Effects of Medical Comorbidity on Anxiety Treatment Outcomes in Primary Care

Published In: Psychosomatic Medicine, v. 75, no. 8, Oct. 2013, p. 713-720

Posted on RAND.org on January 01, 2013

by Laura Campbell-Sills, Murray Stein, Cathy D. Sherbourne, Michelle G. Craske, Greer Sullivan, Daniela Golinelli, Ariel J Lang, Denise A. Chavira, Alexander Bystritsky, Raphael D. Rose, Stacy Shaw Welch, Gene A. Kallenberg, Peter Roy-Byrne

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OBJECTIVE: To evaluate the effects of medical comorbidity on anxiety treatment outcomes. METHODS: Data were analyzed from 1004 primary care patients enrolled in a trial of a collaborative care intervention for anxiety. Linear-mixed models accounting for baseline characteristics were used to evaluate the effects of overall medical comorbidity (two or more chronic medical conditions [CMCs] versus fewer than two CMCs) and specific CMCs (migraine, asthma, and gastrointestinal disease) on anxiety treatment outcomes at 6, 12, and 18 months. RESULTS: At baseline, patients with two or more CMCs (n = 582; 58.0%) reported more severe anxiety symptoms (10.5 [95% confidence interval {CI} = 10.1–10.9] versus 9.5 [95% CI = 9.0–10.0], p = .003) and anxiety-related disability (17.6 [95% CI = 17.0–18.2] versus 16.0 [95% CI = 15.3–16.7], p = .001). However, their clinical improvement was comparable to that of patients with one or zero CMCs (predicted change in anxiety symptoms = −3.9 versus −4.1 at 6 months, −4.6 versus −4.4 at 12 months, −4.9 versus −5.0 at 18 months; predicted change in anxiety-related disability = −6.4 versus −6.9 at 6 months, −6.9 versus −7.3 at 12 months, −7.3 versus −7.5 at 18 months). The only specific CMC with a detrimental effect was migraine, which was associated with less improvement in anxiety symptoms at 18 months (predicted change = −4.1 versus −5.3). CONCLUSIONS: Effectiveness of the anxiety intervention was not significantly affected by the presence of multiple CMCs; however, patients with migraine displayed less improvement at long-term follow-up.

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