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Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study

Olivia Remes · Nicholas W.J. Wainwright · Paul G. Surtees · Louise Lafortune · Kay‐Tee Khaw · Carol Brayne

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Mental Health Treatment and Access Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Cardiac Health and Mental Health

Abstract

OBJECTIVE: Generalised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions. DESIGN: Large, population study. SETTING: UK population-based cohort. PARTICIPANTS: 30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996-2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates. MAIN OUTCOME MEASURE: Past-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS: In this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49). CONCLUSION: People with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.

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References

2003SF-36 health survey: Manual and interpretation guide 2013Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 1999The Economic Burden of Anxiety Disorders in the 1990s 2016A systematic review of reviews on the prevalence of anxiety disorders in adult populations 2002Generalized anxiety disorder: prevalence, burden, and cost to society 2002Generalized anxiety and depression in primary care: prevalence, recognition, and management.2010The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions 2001One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample

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