September 1994

Untreated Anxiety Among Adult Primary Care Patients in a Health Maintenance Organization

Author Affiliations

From the Technology Assessment Group Inc, San Francisco, Calif (Drs Fifer, Mazonson, and Lubeck and Ms Mathias); the Department of Health Services, University of Washington School of Public Health, Seattle (Dr Patrick); the Department of Medicine, Stanford University, Palo Alto, Calif (Dr Lubeck); and the Upjohn Co, Kalamazoo, Mich (Dr Buesching). Dr Buesching is now with Eli Lilly & Co, Indianapolis, Ind. Dr Buesching is a former employee of the Upjohn Co but owns no stock or options to purchase further stock in that company. The other authors own no stock or options in the Upjohn Co.

Arch Gen Psychiatry. 1994;51(9):740-750. doi:10.1001/archpsyc.1994.03950090072010

Background:  Untreated anxiety may be particularly difficult for primary care physicians to recognize and diagnose because there are no reliable demographic or medical profiles for patients with this condition and because these patients present with a high rate of comorbid psychological conditions that complicate selection of treatment.

Method:  A prospective assessment of untreated anxiety symptoms and disorders among primary care patients.

Results:  Approximately 10% of eligible patients screened in clinic waiting rooms of a mixed-model health maintenance organization reported elevated symptoms and/or disorders of anxiety that were unrecognized and untreated. These patients with untreated anxiety reported significantly worse functioning on both physical and emotional measures than "not anxious" comparison patients; in fact these patients reported reduced functioning levels within ranges that would be expected for patients with chronic physical diseases, such as diabetes and congestive heart failure. The most severe reductions in functioning were reported by untreated patients whose anxiety was mixed with depression symptoms or disorders.

Conclusion:  Primary care physicians may benefit from screening tools and consultations by mental health specialists to assist in recognition and diagnosis of anxiety symptoms and disorders alone and mixed with depression.