Do primary care patients think it is important to consider anxiety separately from depression?

Problem

Anxiety disorders are common, with a 40% increase in generalised anxiety disorder reported in the general population between 2007 and 2014. Despite this increase, GPs’ recording of anxiety disorders decreased between 1998 and 2008. This may be due to a reluctance to label patients with a formal anxiety disorder, or a tendency to record depression instead of anxiety, particularly if anxiety is comorbid with depression, which is often the case. We know little about whether patients think anxiety should be considered on its own. This study explored whether primary care patients thought GPs should consider anxiety separately from depression, when patients present with both.

Approach

In-depth qualitative interviews were conducted with 20 patients, purposively sampled from GP practices in Bristol, North Somerset, and South Gloucestershire. Interviews were held either in person or over the telephone. A topic guide was used to ensure consistency across the interviews. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Findings

Preliminary analysis of the data suggests that for those with long-term anxiety, and those with chronic co-morbid depression, GPs should discuss anxiety as a clearly distinct diagnosis, with consideration given to the causes, symptoms, impact on their life, and management. Anxiety was frequently felt to be a cause of depression, and patients highlighted the importance of early management of anxiety preventing later transition into depression. In addition, patients also felt that within society, and within primary care, anxiety is viewed as less serious than depression, yet it may be more disabling to patients than depression. Furthermore, receiving a diagnosis is just as important as the management of symptoms, particularly in terms of acceptance and readiness to engage with treatment. Non-specific symptom codes, such as ‘anxiousness’ can be unhelpful for patients, and can contribute to a lack of clarity in understanding their mental health.

Consequences

In order to continue providing patient-centred care, consideration and discussion of anxiety as a distinct disorder of importance that can exist alongside depression may improve patients' understanding of their mental health, increasing readiness to engage with treatment. For those with co-morbid depression, understanding the distinction between the disorders may encourage earlier management of anxiety, and reduce the likelihood of subsequent depressive symptoms. Furthermore, facilitating the conversation regarding the differences between the conditions may promote improved understanding and awareness of anxiety within society. In addition, consideration should be given to how anxiety is diagnosed and communicated to the patient during the consultation, with care taken over the use of non-specific symptom codes and how these are shared with patients.