Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1043 — Diagnostic Error among Veterans with Anxiety and Trauma-related Disorders

Lead/Presenter: Terri Barrera, COIN - Houston
All Authors: Barrera TB (Houston COIN) Kunik ME (Houston COIN) Stanley MA (Houston COIN)

Objectives:
Accurate diagnosis is foundational to evidence-based healthcare, and diagnostic errors can lead to improper treatment and adverse outcomes. In FY2015, 480,663 Veterans enrolled in the Veterans' Healthcare Administration carried a diagnosis of unspecified anxiety disorder. This non-specific diagnosis may be a barrier to receiving appropriate mental health services, given recent findings suggesting that only 32% of Veterans with unspecified anxiety received mental health services in the year following diagnosis as compared to 60-67% of Veterans diagnosed with specific anxiety or trauma-related disorders such as posttraumatic stress disorder (PTSD), panic disorder, generalized anxiety disorder (GAD), and social anxiety disorder (SAD). The goal of this study was to examine the rate of diagnostic error among Veterans diagnosed with unspecified anxiety disorder.

Methods:
We reviewed the medical records of 295 Veterans screened for inclusion in a trial of a skills-based intervention for late-life anxiety in primary care. Of these, 62 Veterans received an unspecified anxiety diagnosis in their medical record within the 2 years prior to screening. We then examined diagnostic data from the Structured Clinical Interview for DSM administered during study screening to determine whether Veterans met diagnostic criteria for a specific anxiety or trauma-related disorder.

Results:
Fewer than 2% of Veterans diagnosed with unspecified anxiety actually met diagnostic criteria for this disorder. Of the 62 Veterans who received an unspecified anxiety diagnosis in their medical record, 75% met diagnostic criteria for a specific anxiety or trauma-related disorder (GAD 44%, PTSD 37%, panic disorder 19%, SAD 19%).

Implications:
The majority of unspecified anxiety diagnoses are erroneous as fewer than 2% of Veterans diagnosed with unspecified anxiety actually meet diagnostic criteria for this disorder.

Impacts:
Improving the diagnostic process is a critical step in VHA's mission to deliver high quality Veteran-centered healthcare. The provision of high quality healthcare requires accurate and timely diagnosis. Clinical practice guidelines for treating unspecified anxiety disorder do not exist within or outside VHA, and evidence-based pharmacological and psychological treatment recommendations for anxiety and trauma-related disorders differ according to diagnosis. Thus, an erroneous diagnosis of unspecified anxiety disorder is a barrier to receipt of appropriate evidence-based care for specific disorders such as PTSD, GAD, and panic disorder. The data from this study highlight the need to improve the diagnostic process for Veterans with anxiety and trauma-related disorders to ensure access to appropriate evidence-based treatments.