Psychiatric treatment in primary care patients with anxiety disorders: a comparison of care received from primary care providers and psychiatrists

Abstract

Objective: This study examined psychiatric treatment received by primary care patients with anxiety disorders and compared treatment received from primary care physicians and from psychiatrists.

Method: Primary care patients at 15 sites were screened for anxiety symptoms. Those screening positive were interviewed to assess for anxiety disorders. Information on psychiatric treatment received and provider of pharmacological treatment were collected.

Results: Of 539 primary care participants with at least one anxiety disorder, almost half (47.3%) were untreated. Nearly 21% were receiving medication only for psychiatric problems, 7.2% were receiving psychotherapy alone, and 24.5% were receiving both medication and psychotherapy. Patients receiving psychopharmacological treatment received similar medications, often at similar dosages, regardless of whether their prescriber was a primary care physician or a psychiatrist. One exception was that patients were less likely to be taking benzodiazepines if their provider was a primary care physician. Those receiving medications from a primary care provider were also less likely to be receiving psychotherapy. Overall, patients with more functional impairment, more severe symptoms, and comorbid major depression were more likely to receive mental health treatment. Members of racial/ethnic minority groups were less likely to be treated. Frequently endorsed reasons for not receiving pharmacological treatment were that the primary care physician did not recommend it and the patient did not believe in taking medication for emotional problems.

Conclusions: Nearly half the primary care patients with anxiety disorders were not treated. However, when they were treated, the care received from primary care physicians and psychiatrists was relatively similar.

Figure 1. Reasons given for not receiving pharmacotherapy (N=119)

Figure 2. Reasons given for not receiving psychotherapy (N=153)