Prevalence Of Generalized Anxiety Disorder In Family .
RESEARCHPrevalence of generalizedanxiety disorder in familypractice clinicsGeneralized anxiety disorder is a common mental health in general practice. The aims of this study are to determinethe prevalence of generalized anxiety disorder (GAD) among patients attending family practice clinics and its relationto socio-demographic factors and chronic diseases. A cross-sectional design was used on 811 patients over a twomonth period in family medicine clinics at a large teaching hospital in Jordan. This study utilized a self -administeredquestionnaire that included questions about socio-demographic factors, chronic diseases, and GAD 7-item (GAD7).Patients who were positively diagnosed to have anxiety were then interviewed using DSM-IV criteria to confirm thediagnosis. The prevalence of generalized anxiety disorder was 23.7%. Patients aged 36-45 were five times more likelyto have anxiety than other age groups. Women were twice as likely to have GAD as compared to men. Illiterate patientswere more likely to have this disorder than others. Patients with a positive family history of anxiety were more diagnosedwith GAD than patients with a negative family history, and patients with asthma or arthritis were more likely to developGAD than other chronic conditions. The prevalence of GAD among patients attending family medicine clinics is relativelyhigh and is associated with socio-demographic factors and chronic diseases, which necessitate enhancing awareness ofthe prevalence, diagnosis and management of generalized anxiety disorders among family practitioners.Keywords: Generalized anxiety disorder, family practice, chronic diseasesIntroductionGeneralized anxiety disorder (GAD) is oneof the most common mood disorders and ischaracterized by periods of increased worry andanxiety for a minimum of 6 months associatedwith at least three other symptoms of thefollowing: restlessness, muscle tension, sleepdisturbance, irritability, difficulty concentrating,and fatigue [1].The prevalence of GAD in the primary caresetting is variable worldwide and estimated torange between (2.4 %-31.2 %) [2-4]. GAD waslinked to many contributing factors based onmany studies, such as age [5], gender [6], level ofeducation, marital status, family income, livingplace and religious views [7], each of which wasfound to affect the probability of getting GADin a person's life time expectancy [2].Patients with GAD usually become chronicsufferers as they may have their symptomsfor many years before being diagnosed andmanaged [8]. Many studies showed that peopleaffected with GAD were lower producers in the945society and higher users of health care servicesthan other people not affected with GAD [911]. Patients with GAD usually present withsomatic symptoms, which are common initialpresentations. Examples of such symptomsare chest pain, fatigue, headache, insomniaand abdominal pain [12]. The most commonsomatic complaint was gastric related symptoms(14.6%) [13], resulting in difficult detectionamong primary care settings and only 10% ofthem presented to a psychiatrist.Anxiety disorders have been studied in thegulf area [14,15], while locally in Jordan surveyswere done regarding panic disorder [16] anddental anxiety disorder [17] This is the firststudy that addresses the prevalence of GAD infamily medicine practice (FMP) ,the aim of thisstudy is to find the prevalence of GAD and itsassociation with socio-demographic variablesand common chronic diseases.Farihan F Barghouti1,Amina I Al Masalha1,Heba Fayyomi1,Latifa O Mari'e1 andMuayyad M Ahmad2*Department of Family and CommunityMedicine, The University of Jordan1Department of Clinical Nursing,School of Nursing, The University ofJordan: Amman 11942, Jorda2*Author for correspondence:mma4jo@yahoo.comMethodsThis cross –sectional study was conductedon 811 patients aged 16 and older attendingClin. Pract. (2018) 15(SII), 945-951ISSN 2044-9038
