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

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Performance Characteristics of Self-report Instruments for Diagnosing Generalized Anxiety and Panic Disorders in Primary Care: A Systematic Review (August 2011)

Principal Investigator: Sophiya Benjamin, M.D.; Co-Investigators: Nathaniel R. Herr, Ph.D.; Jennifer McDuffie, Ph.D.; John W. Williams Jr., M.D., M.H.Sc

Evidence-based Synthesis Program (ESP) Center Durham VA Medical Center

Washington (DC): Department of Veterans Affairs; August 2011

Download PDF: Complete Report, Executive Summary, Report, Appendices

Summary / Overview

Generalized anxiety disorder (GAD) and panic disorder (PD) are two common mental illnesses that present in primary care clinics, often with physical symptoms that can inhibit appropriate diagnosis and treatment. Recognition of these disorders by primary care physicians is much lower than the expected rates�in part due to somatic presentations but also due to the lack of routine screening that is in place for some other mental illnesses. Patients with anxiety disorders are often high utilizers of health care resources, and when their anxiety disorders are not diagnosed and treated, they can frequently undergo more expensive testing to rule out medical causes.

Identification of accurate and feasible screening instruments for GAD and PD that have been validated in primary care settings have the potential to improve detection and facilitate treatment of these disorders within the primary care clinic, or to generate appropriate referral. Our report is a systematic review of the literture to evaluate the performance of self-report instruments used to diagnose GAD and PD in primary care settings.

Three key questions (KQs) guided this systematic review:

Key Question #1: In general medical patients with somatic symptoms, what are the performance characteristics (e.g., sensitivity, specificity) of self-report questionnaires for diagnosing generalized anxiety disorder or panic disorder? Key Question #2: For questionnaires evaluated in KQ 1, which measures are most feasible to use in primary care settings? Specifically, what is the reading comprehension level, time required to complete, response format, and compatibility with telephone administration? Key Question #3: For questionnaires evaluated in KQ 1, do the performance characteristics vary by gender, race, age group, or setting?