Skip to main content
SpringerLink
Log in

Anxiety Disorders in the USA, 1990 to 1997

Trend in Complaint, Diagnosis, Use of Pharmacotherapy and Diagnosis of Comorbid Depression

  • Pharmacoepidemiology
  • Published:
Clinical Drug Investigation Aims and scope Submit manuscript

Abstract

Objective: To discern the trend in the prevalence and population-adjusted rate of US office-based physician visits documenting a diagnosis of anxiety among patients ≥18 years of age.

Design: This was a retrospective study of data from a large national survey in the USA.

Methods: Data from the National Ambulatory Medical Care Survey for the years 1990 through 1997 were used for this analysis. Anxiety was defined as International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 300.00 to 300.02. Subcategories included: (i) anxiety, unspecified type (300.00); (ii) panic disorder (300.01); and (iii) generalised anxiety disorder (GAD) [300.02]. Office visits resulting in a diagnosis of anxiety were partitioned into four time intervals for trend analysis: 1990 to 1991; 1992 to 1993; 1994 to 1995; 1996 to 1997.

Results: The annualised mean number of office visits documenting a diagnosis of anxiety increased from 5 739 390 in 1990–1991 to 8 429 413 in 1996–1997. The majority of patients were female, aged between 40 and 59 years, and White. On average, 44.4% of patients were prescribed an antianxiety medication. The proportion of patients with a concomitant diagnosis of depression increased from 7.1 to 12.8%. Use of antidepressants increased from 16.2 to 34.2% of patients, with use of a selective serotonin reuptake inhibitor increasing more than 5-fold. The proportion of patients prescribed both an antianxiety medication and an antidepressant increased from 7.4 to 13.8%. There existed a 1.4-fold increase in the population-adjusted rate of office visits documenting a diagnosis of anxiety, rising from 30.8 office visits per 1000 US population ≥18 years old in 1990–1991 to 42.8 per 1000 in 1996-1997; a 1.2-fold increase in anxiety of unspecified type, from 23.2 to 28.7 per 1000; panic disorder more than doubled, from 4.5 to 9.5 per 1000; and GAD increased from 3.3 to 5.2 per 1000.

Conclusion: The high prevalence of anxiety disorders, predominant in women, represents a major public health concern. Previous research suggests that anxiety disorders are associated with a decreased quality of life, an increased rate of cardiovascular/cerebrovascular events, and an increased risk of mortality due to suicide. Further research is required to discern the reasons for the growth in the prevalence of anxiety disorders, and to examine the effectiveness of medical management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Table II
Table III
Table IV
Table V
Fig. 2
Fig. 3
Table VI

Similar content being viewed by others

References

  1. Schatzberg AF. Overview of anxiety disorders: prevalence, biology, course, and treatment. J Clin Psychiatry 1991; 52 Suppl.: 5–9

    PubMed  Google Scholar 

  2. Kessler RC, McGonagle KA, 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

    Article  PubMed  CAS  Google Scholar 

  3. Cameron OG, Hill EM. Women and anxiety. Psychiatr Clin North Am 1989; 12: 175–86

    PubMed  CAS  Google Scholar 

  4. Greenberg PE, Sisitsky T, Kessler RC, et al. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 1999; 60: 427–35

    Article  PubMed  CAS  Google Scholar 

  5. Wittchen HU, Zhao Z, Kessler RC, et al. DSM-ITI-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 355–64

    Article  PubMed  CAS  Google Scholar 

  6. Lydiard RB. An overview of generalized anxiety disorder: disease state-appropriate therapy. Clin Ther 2000; 22Suppl. A: A3–19

    Article  PubMed  CAS  Google Scholar 

  7. Rice DP, Miller LS. Health economics and cost implications of anxiety and other mental disorders in the United States. Br J Psychiatry 1998; 34 Suppl.: 4–9

    Google Scholar 

  8. Kendler KS, Neale MC, Kessler RC, et al. Major depression and generalized anxiety disorder. Same genes, (partly) different environment? Arch Gen Psychiatry 1992; 49: 716–22

    Article  PubMed  CAS  Google Scholar 

  9. Kendler KS. Major depression and generalized anxiety disorder: same genes (partly) different environments — revisited. Br J Psychiatry 1996; 30 Suppl.: 68–75

    Google Scholar 

  10. Hales RE, Hilty DA, Wise MG. A treatment algorithm for the management of anxiety in primary care practice. J Clin Psychiatry 1997; 58Suppl. 3: 76–80

    PubMed  CAS  Google Scholar 

  11. Leaman TL. Anxiety disorders. Prim Care 1999; 26: 197–210

    Article  PubMed  CAS  Google Scholar 

  12. Pollack MH, Marzol PC. Panic: course, complications and treatment of panic disorder. J Psychopharmacol 2000; 14 (2 Suppl. 1): S25–30

    PubMed  CAS  Google Scholar 

  13. Newman MG, Borkovec TD, Hope DA, et al. Future directions in the treatment of anxiety disorders: an examination of theory, basic science, public policy, psychotherapy research, clinical training, and practice. J Clin Psychology 1999; 55: 1325–45

    Article  CAS  Google Scholar 

  14. National Center for Health Statistics. 1990 summary: National Ambulatory Medical Care Survey, United States. Advance data from Vital Health Stat; no. 213. Hyattsville, Maryland: National Center for Health Statistics; 1992

    Google Scholar 

  15. Schappert SM. National Ambulatory Medical Care Survey, 1991 summary. National Center for Health Statistics. Vital Health Stat 1994; 13: 1–110

