Anxiety disorders in primary care:: Prevalence, impairment, comorbidity, and detection
Anxiety disorders in primary care:: Prevalence, impairment, comorbidity, and detection
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DOI：
10.7326/0003-4819-146-5-200703060-00004
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发表时间：
2007-03-06
影响因子：
39.2
通讯作者：
Lowe, Bernd
中科院分区：
文献类型：
--
作者：
Kroenke, Kurt;Spitzer, Robert L.;Lowe, Bernd
背景资料：焦虑症，虽然像抑郁症一样常见，但受到的关注较少，往往未被发现和治疗不足。目的：确定目前的患病率，损害，并合并症的焦虑症在初级保健，并评估一个简短的措施，检测这些disorders.Design：Criterion-standard study之间进行2004年11月和2005年6月。设置：15个美国初级保健诊所。参与者：965例随机抽样的患者从连续的诊所患者谁完成了自我报告问卷，并同意后续的电话interview.Measurements：7项焦虑措施（广泛性焦虑症[GAD]-7规模）在诊所，随后由电话管理，结构化的精神病学访谈的精神卫生专业人士谁是不知情的GAD-7的结果。功能状态（医疗结果研究简表-20），抑郁和躯体症状，以及自我报告的残疾天数和医生就诊情况也进行了评估。965例患者中，19.5%（95% CI，17.0%-22.1%）至少有1种焦虑障碍，8.6%（CI，6.9%至10.6%）有创伤后应激障碍，7.6%（CI，5.9%至9.4%）患有广泛性焦虑障碍，6.8%（CI，5.3%至8.6%）患有惊恐障碍，6.2%（CI，4.7%至7.9%）患有社交焦虑障碍。随着焦虑症数量的增加，每种障碍都与显著增加（P < 0.001）的实质性损害有关。许多患有焦虑症的患者（41%）报告目前没有治疗。受试者工作特征曲线分析表明，无论是GAD-7规模和它的2个核心项目（GAD-2）表现良好（曲线下面积，0.80至0.91）作为筛选工具，所有4焦虑disorders.Limitation：本研究包括非随机抽样选定的初级保健做法。结论：焦虑症是普遍的，致残的，往往在初级保健治疗。一个2项筛选测试可以提高detection.Conclusions：焦虑症是普遍存在的，禁用，往往未经治疗的初级保健。一个2项筛选测试可以提高检测。
Background: Anxiety, although as common as depression, has received less attention and is often undetected and undertreated.Objective: To determine the current prevalence, impairment, and comorbidity of anxiety disorders in primary care and to evaluate a brief measure for detecting these disorders.Design: Criterion-standard study performed between November 2004 and June 2005.Setting: 15 U.S. primary care clinics.Participants: 965 randomly sampled patients from consecutive clinic patients who completed a self-report questionnaire and agreed to a follow-up telephone interview.Measurements: 7-item anxiety measure (Generalized Anxiety Disorder [GAD]-7 scale) in the clinic, followed by a telephone-administered, structured psychiatric interview by a mental health professional who was blinded to the GAD-7 results. Functional status (Medical Outcomes Study Short Form-20), depressive and somatic symptoms, and self-reported disability days and physician visits were also assessed.Results: Of the 965 patients, 19.5% (95% CI, 17.0% to 22.1%) had at least 1 anxiety disorder, 8.6% (CI, 6.9% to 10.6%) had posttraumatic stress disorder, 7.6% (CI, 5.9% to 9.4%) had a generalized anxiety disorder, 6.8% (CI, 5.3% to 8.6%) had a panic disorder, and 6.2% (CI, 4.7% to 7.9%) had a social anxiety disorder. Each disorder was associated with substantial impairment that increased significantly (P < 0.001) as the number of anxiety disorders increased. Many patients (41%) with an anxiety disorder reported no current treatment. Receiver-operating characteristic curve analysis showed that both the GAD-7 scale and its 2 core items (GAD-2) performed well (area under the curve, 0.80 to 0.91) as screening tools for all 4 anxiety disorders.Limitation: The study included a nonrandom sample of selected primary care practices. Conclusions: Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.Conclusions: Anxiety disorders are prevalent, disabling, and often untreated in primary care. A 2-item screening test may enhance detection.