Primary care studies anxiety disorders

Shah and Jenkins (2000) in a review of mental health economic studies from around the world identified 40 cost-of-illness studies, of which five covered all disorders, one neuroses, two panic disorders and one anxiety. All were from developed countries. There were numerous cost-effectiveness studies but none involving the anxiety disorders specifically. One study in the UK examined the cost-benefit analysis of a controlled trial of nurse therapy for neurosis in primary care (Ginsberg et al, 1984). 

Evaluation of the economics of mental illness in primary care is an ongoing initiative of the UK Department of Health (Lloyd and Jenkins, 1995). A similar American study in Washington State included sub-threshold anxiety or depression, but these imposed relatively little economic load compared with disorder-level anxiety or depression (Simon et al, 1995). Mental health treatment accounted for only a small part of overall utilization, approximately 5%. Nevertheless, most patients with anxiety or depressive disorders showed considerable improvement. This was accompanied by only modest reductions in cost. 

An Australian study compared medical utilization and costs in patients with panic disorder, those with social anxiety disorder, and a control group (Rees et al, 1998). Almost half of the panic disorder patients had seen a primary-care physician more than seven times over a 6-month period, compared with 7% of the social phobic patients and none of the control group. The mean costs were A 150, A 60 and A 20 respectively. The patients with panic disorder were treated with antidepressants (39%), benzodiazepines (15%), relaxants (12%), beta-blockers (7%) and other medication (7%). Twenty per cent received no medication. Patients with panic... 

N. Sartorium, T. B. Ustun, Y. Lecrubier, et al. Depression co-morbid with anxiety results from the WHO study on psychological disorders in primary health care, Br. J Psychiatry, 169 (suppl 30), 38 (1996). 

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