Diagnosis and Treatment of Depression and Anxiety in Rural and Nonrural Primary Care: National Survey Results

Data from the 2006 National Ambulatory Medical Care Survey were examined for differences in the diagnosis and treatment of depressive and anxiety disorders in rural and nonrural primary care settings. A sample of 11,658 patient visits to primary care providers was examined. ICD-9-CM codes were used to identify prevalence rates of depressive and anxiety disorder diagnoses. Treatments also were examined with criteria from American Psychiatric Association practice guidelines. No rural-nonrural differences were found in diagnosis rates for depression (about 3%) or anxiety disorders (about 1.5%). Approximately 67% of individuals with a depressive disorder and 36% of those with an anxiety disorder received a recommended treatment during the visit, with no rural-nonrural differences. Although few differences were found between rural and nonrural primary care visits, these data support the notion that anxiety and depression are underdiagnosed in primary care. Moreover, recognition and diagnosis often do not translate into adequate treatment in both rural and nonrural primary care settings.

BACKGROUND AND OBJECTIVES:Childhood and adolescent anxiety is generally associated with a varied somatic symptom pattern thought to reflect autonomic system activity. Few studies have examined the autonomic characteristics of generalized anxiety disorder (GAD). This omission is at odds with contemporary models of autonomic cardiovascular control. The current study aimed to find differences in autonomic functions between children with a diagnosis of childhood anxiety disorder and a control group using a case-control design.DESIGN AND SETTING:A cross sectional experimental study conducted in the years 2004-2005 in the psycho-physiology lab of a tertiary care multi-speciality teaching hospital.METHODS:Assessments were carried out using a semistructured interview, K-SADS (Schedule for Affective Disorders and Schizophrenia for Children and Adolescents); STAIC (State and Trait Anxiety Inventory for Children); CDRS (Childhood Depression Rating Scales); SCARED (Self-Report for Childhood Anxiety–Related Disorders). Autonomic reactivity was tested using the standard battery of tests.RESULTS:There were differences between 34 children and adolescents (age range, 8-18 years) with a diagnosis of childhood anxiety disorder and a control group of 30 age- and sex-matched subjects from a nearby school in autonomic activity and reactivity between individuals with anxiety disorder and non-anxious control subjects. Our finding is suggestive of autonomic rigidity or diminished physiologic flexibility in children with anxiety disorderCONCLUSIONS:The study is probably the first of its kind to look into the issue in detail using a detailed battery of the autonomic function tests, and the results are of help in better understanding the condition. The result of the present experiment supports differences in autonomic activity and reactivity between individuals with anxiety disorder and non-anxious control subjects.

INTRODUCTION: Psychological disorders are a critical issue in today’s modern society, yet it remains to be continuously neglected. Anxiety and depression are prevalent psychological disorders that persuade a generous number of populations across the world and are scrutinized as global problems. METHODS: The three-step methodology is employed in this study to determine the diagnosis of anxiety and depressive disorders. In this survey, a methodical review of ninety-nine articles related to depression and anxiety disorders using different traditional classifiers, metaheuristics and deep learning techniques was done. RESULTS: The best performance and publication trend of traditional classifiers, metaheuristic and deep learning techniques have also been presented. Eventually, a comparison of these three techniques in the diagnosis of anxiety and depression disorders has been appraised. CONCLUSION: There is further scope in the diagnosis of anxiety disorders such as social anxiety disorder, phobia disorder, panic disorder, generalized anxiety, and obsessive-compulsive disorders. Already, there has been a lot of work has been done on conventional approaches to the prognosis of these disorders. So, there is need to need to scrutinize the prognosis of depression and anxiety disorders using the hybridization of metaheuristic and deep learning techniques. Also, the diagnosis of these two disorders among academic fraternity using metaheuristic and deep learning techniques need to be explored.

Childhood abuse, depression, and anxiety in adult psychiatric outpatients.

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Background: The current diagnostic system for subjects at enhanced clinical risk of psychosis allows concurrent comorbid diagnoses of anxiety and depressive disorders. Their impact on the presenting high-risk psychopathology, functioning, and transition outcomes has not been widely researched. Methods: In a large sample of subjects with an At-Risk Mental State (ARMS, n = 509), we estimated the prevalence of DSM/SCID anxiety or depressive disorders and their impact on psychopathology, functioning, and psychosis transition. A meta-analytical review of the literature complemented the analysis. Results: About 73% of ARMS subjects had a comorbid axis I diagnosis in addition to the “at-risk” signs and symptoms. About 40% of ARMS subjects had a comorbid diagnosis of depressive disorder while anxiety disorders were less frequent (8%). The meta-analysis conducted in 1683 high-risk subjects confirmed that baseline prevalence of comorbid depressive and anxiety disorders is respectively 41% and 15%. At a psychopathological level, comorbid diagnoses of anxiety or depression were associated with higher suicidality or self-harm behaviors, disorganized/odd/stigmatizing behavior, and avolition/apathy. Comorbid anxiety and depressive diagnoses were also associated with impaired global functioning but had no effect on risk of transition to frank psychosis. Meta-regression analyses confirmed no effect of baseline anxiety and/or depressive comorbid diagnoses on transition to psychosis. Conclusions: The ARMS patients are characterized by high prevalence of anxiety and depressive disorders in addition to their attenuated psychotic symptoms. These symptoms may reflect core emotional dysregulation processes and delusional mood in prodromal psychosis. Anxiety and depressive symptoms are likely to impact the ongoing psychopathology, the global functioning, and the overall longitudinal outcome of these patients.

