New screening tool for anxiety disorders

Mar 12 2007

A new study by researchers led by Kurt Kroenke, M.D., of the Indiana University School of Medicine and the Regenstrief Institute, Inc. reports that nearly 20 percent of patients seen by primary care physicians have at least one anxiety disorder.

The study outlines the effectiveness of a new screening tool which can alert busy primary care physicians to those patients with one or more anxiety disorders. The study is published in the March 6 issue of the Annals of Internal Medicine.

The GAD-7, a seven-question, self-administered screening tool, identifies patients with undiagnosed generalized anxiety disorder, panic disorder, post traumatic stress disorder or social anxiety disorder. The new study, which looked at 965 patients in 15 primary care clinics, found anxiety to be as prevalent as depression, and much more common than previously thought, in patients who were visiting a physician for a physical problem or illness.

"Anxiety often manifests as a physical symptom like pain, fatigue, or inability to sleep, so it is not surprising that one out of five patients who come to a doctor’s office with a physical complaint have anxiety," said Dr. Kroenke, I.U. School of Medicine professor of medicine and Regenstrief Institute, Inc. research scientist. Dr. Kroenke, an internist, is an internationally recognized researcher who studies physical symptoms, especially pain, and their links to mental disorders including anxiety and depression.

Dr. Kroenke and colleagues found that even administering the first two questions of the GAD-7 flagged those patients with possible anxiety disorders for physician follow-up. These questions ask the patient if he or she has felt nervous or has been unable to stop or control worrying over the previous two weeks. Bringing this information to the physician’s attention is important because the doctor may be focused on the patient’s physical complaints and unless prompted by the patient or test results is unlikely to assess the patient’s mental status.

"Doctors like to quantify things. We can objectively measure blood pressure, blood sugar or cholesterol, but symptoms of anxiety can be missed in a busy primary care practice. The seven-question GAD-7 and remarkably even the two-question "ultra brief" version gives the physician a tool to quantify the patient’s symptoms – sort of a lab test for anxiety," he said.

Patients with anxiety have worse functional status, more disability days and more physician visits than patients without mental illness. Untreated anxiety disorders can be disabling.

In addition to Dr. Kroenke, co-authors of the study are Robert L. Spitzer, M.D., Janet B.W. Williams, D.S.W., Patrick O. Monahan, Ph.D. and Bernd Lowe, M.D., Ph.D. The study was partially funded by Pfizer, Inc.