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

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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

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

    Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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 

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

    Article  PubMed  Google Scholar 

  • 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 

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

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • 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 

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

    Article  PubMed  CAS  Google Scholar 

  • 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 

  • 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 

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

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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 

  • 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.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

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

Download references

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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