A new case-finding tool for anxiety: a pragmatic diagnostic validity study in primary care

Abstract

Objective: Anxiety is common in the community and in family practice (FP) patients. It is a treatable condition but often not diagnosed. The aim of this study was to determine the validity of two written questions to aid family physicians in the identification of anxiety. The first question asks the patient whether they have been worrying a lot during the past month; and the second question asks whether the patient would like help with this problem.

Methods: The study was a pragmatic cross sectional validity study conducted with 19 family physicians in six clinics in New Zealand. The outcomes were the sensitivity, specificity, and likelihood ratios compared with the HADS anxiety score > or = 11 as a gold standard.

Results: The study recruited 982 consecutive patients receiving no psychotropic drugs. The FP diagnosis had a sensitivity of 58% (95% CI 45% to 69%) and a specificity of 87% (95% CI 85 to 89). The worry question alone had a sensitivity of 76% (95% CI 64% to 85%) and a specificity of 82% (95% CI 79% to 84%). The positive likelihood ratio for patients wanting help today was 9.29 (95% CI 5.62 to 15.36). The likelihood ratio for patients worrying but not wanting help was 2.29 (95% CI 1.48 to 3.55). The likelihood ratio (negative) for those not worrying was 0.29 (95% CI 0.18 to 0.46).

Conclusions: The use of a case-finding question for anxiety and a question asking whether help is wanted increases the positive likelihood ratio indicating that the use of the two questions may aid family physicians in identifying cases of anxiety.