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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3113 — Performance Characteristics of Self-report Instruments for Diagnosing Generalized Anxiety and Panic Disorders in Primary Care: A Systematic Review

Benjamin S, Durham VA Healthcare System; Herr NR, Duke University Medical Center; McDuffie JNagi A, and Williams JW, Durham VA Healthcare System;

Objectives:
Generalized anxiety disorder (GAD) and panic disorder (PD) are two common mental illnesses that present in primary care clinics, but recognition of these disorders by primary care physicians is much lower than the expected rates—in part due to the lack of routine screening common for other mental illnesses. The purpose of this study was to conduct a systematic review of the literture to evaluate the usability and performance of self-report instruments for GAD and PD in primary care settings.

Methods:
We searched MEDLINE® (via PubMed), PsycINFO®, and the Cochrane Library for peer-reviewed, English language articles comparing a self-report anxiety questionnaire to a criterion standard assessment for anxiety disorders. Investigator pairs screened studies for eligibility and abstracted data using structured data collection forms. Each study was assessed for risk of bias using the QUADAS instrument. Pooled analyses, using summary ROCs, were performed when appropriate.

Results:
The search yielded 2890 titles, of which 9 unique studies (of 8 instruments), involving 3642 subjects, met eligibility criteria. Seven of the 9 studies were judged to be low risk of bias. Among the five screening instruments for GAD, the GAD-7 performed the best (sensitivity 89%, specificity 82%), while among the six screening instruments for PD, the panic module of the Patient Health Questionnaire (PHQ) performed the best (sensitivity 80%, specificity 99%). One study assessed performance characteristics of the Brief Panic Disorder Scale by race, finding greater specific in Caucasians than among African Americans. None of the studies addressed differences in performance based on gender, age, or setting.

Implications:
A number of self-report questionnaires assess for common anxiety disorders, but each instrument has been evaluated in few studies; none were conducted in Veterans. These instruments appear feasible for use in primary care. Based on a single study, performance characteristics may vary by race.

Impacts:
Based on current evidence, the GAD-7 or PHQ are recommended to clinicians and programs such as the integrated mental health primary care service who wish to screen for anxiety disorders in primary care. We recommend additional studies in Veterans Affairs samples to evaluate performance characteristics and assess for race, age and gender effects.


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