Skip to main content
SpringerLink
Log in

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

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

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

Similar content being viewed by others

References

  1. Robins LN, Helzer JE, Weissman MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry. 1984;41:949–58.

    PubMed  CAS  Google Scholar 

  2. Regier DA, Goldberg ID, Taube CA. The de facto U.S. mental health services system. Arch Gen Psychiatry. 1978;35:685–96.

    PubMed  CAS  Google Scholar 

  3. Regier DA, Goldberg ID, Burns BJ, et al. Specialist/generalist division of responsibility for patients with mental disorders. Arch Gen Psychiatry. 1984;41:934–41.

    PubMed  CAS  Google Scholar 

  4. Markowitz JS, Weissman MM, Ouellette RM. Quality of life and panic disorder. Arch Gen Psychiatry. 1989;46:984–92.

    PubMed  CAS  Google Scholar 

  5. Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the Medical Outcomes Study. JAMA. 1989;262:914–9.

    Article  PubMed  CAS  Google Scholar 

  6. Simon GE, VonKorff M. Somatization and psychiatric disorder in the NIMH Epidemiologic Catchment Area Study. Am J Psychiatry. 1991;148:1494–500.

    PubMed  CAS  Google Scholar 

  7. Simon GE. Psychiatric disorder and functional symptoms as predictors of health care use. Psychiatr Med. 1992;10:49–59.

    PubMed  CAS  Google Scholar 

  8. Boyd JH, Weissman MM. Epidemiology of affective disorders. Arch Gen Psychiatry. 1983;38:1039–46.

    Google Scholar 

  9. Myers JK, Weissman MM, Tischler GL, et al. Six-month prevalence of psychiatric disorders in three communities. Arch Gen Psychiatry. 1984;41:959–67.

    PubMed  CAS  Google Scholar 

  10. VonKorff M, Shapiro S, Burke JD, et al. Comparison of Diagnostic Interview Schedule, General Health Questionnaire and practitioner assessments. Arch Gen Psychiatry. 1987;44:152–6.

    CAS  Google Scholar 

  11. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA. 1990;264:2524–8.

    Article  PubMed  CAS  Google Scholar 

  12. Johnson J, Weissman MM, Lerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA. 1992;267:1478–83.

    Article  PubMed  CAS  Google Scholar 

  13. Katon W, VonKorff M, Lin E, et al. Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry. 1990;12:355–62.

    Article  PubMed  CAS  Google Scholar 

  14. Brown GW, Bifulco A, Harris TO, Bridge L. Life stress, chronic subclinical symptoms and vulnerability to clinical depression. J Affect Disord. 1986;11:1–19.

    Article  PubMed  CAS  Google Scholar 

  15. Murphy JM, Sobol AM, Olivier DC, et al. Prodromes of depression and anxiety: The Stirling County Study. Br J Psychiatry. 1989;155:490–5.

    PubMed  CAS  Google Scholar 

  16. Wells KB, Burnham A, Rogers W, Hays R, Camp P. The course of depression in adult outpatients. Arch Gen Psychiatry. 1992;49:788–94.

    PubMed  CAS  Google Scholar 

  17. Hiller W, Zardig M, Rose M. The overlap between depression and anxiety on different levels of psychopathology. J Affect Disord. 1989;16:223–31.

    Article  PubMed  CAS  Google Scholar 

  18. Clayton PJ, Grove WM, Coryell W, Keller M, Hirschfeld R, Fawcett J. Follow-up and family study of anxious depression. Am J Psychiatry. 1991;148:1512–7.

    PubMed  CAS  Google Scholar 

  19. Katon W, Roy-Byrne PP. Mixed anxiety and depression. J Abnorm Psychol. 1991;3:337–45.

    Article  Google Scholar 

  20. Zinbarg R, Barlow D. Liebowitz M, et al. DSM-IV field trial: mixed anxiety-depression. Am J Psychiatry. 1994 (in press).

