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Article |

Untreated Anxiety Among Adult Primary Care Patients in a Health Maintenance Organization

Sheila K. Fifer, PhD; Susan D. Mathias, MPH; Donald L. Patrick, PhD, MSPH; Peter D. Mazonson, MD, MBA; Deborah P. Lubeck, PhD; Don P. Buesching, PhD
Arch Gen Psychiatry. 1994;51(9):740-750. doi:10.1001/archpsyc.1994.03950090072010.
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Background:  Untreated anxiety may be particularly difficult for primary care physicians to recognize and diagnose because there are no reliable demographic or medical profiles for patients with this condition and because these patients present with a high rate of comorbid psychological conditions that complicate selection of treatment.

Method:  A prospective assessment of untreated anxiety symptoms and disorders among primary care patients.

Results:  Approximately 10% of eligible patients screened in clinic waiting rooms of a mixed-model health maintenance organization reported elevated symptoms and/or disorders of anxiety that were unrecognized and untreated. These patients with untreated anxiety reported significantly worse functioning on both physical and emotional measures than "not anxious" comparison patients; in fact these patients reported reduced functioning levels within ranges that would be expected for patients with chronic physical diseases, such as diabetes and congestive heart failure. The most severe reductions in functioning were reported by untreated patients whose anxiety was mixed with depression symptoms or disorders.

Conclusion:  Primary care physicians may benefit from screening tools and consultations by mental health specialists to assist in recognition and diagnosis of anxiety symptoms and disorders alone and mixed with depression.


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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