Generalized Anxiety and Depression in Primary Care: Prevalence, Recognition, and Management

Aims: Determine attitudes toward patients with generalized anxiety disorder (GAD) and major depressive episodes (MDE) in primary care; determine prevalence of GAD, MDE, and comorbidGAD/MDE among primary care patients; assess physician recognition of GAD and MDE; and describeprimary care interventions for these patients. Method: 558 primary care physicians participated in a 1-day survey. Over 20,000 patients completed a diagnostic-screening questionnaire for GAD andMDE. Physician questionnaires included a standardized clinical appraisal of somatic and psychosocialsymptoms and information on past and current treatments and a prestudy questionnaire assessingexperience with and attitudes toward patients with GAD and MDE. Results: 56.9% of physicians viewed GAD as a genuine mental disorder with clinical management problems and considerable patientburden; 27.4% treated GAD patients differently from MDE patients. 5.3% of patients met criteriafor GAD, 6.0% for MDE, 3.8% for pure GAD, 4.4% for pure MDE, and 1.6% for comorbid GAD/MDE. Pure GAD and MDE were associated with disability, high utilization of health care resources,and suicidality, which were even higher with comorbid GAD/MDE. Physicians recognized clinicallysignificant emotional problems in 72.5% of patients with pure GAD, 76.5% with pure MDE, and85.4% with comorbid GAD/MDE. However, correct diagnosis was much lower (64.3% for MDE and34.4% for GAD). Although the majority of patients with recognized GAD or MDE were treated, onlya small minority with GAD were prescribed medications or referred to specialists. Conclusion: The high proportion of respondents with pure GAD is inconsistent with previous reports that GAD is usuallycomorbid with depression. GAD remains poorly recognized and inadequately treated. Improvingthe recognition and treatment of GAD in primary care patients is discussed relative to new treatments.