  21. Goldberg D, Hiller VC. A scaled version of the General Health Questionnaire. Psychol Med. 1979;9:139–45.

    Article  PubMed  CAS  Google Scholar 

  22. Di Nardo PA, Barlow DH. Anxiety Disorders Interview Schedule-Revised (ADIS-R). Albany, NY: Center for Stress and Anxiety Disorders, University of Albany, State University of New York, 1988.

    Google Scholar 

  23. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychiatry. 1959;32:50–5.

    CAS  Google Scholar 

  24. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.

    Article  PubMed  CAS  Google Scholar 

  25. Raskind JH, Beck AT, Brown G, Steer RA. Taking the measure of anxiety and depression: validity of the reconstructed Hamilton Rating Scales. J Nerv Ment Dis. 1987;175:474–9.

    Article  Google Scholar 

  26. Goldman HH, Skodol AE, Lave TR. Revising Axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry. 1992;9:1148–56.

    Google Scholar 

  27. Barlow DH. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. New York: Guilford, 1988.

    Google Scholar 

  28. Di Nardo PA, Moras K, Barlow DH, Rapee RM, Brown TA. Reliability of DSM-III-R anxiety disorder categories using the Anxiety Disorder Interview Schedule-Revised (ADIS-R). Arch Gen Psychiatry. 1993;50:251–6.

    PubMed  CAS  Google Scholar 

  29. VonKorff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol. 1992;45:197–203.

    Article  CAS  Google Scholar 

  30. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (3rd Ed., revised). Washington, DC: APA, 1987.

    Google Scholar 

  31. Barrett JE, Barrett JA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in general practice. Arch Gen Psychiatry. 1988;45:1100–6.

    PubMed  CAS  Google Scholar 

  32. Fifer SK, Mathies SD, Patrick DL, Maxonson PD, Lubeck DP, Bvesching DP. Untreated anxiety among adult primary-care patients in a health maintenance organization. Arch Gen Psychiatry. 1994 (in press).

  33. Wittchen H-U, Essay CA. Comorbidity and mixed anxiety depressive disorders: is there epidemiologic evidence? J Clin Psychiatr. 1993;54(5):9–15.

    Google Scholar 

  34. Angst J, Merikangas KR, Scheidegger P, Wicki W. Recurrent brief depression: a new subtype of affective disorder. J Affect Disord. 1990;19:87–98.

    Article  PubMed  CAS  Google Scholar 

  35. Coryell W, Endicott J, Keller MB. Predictors of relapse into major depressive disorder in nonclinical population. Am J Psychiatry. 1991;148:1353–8.

    PubMed  CAS  Google Scholar 

  36. Katon W, Lin E, Vonkorff M, Bush T, Walker E, Simon G, Robinson P. The predictors of persistence of depression in primary care. J Affect Disord. 1994 (in press).

  37. Watson D, Pennebaker JW. Health complaints, stress and distress: exploring the control role of negative affectivity. Psychol Rev. 1989;96:234–54.

    Article  PubMed  CAS  Google Scholar 

  38. Schulberg HC, Coulehan JL, Block MR, et al. Clinical trials of primary care treatments for major depression: issues in design, recruitment and treatment. Int J Psychiatry Med. 1993;23:29–42.

    Article  PubMed  CAS  Google Scholar 

  39. Catalan J, Gath D, Edmonds G, Ennis J. The effects of nonprescribing of anxiolytics in general practice: controlled evaluation of psychiatric and social outcome. Br J Psychiatry. 1984;144:593–601.

    Article  PubMed  CAS  Google Scholar 

  40. Shapiro AK, Struening EL, Shapiro E, Milcarek BI. Diazepam: how much better than placebo? J Psychiatr Res. 1983;17:51–73.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. the University of Washington School of Medicine, Seattle, Washington

    Peter Roy-Byrne MD (Professor and Vice-Chairman), 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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wayne Katon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Eugene Broadhead MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Pierre Lepine MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeff Richards PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Phillip J. Brantley PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joan Russo PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Richard Zinbarg PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David Barlow PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michael Liebowitz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

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

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Issue Date:

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

Key words

Search

Navigation