    Google Scholar 

  16. Schappert SM. National Ambulatory Medical Care Survey, 1992 summary. Advance data from Vital Health Stat; no. 253. Hyattsville, Maryland: National Center for Health Statistics; 1994

    Google Scholar 

  17. Woodwell DW, Schappert SM. National Ambulatory Medical Care Survey, 1993 summary. Advance data from Vital Health Stat; no. 270. Hyattsville, Maryland: National Center for Health Statistics; 1995

    Google Scholar 

  18. Schappert SM. National Ambulatory Medical Care Survey, 1994 summary. Advance data from Vital Health Stat; no. 273. Hyattsville, Maryland: National Center for Health Statistics; 1996

    Google Scholar 

  19. Woodwell DA. National Ambulatory Medical Care Survey, 1995 summary. Advance data from Vital Health Stat; no. 286. Hyattsville, MD: National Center for Health Statistics; 1997

    Google Scholar 

  20. Woodwell DA. National Ambulatory Medical Care Survey, 1996 summary. Advance data from Vital Health Stat; no. 295. Hyattsville, MD: National Center for Health Statistics; 1997

    Google Scholar 

  21. Woodwell DA. National Ambulatory Medical Care Survey, 1997 summary. Advance data from Vital Health Stat; no. 305. Hyattsville, MD: National Center for Health Statistics; 1999

    Google Scholar 

  22. Bryant E, Shimizu I. Sampling design, sampling variance, and estimation procedures for the National Ambulatory Medical Care Survey. National Center for Health Statistics, Vital Health Stat 1988; 2: 1–39

    Google Scholar 

  23. U.S. Public Health Service and Health Care Financing Administration. International Classification of Diseases, 9th Revision, Clinical Modification, Volume 1. DHHS publication no. (PHS) 89-1260. Washington (DC), Public Health Service; 1989

    Google Scholar 

  24. Schneider D, Appleton L, McLemore T. Areason for visitclassification for ambulatory care. National Center for Health Statistics. Vital Health Stat 1979; 2(78): 1–63

    Google Scholar 

  25. Instruction Manual: Reason for Visit Classification and Coding Manual, 1994. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Hyattsville, MD: National Center for Health Statistics, 1995

  26. Food and Drug Administration. National Drug Code Directory, 1985 edition. Washington: Public Health Service; 1985

    Google Scholar 

  27. Food and Drug Administration. National Drug Code Directory, 1995 edition. Washington: Public Health Service; 1995

    Google Scholar 

  28. Koch H, Campbell W. The collection and processing of drug information. National Ambulatory Medical Care Survey, 1980. National Center for Health Statistics, Vital Health Stat 1982; 2: 1–90

    Google Scholar 

  29. SETS. Statistical Export and Tabulation System 1.22a: Users Reference Manual. United States Department of Health and Human Services, National Center for Health Statistics; 1991

  30. Sclar DA, Robison LM, Skaer TL, et al. Ethnicity and the prescribing of antidepressant pharmacotherapy: 1992–1995. Harv Rev Psychiatry 1999; 7: 29–36

    PubMed  CAS  Google Scholar 

  31. U.S. Census Bureau. Resident population estimates of the United States by age and sex: April 1, 1990 to November 1, 1999. Washington (DC): Population Estimates Program Population Division. Internet release date: 1999 Dec 23. http://www.census.gov/population/estimates/nation/intfile2-l.txt [accessed 2000 Sep 19]

    Google Scholar 

  32. Ninan PT. The functional anatomy, neurochemistry, and pharmacology of anxiety. J Clin Psychiatry 1999; 60Suppl. 22: 12–7

    PubMed  CAS  Google Scholar 

  33. Feigner JP. Overview of antidepressants currently used to treat anxiety disorders. J Clin Psychiatry 1999; 60Suppl. 22: 18–22

    Google Scholar 

Download references

Acknowledgements

This study was supported by the Pharmacoeconomics and Pharmacoepidemiology Research Unit, College of Pharmacy, Washington State University. Presented in part at the 3rd International Meeting of the College of Psychiatric and Neurologic Pharmacists, April 6–9, 2000, Washington, DC, USA.

Author information

Authors and Affiliations

  1. Pharmacoeconomics and Pharmacoepidemiology Research Unit, College of Pharmacy, Washington State University, PO Box 646510, Pullman, Washington, 99164-6510, USA

    Tracy L. Skaer (Assistant Dean and Associate Professor of Pharmacy Practice), Linda M. Robison, David A. Sclar & Richard S. Galin

  2. Pullman Memorial Hospital, Pullman, Washington, USA

    Tracy L. Skaer (Assistant Dean and Associate Professor of Pharmacy Practice) & Richard S. Galin

  3. Graduate Program in Health Policy and Administration, Washington State University, Spokane, Washington, USA

    Tracy L. Skaer (Assistant Dean and Associate Professor of Pharmacy Practice) & David A. Sclar

  4. Graduate Program in Statistics, Washington State University, Pullman, Washington, USA

    David A. Sclar

  5. Eastern Branch, Washington Institute for Mental Illness Research and Training, Spokane, Washington, USA

    David A. Sclar

  6. Neuro-Psychiatric Institute, University of California at Los Angeles, Los Angeles, California, USA

    Richard S. Galin

Authors
  1. Tracy L. Skaer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda M. Robison
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David A. Sclar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard S. Galin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tracy L. Skaer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skaer, T.L., Robison, L.M., Sclar, D.A. et al. Anxiety Disorders in the USA, 1990 to 1997. Clin. Drug Investig. 20, 255–265 (2000). https://doi.org/10.2165/00044011-200020040-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00044011-200020040-00007

Keywords

Search

Navigation