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.
Similar content being viewed by others
References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. (text revision).
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.
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.
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.
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.
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.
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.
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.
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.
Eng, W., & Heimberg, R. G. (2006). Interpersonal correlates of generalized anxiety disorder: Self versus other perception. Journal of Anxiety Disorders, 20, 380–387.
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.
Hoffman, D. L., Dukes, E. M., & Wittchen, H. U. (2008). Human and economic burden of generalized anxiety disorder. Depression and Anxiety, 25, 72–90.
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.
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.
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.
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.
Leon, A. C., Portera, L., & Weissman, M. M. (1995). The social costs of anxiety disorders. British Journal of Psychiatry, 166, 19–22.
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.
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.
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.
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.
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.
Miller, G. A., & Chapman, J. P. (2001). Misunderstanding analyses of covariance. Journal of Abnormal Psychology, 110, 40–48.
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.
Olfson, M. (2000). Impairment in generalized anxiety disorder. American Journal of Psychiatry, 157, 2060–2061.
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.
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.
Olfson, M., & Gameroff, M. J. (2007). Generalized anxiety disorder, somatic pain and health care costs. General Hospital Psychiatry, 29, 310–316.
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.
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.
Roy-Byrne, P. P., & Wagner, A. (2004). Primary care perspectives on generalized anxiety disorder. Journal of Clinical Psychiatry, 65, 20–26.
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.
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.
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.
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.
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.
Wittchen, H. U. (2002). Generalized anxiety disorder: Prevalence, burden, and cost to society. Depression and Anxiety, 16, 162–171.
Wittchen, H. U., & Hoyer, J. (2001). Generalized anxiety disorder: Nature and course. Journal of Clinical Psychiatry, 62, 15–19.
World Health Organization. (1990). Global burden of disease 1990 disability weights. Retrieved August 26, 2005, from http://www.who.int/healthinfo/bodreferencesdisabilityweights.xls .
Acknowledgment
This research was supported by a Health Resources and Services Administration, Department of Health and Human Services GPE Grant #1D40HP00001.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-011-9248-1