Objective: Prenatal cannabis use is associated with adverse pregnancy and neonatal outcomes, but research on its association with child anxiety and depressive disorders is limited. This study aimed to test the hypothesis that prenatal cannabis use is associated with child anxiety or depressive disorder diagnoses. Methods: Population-based retrospective birth cohort study of children (N=115,553) born between 1/1/2011-12/31-2017 to pregnant individuals (N= 97,376) universally screened for prenatal cannabis use. Cox proportional hazards regression models examined associations between cannabis use during early pregnancy (at ~8-10 weeks gestation based on self-reported use or a positive urine toxicology test for delta-9-tetrahydrocannabinol [THC]) and child anxiety and depressive disorders from ages 6 to 13 years based on diagnosis codes, adjusting for maternal sociodemographic and clinical characteristics. Results: The median (IQR) age at pregnancy onset was 31 (6) years. Most pregnancies (61.4%) were to non-White individuals; 4.4% screened positive for any cannabis use; 3.7% had a positive toxicology test and 1.9% self-reported use. Overall, 9,230 children were diagnosed with an anxiety disorder at (median (IQR)) age of 8 (3) years and 1,224 with depressive disorder at median (IQR) age of 9 (3) years. Prenatal cannabis use was associated with lower risk of child anxiety disorders (aHR:0.84:95%CI: 0.75-0.95) which remained significant when defined by a toxicology test but not when defined by self-report. Maternal prenatal cannabis use was not associated with child depressive disorders (aHR:1.15:95%CI: 0.85-1.54).Conclusions: Prenatal cannabis use during early pregnancy was not associated with an increased risk of offspring anxiety or depressive disorders.

Association of depression and anxiety disorders with outcomes after revascularization in chronic limb-threatening ischemia hospitalizations nationwide

Objective To help physicians improve detection rate of depressive and anxiety disorders by exploring the complaints of gastrointestinal(GI) outpatients with these disorders in the general hospitals. Methods A multicenter cross-sectional study was conducted from May to June in 2007.A total of 1995 subjects from 13 general hospitals in China were screened with the hospital anxiety and depression scale(HADS) and patient health questionnaire 15-item (PHQ-15). Meanwhile patients' complaints were recorded. Psychiatrists interviewed subjects scored ≥8 on HADS and made diagnoses by using the mini international neuropsychiatric interview(MINI). There were 323 outpatients diagnosed as depressive or anxiety disorders and 1287 outpatients without diagnosis of depressive or anxiety disorders. The complaints and PHQ-15 sores were compared between these two groups.The logistic regression analysis was used to determine the risk of having depressive or anxiety disorders with the number of complaints as an independent variable. Results Some symptoms between two groups were statistically significant, including weakness(34.1% vs 18.8%; χ2 =18.04; P=0.000), fatigue(9.6% vs 5.7%; χ2 =6.58, P=0.010)and insomnia(7.1% vs 3.4%; χ2=8.87; P=0.003). Logistic regression analysis showed that with each additional complaint, the odds for an interview-based diagnosis of depressive or anxiety disorders increased, the odds ratio(OR) was 1.12(95%CI, 1.08~1.17, P=0.000). In comparison to the outpatients without depressive or anxiety disorders, outpatients with these disorders signifycantly had higher PHQ-15 scores ((11.12±4.92) vs (6.68±4.05); t=16.84, P=0.000). Conclusion The GI outpatients with depressive and/or anxiety disorders have worse mental heath and more complaints, compared to patients without these disorders.These results may help physicians to better identify depressive disorders and anxiety disorders. Key words: Gastrointestinal; Outpatients; Depression; Anxiety

Incompleteness and harm avoidance in OCD, anxiety and depressive disorders, and non-clinical controls

Textbook of Anxiety Disorders, 2nd ed.edited by SteinDan J. , HollanderEric , RothbaumBarbara O. . Washington, D.C., American Psychiatric Publishing, Inc., 2010, 822pp., $125.00.

