Epidemiology and management of anxiety disorders in primary care

PhD project (3/4 yr research project leading to independent research at the doctorate level)

Nicola Wiles, David Kessler, Katrina Turner


Return to list

Rationale

Studies from the USA and Europe show that anxiety disorders are prevalent and disabling (1-4). However, there has been little research in UK primary care into anxiety disorders. Two studies have estimated the prevalence of anxiety disorders in UK primary care (5, 6) but neither distinguished between the sub-types of anxiety. Such data are need to inform the planning and provision of NHS services.

Anxiety may be under-diagnosed and under-treated in primary care. Two previous studies have examined detection of common mental disorders (CMDs) in the UK (7, 8) but neither distinguished between detection rates for anxiety and depression. Accurate estimates of the rate of GP detection of anxiety disorder in primary care attenders would, together with information on the barriers and facilitators to the identification of such disorders, provide a robust evidence base for promoting greater awareness of anxiety disorders.

Aims & objectives

Aims
1. To estimate the prevalence of anxiety disorders (& subtypes) in primary care attenders
2. To estimate the sensitivity, specificity and predictive values of general practitioner (GP) diagnoses of anxiety disorders
3. To identify barriers and facilitators to the identification of anxiety disorders in primary care
4. To describe outcomes for patients whose anxiety disorder is not identified by their GP
5. To describe the clinical management of those with anxiety disorders

Methods

A cross-sectional survey of primary care attenders will be used to estimate the prevalence of anxiety disorder (& sub-types), and provide data on the sensitivity, specificity and predictive values of GP diagnoses. A longitudinal phase will address the question of detection of anxiety disorders by GPs over time and will gather data on treatment and outcome.

As part of a mixed methods approach there will be a qualitative study focussing on the barriers and facilitators to the identification of anxiety, the management of anxiety disorders in primary care and the impact anxiety has on individual’s lives. It will involve semi-structured interviews with service users, primary health care practitioners and third sector personnel including IAPT practitioners. Interviews will focus on attitudes towards and knowledge about anxiety disorders, their detection and management, the importance of sub-types and distinguishing between anxiety and depression.

References

1.EMI. Act.Psych.Scand.2004;109:21-7.
2.Ansseau. Eur.Psych.2005;20:225-35.
3.Spitzer.JAMA.1995;274:1511-7.
4.Kroenke. Ann.Int.Med. 2007;146:317-25.
5.King. BrJPsych. 2008;192:362-7.
6.Martin-Merino. Fam.Pract. 2010;27:9-16.
7.Ronalds. BrJPsych. 1997;171:427-33.
8.Kessler. BMJ. 1999;318:436-40


Created on Oct. 6, 2016, 8:47 a.m.

Edit this page