RESEARCHMuayyad M Ahmad(FMP) to receive health care for various reasons,in which verbal consent was taken.Data were collected over two month’sduration starting form the first of January2015 to the end of February 2015 at thefamily medicine practice. This practice is atraining walk-in clinics for all chronic and acuteconditions that serve medically insured patientsfrom Amman and surrounding governorates.The study was approved by the ethical scientificresearch committee at the faculty of medicineand from the ethical committee at the hospitalwhere the study was conducted.A self-administered validated questionnairewritten in Arabic was given to patients whoare willing to participate, we excluded patientswho are on treatment for anxiety disordersand patients who are mentally incompetent,the process of questionnaire distribution andcompletion of data were supervised by a staffnurse and two medical students.The questionnaire consists of threeparts, a socio-demographic part, and a partregarding chronic illnesses (diabetes mellitus,hypertension, bronchial asthma, chronicobstructive pulmonary disease (COPD),rheumatologic diseases, thyroid disease andpsychiatric illnesses). The third part is GAD7,which is an internationally recognized andvalidated screening tool for [18].All participants that scored 10 or moreon GAD7 were labeled "positive" and wereinterviewed by one of the three senior familymedicine residents ( who undertake incentiveshort course in psychiatry) ,to confirm thediagnosis using DSMIV criteria.Any participant that did not meet DSMIVcriteria for GAD7 was considered negativefor GAD7 regardless of GAD7 results. Thequestionnaire was reviewed for content validityand was pretested for language simplicity andclarity. Reliability was tested on 80 patientswho were not part of the study sample prior tostarting data collection.Statistical analysis was done using StatisticalPackage for Social Sciences (SPSS-IBM,version 25) to analyze sample characteristicsin percentage value, the analyses of risk factorsassociated with anxiety were performed bycomparing individuals with positive anxietydiagnosis on DSM-IV on demographics and946comorbid conditions. Multiple-group logisticregressions were used to examine the variablesof the study, which have three or more uniquevalues; whereas binary logistic regressionswere used when the dependent variables haveonly two groups. With multinomial logisticregression, the assumption is that the odds ofpreferring one alternative are independent ofother alternatives in the variable. Furthermore,when the number of groups is K, the numberof independent binary choices is K-1. Morespecifically, the possible pairs of comparisonsin the age groups are five. In addition, thegroup with the highest number is chosen as thereference alternative in each variable. However,when the alternative within the groups arepositive or negative, then the negative one waschosen as the reference group, using odds ratio(OR) and statistical significance of p-value .05ResultsThe total number of participants in thesample was 811. Women were more than men573 versus 238. The age group 36-45 was themost frequent in our sample 218(26.9%). Thosewho were married were more frequent (70.2%).Majority of patients were of low income(less than 500Jordanin dinars) (57.2%). Themajority of the sample had a bachelor degree ordiploma n 435 (53.6%). Only 70 participants(8.6%) had a family history of anxiety. Only84 participants (10.4%) had diabetes. Onehundred fifty-five (19.1%) had hypertension.People with cardiovascular disease comprised3.1% of the sample. Those who had asthma werecomprised 11.1% of the sample. People witharthritis accounted for 11.5 % of the sample.About 15.4% of the sample had dyslipidemia.Only three participants had depression andtwelve had gastrointestinal disease (TABLE 1).The prevalence of generalized anxietydisorder using GAD7 is found to be 23.7 % inour sample. Patients with positive generalizedanxiety diagnosis on DSM-IV were 137 (17%).TABLE 2 shows the relationship betweensocio-demographic variables and chronicillnesses with DSMIV anxiety status.The possibility of anxiety occurrence isalmost five times more likely among individualswithin the age groups 36-45 as compared toabove 65 years (p 0.05). Males are less likelyto have anxiety in comparison to females (p 10.4172/clinical-practice.1000432Clin. Pract. (2018) 15(SII)
Prevalence of generalized anxiety disorder in family practice clinicsTABLE 1: Sample -65 65GenderMaleFemaleMarital statusSingleMarriedDivorce, separatedWidowIncome 500500-1000 1000EducationIlliterateElementary or middleSecondaryBSc or diplomaMSC or PhDFamily history of scular esNo0.002), odds ratio (OR) .48 (95%CI .30-.77).Illiterate individuals are three times more likelyto develop anxiety than educated people OR3.43 (95%CI 1.06-11.09) (p .05) as comparedto those with Bachelor degree and diploma.Patients with family history of anxiety werealmost two times and a half more liable tohave anxiety than patients with negative familyClin. Pract. (2018) 15(SII)RESEARCHTotal (N 811)No (%)152 (18.7)187 (23.1)218 (26.9)128 (15.8)89 (11.0)37 (4.6)238 (29.3)573 (70.7)201 (24.8)569 (70.2)17 (2.1)24 (3.0)464 (57.2)292 (36.0)55 (6.8)12 (1.5)88 (10.9)222 (27.4)435 (53.6)54 (6.7)70 (8.6)735 (90.6)84 (10.4)727 (89.6)155 (19.1)656 (80.9)25 (3.1)786 (96.9)90 (11.1)721 (88.9)93 (11.5)718 (89.5)125 (15.4)686 (84.6)history of anxiety. A p .001, with OR 2.47(95%CI 1.44-4.25). Participants with historyof asthma were almost two times to suffer fromanxiety than who are not asthmatic with p of.04, OR 1.71 (95%CI 1.01-2.87). Patient witharthritis were three times more likely to haveanxiety than normal ones. P .001, OR 3.25(95%CI 2.02-5.21),10.4172/clinical-practice.1000432947
