COMORBID ANXIETY DISORDER AND THE FUNCTIONING AND WELL-BEING OF CHRONICALLY ILL PATIENTS OF GENERAL MEDICAL PROVIDERS

Background: The comorbidity of psychiatric disorders with chronic heal th conditions has emerged as a topic of considerable clinical and poli cy interest, in part owing to the evidence that anxiety disorders them selves are associated with morbidity. However, the implications for he alth-related quality of life that result from anxiety disorders, which are comorbid to chronic medical or psychiatric illness, are not well understood, especially in primary care samples. Methods: A 2-year obse rvational study of 875 adult patients with hypertension, diabetes, hea rt disease, and current depressive disorder or subthreshold depression receiving care from general medical providers was conducted. The uniq ue effect of any comorbid anxiety disorder on functioning and well-bei ng (determined with the use of the 36-Item Short-Form Health Survey [S F-36]) was estimated, as well as the differential impact at baseline, 2-year follow-up, and change over time, of any comorbid anxiety disord er for patients with chronic medical conditions or depression. Results : Patients with comorbid anxiety who received general medical care had lower levels of functioning and well-being than those without comorbi d anxiety. These differences were most pronounced in mental health-rel ated quality-of-life measures and when anxiety was comorbid with chron ic medical conditions rather than with depression. Hypertensive and di abetic patients with comorbid anxiety were as debilitated as patients with depression or heart disease, and this low health-related quality of life persisted over time. Comorbid anxiety had less of an effect on patients with heart disease who already had a low health-related qual ity of life. Conclusion: The finding of substantial differences in the quality of life between hypertensive and diabetic patients with and w ithout comorbid anxiety disorder highlights the clinical and societal importance of identifying comorbid anxiety in these patients.