Generalized anxiety disorder and health care use.

Abstract

OBJECTIVE: To examine self-reported health care use and health care-seeking behaviour of patients meeting DSM-IV's diagnostic criteria for generalized anxiety disorder (GAD). DESIGN: Survey of outpatients recruited at three different times of the day using questionnaires on worry and anxiety (a six-item screening questionnaire based on DSM-IV criteria for GAD), on perceived health problems, and on health care use and health care-seeking behaviour. The assessment package also included well validated assessment instruments for insomnia and depression symptoms. All patients seeking health care were invited to participate. Participants completed the survey as they waited in the reception area. SETTING: Four randomly selected community-based medical clinics of Quebec city's metropolitan area. PARTICIPANTS: A final sample of 1110 patients among 1878 outpatients invited to participate included 219 (19.7%) who tested positive for GAD. MAIN OUTCOME MEASURES: Self-reported worry and anxiety (based on DSM-IV criteria for GAD), self-perceived health problems, health care use and health care-seeking behaviour, insomnia, and symptoms of depression. RESULTS: Participants who tested positive on a screening test for GAD reported more annual medical visits (5.3 versus 3.4) than other patients. Those who reported at least five annual medical visits were nearly four times more likely to have positive results for GAD. Women were 1.6 times more likely to have positive results than men were. Patients who tested positive reported insomnia-type sleep disturbances, depressive symptoms, fatigue, and gastric problems significantly more often than others. Forty-two percent had consulted a family physician in the past year with a complaint of anxiety. Eighty percent of patients who tested positive reported they believed they had an anxiety problem, and this belief predicted positive test results (odds ratio = 20.3). Yet most reported not having sought other types of medical or psychological care specifically for anxiety in the past year. CONCLUSION: Some patients in this sample with symptoms of GAD mainly seek primary care for their symptoms. Questions about excessive worrying and anxiety, as part of routine examination, can increase recognition of GAD.

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