Muayyad M AhmadRESEARCHTable 2: Analyses of socio-demographic variables with DSM-IV anxiety status.VariablesDSM-IV (N 137)Odd ratio95%confidence intervalNo (%)p-value(OR)95% CIAge.68.40-1.1715-2524 (17.5).1726-3532 (23.4).26.75.46-1.2447 (34.3)36-45 (reference).60.33-1.0846-5518 (13.1).0956-6514 (10.2).25.68.35-1.31.04. 21. 05-.90 652 (1.5)GenderFemale112 (81.8)Male25 (18.2). 002.4830-.77Marital statusSingle.12.69.43-1.10Married26 (19.0)101 (73.7)(reference).99.99.28-3.52Divorce,3 (2.2).77-4.721.91separated7 (5.1).16WidowIncome 500 (reference)87 (63.5)500-100045 (32.8).24.79.53-1.17 10005 (3.6).08.43.17-1.12EducationIlliterateElementary or5 (3.6).043.431.06-11.09middle22 (16.1).091.60.93-2.75Secondary31 (22.6).28.78.50-1.23BSc or diploma75 (54.7)(reference)4 (2.9).07.38.14-1.10MSC or PhDFamily historyanxiety22 (16.1).0012.471.44-4.25YesDMYes15 (10.9).801.08.60-1.95BPYes31 (22.6).251.30.83-2.02CVDYes7 (5.1).141.96.80-4.79Asthma.04Yes22 (16.1)1.711.01-2.87ArthritisYesDyslipidemiaYes33 (24.1).0013.252.02-5.2125 (18.2).31.78.48-1.27DiscussionIn this study we found that the prevalenceof generalized anxiety disorder using theGAD7 scale is 23.7%, which is relatively highin comparison to previous studies [2,3] andlower than what other researchers found thatgeneralized anxiety disorder is commonly seenin primary care settings [4,19,20]. This high948prevalence in our patients could be attributedto many factors. First, this center is located ina country whose political surroundings arequite labile and a difficult economic statusthat could influence the Jordanian peopleon a psychological level. On the other hand,most patients attending our family practice aregovernmentally insured with low income, and10.4172/clinical-practice.1000432Clin. Pract. (2018) 15(SII)
Prevalence of generalized anxiety disorder in family practice clinicspeople with low income usually are at higherrisk to suffer from anxiety [21].In this study we accomplished that theprevalence of GAD varies according to age, itwas five times higher among patients of 3645of age as compared to other age groups. Thisvariation was comparable to other studies [5,22].This result can be attributed to the stressfulfactors that tend to cluster in this age group,including work and parenting responsibilities[23]. Patients that present to primary careclinics tend to be middle aged, as it could bemore difficult for elderly patients to present toclinics, either for health related reasons or otherco-morbidities or due to the denial of having ahealth issue. In addition, elderly patients mightbe suffering from anxiety or depression whichwould prevent them from seeking healthcarein the first place [22] , or they could have beentreated for GAD which could lower the numberof patients diagnosed with it.5 In our studyGAD was more prevalent in women, this resultwas consistent with other studies [6,24].We also found that people with low levelof education were more likely to suffer fromanxiety than highly educated people, which iscomparable to other studies [25]. Locally inJordan, a survey was done by The JordanianMinistry of Labor in 2007-2011 which showedthat people who had low level of education weremostly unemployed [26] and the unemployedusually have a lower income which put them atrisk of suffering from anxiety [21].Studies showed that mental disordersincluding GAD can be associated with chronicillnesses and cause serious consequences towork loss or absence [27,28]. In our study, weevaluated the relationship between GAD7 andeach of hypertension, diabetes, dyslipidemia,asthma, arthritis and CVD, yet we found nosignificant association except for a history ofarthritis and asthma.Rheumatoid arthritis (RA) is a severedisabling disease; hence a high level of anxietyis not unexpected. Patients with rheumatologicdisorders are common sufferers from anxiety.This might be attributed to the