Physician office visits of adults for anxiety disorders in the United States, 1985-1998

Abstract

Objective: To determine the number of physician office visits by adults in which an anxiety disorder diagnosis was recorded and rates of treatment during these visits.

Design: We used data from the 1985, 1993, 1994, 1997, and 1998 National Ambulatory Medical Care Surveys, which is a nationally representative series of surveys of office-based practice employing clustered sampling.

Setting: Office-based physician practices in the United States.

Participants: A systematically sampled group of office-based physicians.

Results: The number of office visits with a recorded anxiety disorder diagnosis increased from 9.5 million in 1985 to 11.2 million per year in 1993-1994 and 12.3 million per year in 1997-1998, representing 1.9%, 1.6%, and 1.5% of all office visits in 1985, 1993-1994, and 1997-1998, respectively. The majority of recorded anxiety disorder diagnoses were not for specific disorders, with 70% of anxiety disorder visits to primary care physicians coded as "anxiety state, unspecified." Visits to primary care physicians accounted for 48% of all anxiety disorder visits in 1985 and 1997-1998. Treatment for anxiety was offered in over 95% of visits to psychiatrists but in only 60% of visits to primary care physicians. Primary care physicians were less likely to offer treatment for anxiety when specific anxiety disorders were diagnosed than when "anxiety state, unspecified" was diagnosed (54% vs 62% in 1997-1998). Prescriptions for medications to treat anxiety disorders increased between 1985 and 1997-1998 while use of psychotherapy decreased over the same time period in visits to both primary care physicians and psychiatrists.

Conclusions: Although there is a large number of office visits with a recorded anxiety disorder diagnosis, under-recognition and under-treatment appear to be a continuing problem, especially in the primary care sector. Medication is being substituted for psychotherapy in visits to both psychiatrists and primary care physicians over time.

FIGURE 1

Proportion of visits with selected anxiety disorder diagnoses. Data are from the 1985, 1993, 1994, 1997, and 1998 National Ambulatory Medical Care Surveys using weights provided by the National Center for Health Statistics.

FIGURE 2

Proportion of anxiety disorder visits in each care sector. Data are from the 1985, 1993, 1994, 1997, and 1998 National Ambulatory Medical Care Surveys using weights provided by the National Center for Health Statistics.

FIGURE 3

Types of medications prescribed during office visits with an anxiety disorder diagnosis. Data are from the 1985, 1993, 1994, 1997, and 1998 National Ambulatory Medical Care Surveys using weights provided by the National Center for Health Statistics. Tricyclic agents include tricyclic and tetracyclic agents and monoamine oxidase inhibitors. Antianxiety agents include benzodiazepines and buspirone.