias SD, Patrick DL, Mazonson PD, Lubeck DP, Buesching DP. Untreated anxiety among adult primary care patients in a health maintenance organization. Arch Gen Psychiatry. 1994;51:740–50.PubMedGoogle Scholar
  8. 8.
    DuPont RL, Rice DP, Miller LS, Shiraki SS, Rowland CR, Harwood HJ. Economic costs of anxiety disorders. Anxiety. 1996;2:167–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Greenberg P, Sisitsky T, Kessler Rea. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60:427–35.PubMedCrossRefGoogle Scholar
  10. 10.
    Costa E, Silva JA. The public health impact of anxiety disorders: a WHO perspective. Acta Psychiatrica Scandinavica. 1998;98:2S-5S.Google Scholar
  11. 11.
    Skaer TL, Robison LM, Sclar DA, Galin RS. Trend in complaint, diagnosis, use of pharmacotherapy and diagnosis of comorbid depression. Clin Drug Invest. 2000;20:237–44.CrossRefGoogle Scholar
  12. 12.
    Bryant E, Shimizu I. Sampling design, sampling variance, and estimation procedures for the National Ambulatory Medical Care Survey. Vital Health Stat. 1988;108:1–39.Google Scholar
  13. 13.
    U.S. Department of Health and Human Services PHS. Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical Modification, Third Edition. Washington DC: U.S. Department of Health and Human Services; 1989.Google Scholar
  14. 14.
    Potthoff R, Woodbury M, Manton K. “Equivalent sample size” and “equivalent degrees of freedom” refinements for inference using survey weights under superpopulation models. J Am Stat Assoc. 1992;87:383–96.CrossRefGoogle Scholar
  15. 15.
    Leaf P, Myers J, McEvoy L. Procedures used in the epidemiologic catchment area study. New York, NY: The Free Press; 1991.Google Scholar
  16. 16.
    Barrett JE, Barrett HA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry. 1988;45:1100–6.PubMedGoogle Scholar
  17. 17.
    Nisenson LG, Pepper CM, Schwenk TL, Coyne JC. The nature and prevalence of anxiety disorders in primary care. Gen Hosp Psychiatry. 1998;20:21–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Olfson M, Shea S, Feder A, et al. Prevalence of anxiety, depression, and substance use disorders in an urban general medicine practice. Arch Fam Med. 2000;9:876–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Harman JS, Mulsant BH, Kelleher KJ, Schulberg HC, Kupfer DJ, Reynolds CF. Narrowing the gap in treatment of depression. Int J Psychiatry Med. 2001;31:255–69.CrossRefGoogle Scholar
  20. 20.
    Shear MK, Greeno C, Kang J, et al. Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry. 2000;157:581–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry. 2001;58:55–61.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Jeffrey S. Harman
    • 1
  • Bruce L. Rollman
    • 1
    • 2
  • Barbara H. Hanusa
    • 2
  • Eric J. Lenze
    • 1
  • M. Katherine Shear
    • 1
  1. 1.the Intervention Research Centers for Mid- and Late-Life Mood Disorders, Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburgh
  2. 2.the Department of MedicineUniversity of Pittsburgh School of MedicinePittsburgh

Personalised recommendations