Improving the detection and management of anxiety disorders in primary care.

There has been considerable emphasis on encouraging GPs to improve their skills in the diagnosis and management of depression, yet anxiety disorders have been relatively neglected. Anxiety symptoms are more common than those of depression in the community, and may be accompanied by significant morbidity. The 2007 UK Adult Psychiatric Morbidity Survey reported a 9% prevalence of mixed anxiety and depression in their doorstep community survey, while generalised anxiety disorder (GAD) affected 4.4% of the population, other anxiety disorders 3.6%, and only 2.3% reported depressive disorders. 1 Despite this, there has been much less research to assess outcomes in anxiety than depressive disorders, and most of the research comes from the US or Europe. Studies suggests that anxiety disorders are often more chronic than other common mental disorders, presumably because anxiety is often left untreated and it is frequently comorbid with depressive disorders or chronic physical health problems. Such comorbidity is associated with poor quality of life, substance misuse, disability, and high health and social costs. 4 GP rates of diagnosis and treatment of anxiety disorders are much lower than expected, given their prevalence. 5 This may be due to both patient and practitioner factors. Patients may have symptoms of anxiety, worry, tension, irritability, or tiredness, which they are unsure about presenting to their GP; whereas GPs may dismiss such symptoms or attribute them to general malaise or a potentially physical condition requiring investigation, and not specifically consider or ask about anxiety symptoms. In addition, many people present with the somatic symptoms associated with their anxiety, possibly thinking that these are more medically legitimate. Those with anxiety disorders may be frequent users of both primary and secondary care services, but if their anxiety is not detected they may not receive appropriate treatment and can also undergo unnecessary, potentially dangerous, and costly investigations. Some patients with anxiety symptoms may have an underlying problem with alcohol use that can obscure the presentation. Both patients and primary care practitioners may consider anxiety symptoms to be 'part of normal living' and be concerned about medicalising this problem. It is important to recognise that, when persistent, these symptoms can cause significant distress and limitation to daily activities. Self-help groups, such as Anxiety UK, are keen to raise the profile of these disorders among GPs and to improve both their detection and management in primary care. 6 Some clinicians consider both anxiety and depression to be …