Characteristics and Predictors of Full and Partial Recovery From Generalized Anxiety Disorder in Primary Care Patients

Abstract

The current study examined the naturalistic course of generalized anxiety disorder (GAD) in a sample of 113 primary care patients across a 2-year period. Initial diagnoses were established using structured clinical interviews according to DSM-IV diagnostic criteria. Results indicated that the majority of patients meeting DSM-IV diagnostic criteria for GAD were still symptomatic to some degree after 2 years of follow-up. Rates of full and partial recovery from GAD, however, were found to be higher than those reported for previous studies of GAD in psychiatric patients. Diagnostic comorbidity, severity of psychosocial impairment, and gender were found to be significantly associated with achieving full or partial recovery from GAD. Psychiatric treatment was not found to be associated with time to full or partial recovery from GAD symptoms, likely due to a treatment-biasing effect. These results underscore that GAD is a chronic and persistent illness in primary care patients. KeywordsGAD; psychiatric treatment; GAD course; anxiety; primary careGeneralized anxiety disorder (GAD) is a highly prevalent mental illness with 1-year and lifetime prevalence rates in the general population at 3.1% and 5.1%, respectively . As many researchers have noted (e.g., Culpepper, 2002), GAD represents a particular problem in the primary care field, where GAD patients are frequently encountered but often unrecognized (Fifer et al., 1994; Niesenson et al., 1998;Wittchen et al., 2002). Anxiety disorder patients in general, and GAD patients in particular, are also among the highest utilizers of medical services (Greenberg et al., 1999;Katon et al., 1990;Rice and Miller, 1998;Roy-Byrne and Katon, 1997). Thus, studying GAD specifically within the primary care population is particularly timely and relevant. Despite the prevalence of GAD, few studies have examined the illness's natural course. Most of the data currently available on the course of GAD are retrospective and have come from epidemiological studies (e.g., Kessler et al., 1999;Wittchen et al., 1994) and/or from short-term follow-ups of patients involved in treatment studies (e.g., Mancusco et al., 1993;Rickels and Schweizer, 1993). One of the only naturalistic, prospective studies of the course of GAD conducted to date found low rates of recovery from GAD among psychiatric outpatients, with high rates of subsequent recurrence among those who do recover (Yonkers et al., 1996(Yonkers et al., , 2000. This same study identified better psychosocial functioning in general, and in specific functioning domains (e.g., relationships with spouse, and life satisfaction, etc.) as significant predictors of GAD recovery.While the results of the studies by Yonkers et al. (1996Yonkers et al. ( , 2000 provide important insights into the naturalistic course of GAD, several aspects of that study's sample need to be considered when interpreting the course findings. First, recruiting the GAD sample from psychiatric treatment settings may represent a significant departure from the typical GAD pat...

Gender Difference in Attentional Bias Toward Negative and Positive Stimuli in Generalized Anxiety Disorder

“…Women with GAD are more likely than men to be unemployed (Angst, Gamma, Baldwin, Ajdacic-Gross, & Rössler, 2009) or to be employed part-time rather than full-time (Steiner et al, 2005). Furthermore, longitudinal studies suggest that females with GAD have worse treatment outcome than do males (Rubio & López-Ibor, 2007), even when controlling for other factors such as depression (Rodriguez, 2006). On the other hand, men are significantly more likely than women to have a comorbid alcohol or substance use disorder and to report that their excessive worry leads to arguments and friction with relatives and friends (Vesga-López et al, 2008).…”

Prevalence and clinical characteristics of remission during treatment in generalized anxiety

“…Th is may partly explain the lower remission rate obtained, as older age is associated with poorer treatment outcome (Simon et al 2006). According to some studies, gender also tends to aff ect the course of generalized anxiety in that women are generally associated with lack of recovery (Rodriguez et al 2006). Yet, in the present study, no gender-related diff erences in remission rate were found.…”

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

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