Symptomatic severity of PRIME-MD diagnosed episodes of panic and generalized anxiety disorder in primary care

Abstract

Background: Panic disorder (PD) and generalized anxiety disorder (GAD) are often unrecognized by primary care physicians (PCPs). The Primary Care Evaluation of Mental Disorders (PRIME-MD) has been used as a case-finding instrument for depression. Yet, little is known on its usefulness as a case-finding tool for anxiety disorders within the context of a clinical trial.

Objective: To examine the: (1) completion rate of the PRIME-MD by patients approached to enroll in a treatment study for PD and GAD; (2) distribution of anxiety diagnoses generated; (3) severity of PD and GAD episodes thus identified; and (4) level of PCPs' agreement with these diagnoses.

Design: Cross-sectional interview.

Patients: Individuals aged 18 to 64 who presented for care at 4 primary care practices.

Measurements: The PRIME-MD, Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A), and the Panic Disorder Severity Scale (PDSS).

Results: Of the 6,700 patients who completed the PRIME-MD Patient Questionnaire (PQ), 2,926 (44%) screened positive for an anxiety disorder, and 1,216 (42%) met preliminary study eligibility and consented to the PRIME-MD Anxiety Module. Of these, 619 (51%) had either GAD (308), PD (94), or both (217) disorders. Later, 329 completed a telephone interview. Of these, 59% with GAD and 68% with PD reported moderate or greater levels of anxiety symptoms on the SIGH-A and PDSS, respectively, and PCPs agreed with the PRIME-MD diagnosis for 98% of these patients.

Conclusions: The PRIME-MD can efficiently screen patients for PD and GAD. Although patients thus identified endorse a wide range of anxiety symptoms, PCPs often agree with the diagnosis.

Figure 1

Recruitment.

Figure 2

Distribution of anxiety severity scores for patients completing a telephone interview by assessment measure and anxiety disorder. Moderate-to-severe levels of anxiety severity are to the right of the arrows. (A) Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A; range: 0 to 56). (B) Panic Disorder Severity Scale (PDSS; range: 0 to 28).