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Functioning and disability levels in primary care out-patients with one or more anxiety disorders

  • C. D. Sherbourne (a1), G. Sullivan (a1) (a2) (a3), M. G. Craske (a4), P. Roy-Byrne (a5) (a6), D. Golinelli (a1), R. D. Rose (a4), D. A. Chavira (a7) (a8), A. Bystritsky (a9) and M. B. Stein (a7) (a10)...

Abstract

Background

Anxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of combinations of anxiety disorders in primary care out-patients.

Method

A total of 1004 patients with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) or post-traumatic stress disorder (PTSD) provided data on their mental and physical functioning, and disability. Multivariate regressions compared functional levels for patients with different numbers and combinations of disorders.

Results

Of the patients, 42% had one anxiety disorder only, 38% two, 16% three and 3% all four. There were few relative differences in functioning among patients with only one anxiety disorder, although those with SAD were most restricted in their work, social and home activities and those with GAD were the least impaired. Functioning levels tended to deteriorate as co-morbidity increased.

Conclusions

Of the four anxiety disorders examined, GAD appears to be the least disabling, although they all have more in common than in distinction when it comes to functional impairment. A focus on unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders, which is the modal presentation in primary care.

Copyright

Corresponding author

*Address for correspondence: C. D. Sherbourne, Ph.D., RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA. (Email: Cathy_Sherbourne@rand.org)

