SUBSYNDROMAL (MIXED) ANXIETY-DEPRESSION IN PRIMARY-CARE

Objective: To determine in primary care settings the prevalence, clini cal characteristics, and functional status of patients who have anxiou s and depressive symptoms who did not meet diagnostic criteria for maj or mood and anxiety diagnoses. Design: Patients were screened with the General Health Questionnaire and interviewed if they exceeded the cut off score of 5. Also, one patient whose score was below the cutoff was interviewed for every two patients whose scores were above the cutoff . Setting: Five primary care sites in the United States, France, and A ustralia. Patient: Two hundred sixty-seven patients presenting to thei r primary care physicians for general medical care and follow-up. Meth ods: Structured diagnostic interviews were conducted and ratings of an xiety, depression, and functional impairment were obtained by trained interviewers. Results: After adjustments for sampling, 5% of the patie nts had symptoms of anxiety, depression, and functional impairment, wi thout meeting formal criteria for a major DSM-III-R mood or anxiety di sorder. This was comparable to the prevalence of diagnosable DSM-III-R mood disorders but only one-fourth the prevalence of diagnosable anxi ety disorders. These patients who had subsyndromal symptoms had rates of lifetime psychiatric disorders and prior psychiatric treatment comp arable to those of patients meeting criteria for major mood and anxiet y disorders. Conclusion: The comparable rates of symptomatic distress, functional impairment, and prior psychiatric illness and treatment su ggest that patients with subsyndromal anxiety and depressive symptoms warrant clinical recognition and possibly specific treatment.