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.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • FUTURE RESEARCH
  • ABBREVIATIONS TABLE
• INTRODUCTION
  • BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • ANALYTIC FRAMEWORK
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KQ 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?
  • KQ 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?
  • KQ 3 For questionnaires evaluated in KQ 1, do the performance characteristics vary by gender, race, age group, or setting?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • STRENGTHS AND LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B STUDY SELECTION FORM
• APPENDIX C EXCLUDED STUDIES
• APPENDIX D DATA EXTRACTION FORM
• APPENDIX E CRITERIA USED IN QUALITY ASSESMENT
• APPENDIX F PEER REVIEW COMMENTS/AUTHOR RESPONSES

Medical Editor: Liz Wing, MA

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System, Durham, N.C., John W. Williams Jr., M.D., M.H.Sc, Director

Suggested citation:

Benjamin S, Herr NR, McDuffie J, Nagi A, Williams JW Jr. Performance Characteristics of Self-report Instruments for Diagnosing Generalized Anxiety and Panic Disorders in Primary Care: A Systematic Review. VA-ESP Project #09-010; 2011

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.