Although there have been many changes in the diagnosis of anxiety and depressive disorders in the past 20 years there have been few comparative enquiries into the clinical outcome of greater diagnostic categories. We therefore compared the outcome of all studies which compared the outcome of specific anxiety and depressive disorders using the standard procedures of systematic review. A Medline search was carried out of all studies comparing the outcome of anxiety and depressive disorders or mixed anxiety--depressive disorders in which information was available separately for each disorder. Eight studies satisfied the search criteria (all involving a period of observation of two years or greater); only one of these included randomisation of treatment and comparison between specific anxiety disorder outcome. There was a somewhat better outcome in patients with depressive disorders compared with anxiety ones, and strong evidence that both anxiety and depressive disorders singly had better outcomes than comorbid mixed disorders. Comorbid anxiety--depressive disorders have a poor outcome compared with single anxiety and depressive disorders, and there is some evidence that anxiety disorders have a worse outcome than depressive ones.

COVID-19 is associated with increased risks for mood or anxiety disorders, but it remains uncertain how the association evolves over time or which patient groups are most affected. We conducted a retrospective cohort study using a nationwide database of electronic health records to determine the risk of depressive or anxiety disorder diagnoses after SARS-CoV-2 infection by 3-month blocks from January 2020 to April 2022. The study population comprised 822,756 patients (51.8% female; mean age 42.8 years) with COVID-19 and 2,034,353 patients with other respiratory tract infections (RTIs) (53.5% female, mean age 30.6 years). First time diagnoses of depressive or anxiety disorders 14 days to 3 months after infection, as well as new or new plus recurrent prescriptions of antidepressants or anxiolytics, were compared between propensity score matched cohorts using Kaplan-Meier survival analysis, including hazard ratio (HR) and 95% confidence interval (CI). Risk of a new diagnosis or prescription was also stratified by age, sex, and race to better characterize which groups were most affected. In the first three months of the pandemic, patients infected with SARS-CoV-2 had significantly increased risk of depression or anxiety disorder diagnosis (HR 1.65 [95% CI, 1.30-2.08]). October 2021 to January 2022 (HR, 1.12 [95% CI, 1.06–1.18]) and January to April 2022 (HR, 1.08 [95% CI, 1.01–1.14]). Similar temporal patterns were observed for antidepressant and anxiolytic prescriptions, when the control group was patients with bone fracture, when anxiety and depressive disorders were considered separately, when recurrent depressive disorder was tested, and when the test period was extended to 6 months. COVID-19 patients ≥65 years old demonstrated greatest absolute risk at the start of the pandemic (6.8%), which remained consistently higher throughout the study period (HR, 1.20 [95% CI, 1.13–1.27]), and overall, women with COVID-19 had greater risk than men (HR 1.35 [95% CI 1.30–1.40]).

Objective: to discuss problems of diagnostics and psychopharmacotherapy of associated depressive disorders and anxiety circle disorders.Material and methods.The article is an analysis of a clinical case with the use of clinical and catamnestic method.Results. Diagnostics of Generalized Anxiety Disorder, issues of its comorbidity with other mental disorders including anxiety and depressive disorders are discussed. The principles of panic disorder diagnosis are analyzed. Diagnostic criteria of associated anxiety and depression in ICD-10, DSM-5 and ICD-11 are considered. Modern approaches to the choice of therapeutic tactics in comorbidal anxiety and depression are given. The analysis of the patient’s treatment is carried out with the justification of the choice of drugs. The possibilities of combined therapy of associated anxiety and depression disorders using vortioxetine are demonstrated. Achievement of qualitative remission of mental disorder without residual symptomatology and full restoration of social functioning of the patient with associated depressive and anxious disorders is shown.Conclusion. The clinical case demonstrates a characteristic chronic fluctuating course of GTR both in combination with different depths of depression and with other anxiety disorders (panic attacks). Diagnostic difficulties and therapeutic possibilities of a patient with double diagnosis: Generalized Anxiety Disorder and Depressive Episode have been analyzed.

Anxiety and depressive disorders are common psychiatric conditions with high rates of co-occurrence. Although traditional cognitive-behavioral therapy (CBT) protocols targeting individual anxiety and depressive disorder diagnoses have been shown to be effective, such "single-diagnosis" approaches pose challenges for providers who treat patients with multiple comorbidities and for large-scale dissemination of and training in evidence-based psychological treatments. To help meet this need, newer "transdiagnostic" CBT interventions targeting shared underlying features across anxiety, depressive, and related disorders have been developed in recent years. Here we provide a rationale for and description of the transdiagnostic CBT model, followed by an overview of key therapeutic strategies included in transdiagnostic CBT protocols for patients with anxiety disorders and comorbid depression. We conclude with a brief review of the empirical evidence in support of transdiagnostic CBT for individuals with anxiety and depressive disorders and identify directions for future research.