Functional Impact and Health Utility of Anxiety Disorders in Primary Care Outpatients
Jan 1, 2005
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Most mental health care—especially care for common disorders such as anxiety and depression—in the United States is provided by primary care physicians rather than mental health specialists. Although efforts to detect and treat depression have received much attention in the last ten years, relatively little research has been done on anxiety disorders in primary care settings, despite the fact that anxiety disorders are encountered in primary care even more frequently than depression. Primary care providers would benefit from a clearer understanding of these disorders and the burden they impose on a patient's overall health. A team from RAND and a group of major universities examined the impact of anxiety disorders (posttraumatic stress disorder, panic disorder, and social phobia) on patient health among 480 adult patients who had visited a primary care physician.
|Patient Condition||Mean Health Utility|
|No depressive disorder or anxiety||.80|
|Irritable bowel syndrome||.67|
|Lower back pain||.66|
|Depressive and anxiety disorder||.59|
|Chronic obstructive pulmonary disease||.58|
NOTES: Mean health utility is a measure of overall health quality. 1.0 = optimal health. The figures have been adjusted for other patient characteristics.
The study found that patients with anxiety disorders were likely to have both physical and mental impairment and overall poor quality of health. The table compares the health impact of anxiety disorders with that of other conditions, using a measure of health quality called "mean health utility." A rating of 1.0—the highest possible rating—is equivalent to optimal health. The comparison shows that the impact of an anxiety disorder is roughly equivalent to that of irritable bowel syndrome, a serious chronic condition. The presence of both anxiety disorder and depressive illness had roughly the same health impact as chronic obstructive pulmonary disease. The study also found that anxiety disorders affect productivity: Patients with an anxiety disorder were significantly more likely to have missed at least one day of work in the previous month.
These findings suggest that effective interventions for anxiety disorders at the primary care level could result in substantial health and productivity improvements.
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