References

Hide All
Andrews, G, Slade, T, Issakidis, C (2002). Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being. British Journal of Psychiatry 181, 306314.
Andrews, G, Sunderland, M, Kemp, A (2010). The consistency of diagnostic thresholds in DSM-V. Australian and New Zealand Journal of Psychiatry. Published online: 5 January 2010. doi:10.3109/00048670903487241.
Blazer, DG, Hughes, D, George, LK, Swartz, M, Boyer, R (1991). Generalized anxiety disorder. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (ed. Robins, L. N. and Regier, D. A.), pp. 180203. Free Press: New York.
Brooks, R, Rabin, R, de Charro, F (eds) (2003). The Measurement and Valuation of Health Status Using EQ-5D: A European Perspective. Kluwer Academic Publishers: Dordrecht, The Netherlands.
Campbell-Sills, L, Norman, SB, Craske, MB, Sullivan, G, Lang, AJ, Chavira, DA, Sherbourne, C, Roy-Byrne, P, Stein, MB (2009). Validation of a brief measure of anxiety-related severity and impairment: The Overall Anxiety Severity and Impairment Scale (OASIS). Journal of Affective Disorders 11, 92–101.
Centers for Disease Control and Prevention (2000). Measuring Healthy Days. CDC: Atlanta, GA.
Centers for Disease Control and Prevention (2009). CDC Health-Related Quality of Life (http://www.cdc.gov/hrqol/). Accessed 25 January 2010.
Craske, MG, Farchione, TJ, Allen, LB, Barrios, V, Stoyanova, M, Rose, R (2007). Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more? Behaviour Research and Therapy 45, 10951109.
Fifer, SK, Mathias, SD, Patrick, DL, Mazonson, PD, Lubeck, DP, Buesching, DP (1994). Untreated anxiety among adult primary care patients in a health maintenance organization. Archives of General Psychiatry 51, 740750.
Hollifield, M, Katon, W, Skipper, B, Chapman, T, Ballenger, JC, Mannuzza, S, Fyer, AJ (1997). Panic disorder and quality of life: variables predictive of functional impairment. American Journal of Psychiatry 154, 766772.
Katon, W, Hollifield, M, Chapman, T, Mannuzza, S, Ballenger, J, Fyer, A (1995). Infrequent panic attacks: psychiatric comorbidity, personality characteristics and functional disability. Journal of Psychiatric Research 29, 121131.
Kessler, RC (2003). The impairments caused by social phobia in the general population: implications for intervention. Acta Psychiatrica Scandinavica Supplementum 108 (Suppl. 417), 1927.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005 a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593602.
Kessler, RC, Chiu, WT, Demler, O, Walters, EE (2005 b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry 62, 617709.
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, H-U, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.
Klerman, GL, Weissman, MM, Ouellette, R, Johnson, J, Greenwald, S (1991). Panic attacks in the community: social morbidity and health care utilization. Journal of the American Medical Association 265, 742746.
Kroenke, K, Spitzer, RL, Williams, JBW, Monahan, PO, Lowe, B (2007). Anxiety disorders in primary care: prevalence, impairment, comorbility, and detection. Annals of Internal Medicine 146, 317325.
Lecrubier, Y, Sheehan, DV, Weiller, E, Amorim, P, Bonora, I, Sheehan, KH, Janavs, J, Dunbar, GC (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry 12, 224231.
Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehan, DV (1997). Assessing impairment in primary care: a psychometric analysis of the Sheehan Disability Scale. International Journal of Psychiatry in Medicine 27, 93–105.
Lochner, C, Mogotsi, M, du Toit, PL, Kaminer, D, Niehaus, DJ, Stein, DJ (2003). Quality of life in anxiety disorders: a comparison of obsessive–compulsive disorder, social anxiety disorder, and panic disorder. Psychopathology 36, 255262.
Luo, N, Johnson, G, Shaw, J, Feeney, D, Coons, SJ (2005). Self-reported health status of the general adult US population as assessed by the EQ-5D and Health Utilities Index. Medical Care 43, 10781086.
Magee, WJ, Eaton, WW, Wittchen, HU, McGonagle, KA, Kessler, RC (1996). Agoraphobia, simple phobia and social phobia in the National Comorbidity survey. Archives of General Psychiatry 53, 159168.
Malik, ML, Connor, KM, Sutherland, SM, Smith, RD, Davison, RM, Davidson, JR (1999). Quality of life and posttraumatic stress disorder: a pilot study assessing changes in SF-36 scores before and after treatment in a placebo-controlled trial of fluoxetine. Journal of Traumatic Stress 12, 387393.
Markowitz, J, Weissman, M, Ouellette, R, Lish, J, Klerman, GL (1989). Quality of life in panic disorder. Archives of General Psychiatry 46, 984992.
Massion, AO, Warshaw, MG, Keller, MB (1993). Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. American Journal of Psychiatry 150, 600607.
Means-Christensen, AJ, Sherbourne, CD, Roy-Byrne, PP, Craske, MG, Stein, MB (2006). Using five questions to screen for five common mental disorders in primary care: the anxiety and depression detector (ADD). General Hospital Psychiatry 28, 108118.
Moriarty, DG, Zack, MM, Kobau, R (2003). The Centers for Disease Control and Prevention's Healthy Days Measures – population tracking of perceived physical and mental health over time. Health and Quality of Life Outcomes I, 37.
Murray, CJ, Lopez, AD (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. Harvard University Press: Cambridge, MA.
Norbeg, MM, Diefenbach, GJ, Tolin, DF (2008). Quality of life and anxiety and depressive disorder comorbidity. Journal of Anxiety Disorders 22, 15161522.
Noyes, R (1990). The comorbidity and mortality of panic disorder. Psychiatric Medicine 8, 4166.
Olatunji, BO, Cisler, JM, Tolin, DF (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clinical Psychology Review 27, 572581.
Olfson, M, Fireman, B, Weissman, MM, Leon, AC, Sheehan, DV, Kathol, RG, Hoven, C, Farber, L (1997). Mental disorders and disability among patients in a primary care group practice. American Journal of Psychiatry 154, 17341740.
Rabin, R, de Charro, F (2001). EQ-5D: a measure of health status from the EuroQol Group. Annals of Medicine 33, 337343.
Roy-Byrne, P, Stein, M (2005). Social anxiety in primary care: hidden in plain view? General Hospital Psychiatry 27, 155157.
Schneier, FR, Heckelman, LR, Garfinkel, R, Campeas, R, Fallon, BA, Gitow, A, Street, L, Del Bene, D, Liebowitz, MR (1994). Functional impairment in social phobia. Journal of Clinical Psychiatry 55, 322331.
Schonfeld, WH, Verboncoeur, CJ, Fifer, SK, Lipschutz, RC, Lubeck, DP, Buesching, DP (1997). The functioning and well-being of patients with unrecognized anxiety disorders and major depressive disorder. Journal of Affective Disorders 43, 105119.
Sheehan, D (1983). The Anxiety Disease. Scribner: New York.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E (1998). The Mini International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 2233.
Sherbourne, CD, Wells, KB, Judd, LL (1996). Functioning and well-being of patients with panic disorder. American Journal of Psychiatry 153, 213218.
Stein, MB, Kean, YM (2000). Disability and quality of life in social phobia: epidemiologic findings. American Journal of Psychiatry 157, 16061613.
Stein, MB, Roy-Byrne, PP, Craske, MG, Bystritsky, A, Sullivan, G, Pyne, JM, Katon, W, Sherbourne, CD (2005). Functional impact and health utility of anxiety disorders in primary care outpatients. Medical Care 43, 11641170.
Stein, MB, Stein, DJ (2008). Social anxiety disorder. Lancet 371, 11151125.
Sullivan, G, Craske, MG, Sherbourne, C, Edlund, M, Rose, R, Golinelli, D, Chavira, DA, Bystritsky, A, Stein, MB, Roy-Byrne, PP (2007). Design of the Coordinated Anxiety Learning and Management (CALM) study: innovations in collaborative care for anxiety disorders. General Hospital Psychiatry 9, 379387.
Tsao, JC, Mystkowski, JL, Zucker, BG, Craske, MG (2005). Impact of cognitive–behavioral therapy for panic disorder on comorbidity: a controlled investigation. Behaviour Research and Therapy 43, 959970.
Ware, JE Jr, Kosinski, M, Turner-Bowker, D, Gandek, B (2002). How to Score Version 2 of the SF-12 Health Survey (with a Supplement Documenting Version 1). QualityMetric Inc.: Lincoln, RI.
Wells, KB, Sturm, R, Sherbourne, CD, Meredith, LS (1996). Caring for Depression. Harvard University Press: Cambridge, MA.
Zatzick, DF, Marmar, CR, Weiss, DS, Browner, WS, Metzler, TJ, Golding, JM, Stewart, A, Schlenger, WE, Wells, KB (1997). Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. American Journal of Psychiatry 154, 16901695.

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