rheumatologicdisease itself or its complications such as jointdeformity and physical impairment [29].Patients with rheumatologic disorderscommonly present to their rheumatologyspecialists whose focus is on the disease itselfeven though it is important to take a holisticapproach to the patient and consider andClin. Pract. (2018) 15(SII)RESEARCHmanage the psychological association suchas anxiety and depression, which could havea significant impact on those patients [30].Regarding asthma and anxiety, studies showedthat a higher degree of psychosocial stressorswere associated with higher incidence of atopicdiseases like asthma [31].The cause for this relation can be referredto environmental factors; families with stressfulenvironment and low social support are morelikely to have children with asthma and itsphysical and psychological complications [32].The underlying biologic mechanisms betweenpsychological factors and asthma are not clear.Some suggest that neuro-immunomodulatorymechanisms are responsible [33]. Inaddition, vagus nerve stimulation can cause apsychological influence leading to upper airwayconstriction [34].We found that patients with a positivefamily history of anxiety disorder have a strongrisk of suffering from GAD. The mechanismbehind this association warrants more studies,the insecure environment for children of parentswith anxiety disorder can put them in a placewhere they cannot cope with stress during theiradulthood and turn into having a generalizedanxiety disorder, this also was supported inanother study that found a good a associationbetween having a family member with anxietydisorder and developing GAD [35].This study has limitation, the questionnaireused in this study contained self-reported dataand the validity of self-reported data has beencalled for question by some authors. Also thisstudy is cross sectional design which limits thecausal references that can be made. Furthermore,we recommend for next studies to measure stresslevel among participants.ConclusionOur study showed that the prevalenceof GAD in Jordan is relatively high, whichmeans that effort must be taken to increase theawareness of its high prevalence, associated sociodemographic factors and chronic diseases andsubsequently diagnose and treat those patientswho attend primary care centers. Further studiesare needed to determine whether diagnosis andintervention for GAD in primary care settingcan outcome and reduce cost to our healthcaresystem.Conflict of interest: The authors declareno conflict of interest in this study.10.4172/clinical-practice.1000432949
RESEARCHMuayyad M AhmadReferencesDSM-IV-TRDiagnosticandStatistical manual of mental disorders:text revision, 4th ed. Washington:American psychiatric association (2000).Kroenke K, Spitzer RL, WilliamsJB. Anxiety disorders in primary care:prevalence, impairment, comorbidity,and detection. Ann. Intern. Med. 146(5),317-325 (2007).Leray E, Camara A, Drapier D,et al. Prevalence, characteristics andcomorbidities of anxiety disorders inFrance: results from the "Mental Healthin General Population" survey (MHGP).Eur. Psychiatry. 26(6), 339-345 (2011).Vermani M, Marcus M, KatzmanMA. Rates of detection of mood andanxiety disorders in primary care: adescriptive, cross-sectional study. Prim.Care Companion CNS. Disord. 2011,13(2).Brenes GA, Knudson M, McCallWV, et al. Age and racial differencesin the presentation and treatment ofGeneralized Anxiety Disorder in primarycare. J. Anxiety. Disord. 22(7),11281136 (2008).Wittchen HU. Generalized anxietydisorder: prevalence, burden, and costto society. Depress. Anxiety. 16(4), 162171 (2002).Qin X, Phillips MR, Wang W, et al.Prevalence and rates of recognition ofanxiety disorders in internal medicineoutpatient departments of 23 generalhospitals in Shenyang, China. Gen.Hosp. Psychiatry. 32(2), 192-200(2010).Bruce SE, Yonkers KA, Otto MW, etal. Influence of psychiatric comorbidityon recovery and recurrence in generalizedanxiety disorder, social phobia, and panicdisorder: a 12-year prospective study.Am. J. Psychiatry. 162(6), 1179-1187(2005).perspective: a valid diagnostic entity?Acta Psychiatr. Scand. 101(1), 29-36(2000).Weiller E, Bisserbe JC, Maier W,Lecrubier Y. Prevalence and recognitionof anxiety syndromes in five Europeanprimary care settings. A report from theWHO study on Psychological Problemsin General Health Care. Br. J. Psychiatry.1998(34),18-23 (1998).Kroenke K, Spitzer RL, Williams JB,et al. Physical symptoms in primary care.Predictors of psychiatric disorders andfunctional impairment. Arch. Fam. Med.3(9), 774-779 (1994).Souêtre E, Lozet H, Cimarosti I, etal. Cost of anxiety disorders: impactof comorbidity. J. Psychosom. Res.38(Supp1), 151-160 (1994).Qureshi NA, Al-Habeeb TA, AlGhamdy YS, Magzoub ME, van derMolen HT. Psychiatric co-morbidity inprimary care and hospital referrals, SaudiArabia. East Mediterr. Health J. 2001,7(3), 492-501 (2001).El-Rufaie OE, Al-Sabosy MA, BenerA, Abuzeid MS. Somatized mentaldisorder among primary care Arabpatients: I. Prevalence and clinical andsociodemographic characteristics. J.Psychosom. Res. 46(6), 549-555 (1999).RA Suleiman, TFE Ahmad. Presenceof Panic Disorder Among PatientsReferred to Psychiatry. Arab Journal ofPsychiatry. 4 (1993).Ayasrah S, Ahmad M. l Anxiety Levels amongCardiac Catheterization Patients: ARandomized Clinical Trial. Res. Theory.Nurs. Pract. 30 (1), 70-84 (2016).Spitzer RL, Kroenke K, Williams JB,Löwe B. A brief measure for assessinggeneralized anxiety disorder: the GAD-7.Arch. Intern. Med. 166(10),1 092-1097(2006).Kessler RC, DuPont RL, Berglund P,Wittchen HU: Impairment in pure andcomorbid generalized anxiety disorderand major depression at 12 months intwo national surveys. Am. J. Psychiatry.156(12), 1915-1923 (1999).Sansone RA, Hendricks CM, GaitherGA, Reddington A. Prevalence of anxietysymptoms among a sample of outpatientsin an internal medicine clinic: a pilotstudy. Depress. Anxiety. 19(2), 133-136(2004).Maier W, Gänsicke M, FreybergerHJ, Linz M, Heun R, Lecrubier Y.Generalized anxiety disorder (ICD-10)in primary care from a cross-culturalKristen Hope Demertzis M, MichelleG. Craske P. Anxiety in primary care.Current Psychiatry Reports 8(4), 291297 (2006).9501
anxiety diagnosis on DSM-IV were 137 (17%). TABLE 2 shows the relationship between socio-demographic variables and chronic illnesses with DSMIV anxiety status. The possibility of anxiety occurrence is almost five times more likely among individuals within the age groups 36-45 as compar
F41.1 Generalized anxiety disorder F40.1 Social phobia F41.2 Mixed anxiety and depressive disorder F33 Recurrent depressive disorder F43.1 Post-traumatic stress disorder F60.31 Borderline personality disorder F43.2 Adjustment disorder F41.0 Panic disorder F90 Hyperkinetic (attention deficit) disorder F42 Obsessive-compulsive disorder
Perinatal Mood, Anxiety, Obsessive, & Trauma related Disorders # Psychosis- Thought Disorder or Episode 1-2% # Major Depressive Disorder 21% # Bi-Polar Disorder 22% of PPD # Generalized Anxiety 15% # Panic Disorder 11% # Obsessive Compulsive Disorder 5-11% # Post Traumatic Stress Disorder 9% Pregnancy and the First year .
Generalised anxiety disorder (GAD) Obsessive compulsive disorder (OCD) Health Anxiety Panic disorder Post traumatic stress disorder (PTSD) Social anxiety disorder Specific phobias Separation anxiety disorder
If you have social anxiety disorder, there are a number of strategies that you can use to learn to overcome your fear of social situations. For social anxiety disorder, tools in the toolbox include: TOOL #1: Observing your social anxiety. An important first step in learning to manage social anxiety involves better understanding your social anxiety.
Anxiety and sleep questionnaires Spielberger State-Trait Anxiety Inventory The STAI [35] assesses self-reported anxiety (both state and trait anxiety) using a validated 40-item Likert scale questionnaire. State anxiety reflects transient (i.e., current moment) emotional anxiety due to situational stress. Trait anxiety assesses an individual’s .
eye movement desensitization and reprocessing / pathological worry / generalized anxiety disorder INTRODuCTION Generalized anxiety disorder (GAD) is a com-mon psychiatric disorder [1]. According to the Diagnostic and Statistical Manual of Mental Dis-orders (DSM-5), the 12-month prevalence for GAD across the world ranges from 0.4 to 3.6%.
Anxiety & Phobia Workbook (The) Bourne Ph.D., Edmund J. Make a full and lasting recovery from generalized anxiety disorder, social anxiety, specific phobias, panic attacks, obsessive-compulsive disorder, and other anxiety-related issues. Assisted Outpatient Treatment – One Family’s Journey ? ? Atlas of Depression ? ? Attacking Anxiety .
Prevalence Generalized Anxiety Disorder (GAD) 5.1% lifetime (Kessler et al, 1996) possibly higher Most common anxiety disorder in primary care (Ballenger et al, 2001) Major Depressive Disorder (MDD) 16.2% lifetime (Kessler et al, 2008) Co-morbid GAD and MDD 62% of those with GAD have had an episode of MDD (Wittchen et al, 1994 59% of t
