Probability and predictors of first treatment contact for anxiety disorders in the United States: analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

J Clin Psychiatry. 2013 Nov;74(11):1093-100. doi: 10.4088/JCP.13m08361.

Abstract

Background: Despite the high prevalence of anxiety disorders and the demonstrated efficacy of their treatment, most individuals with anxiety disorders never utilize mental health services.

Objective: To identify predictors of treatment-seeking for DSM-IV anxiety disorders from a range of sociodemographic factors and comorbid mental disorders.

Design: Survival analysis with time-varying covariates was performed using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Setting: Face-to-face interviews conducted in the United States.

Participants: 34,653 respondents, aged 18 years and older, from the 2004-2005 Wave 2 NESARC.

Main outcome measure: The cumulative probability of treatment-seeking (assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version, Wave 2 version) across the anxiety disorders in 1 year, 10 years, and lifetime and the median delay to the first treatment contact.

Results: Most individuals with panic disorder sought treatment within the same year of disorder onset, whereas the median delays to first treatment contact for generalized anxiety disorder, specific phobia, and social anxiety disorder were 1 year, 13 years, and 16 years, respectively. Several personality disorders and earlier age at anxiety disorder onset decreased the probability of treatment contact. By contrast, younger cohort membership, a recent change in marital status, treatment for a psychiatric disorder other than substance use disorder, and comorbid anxiety disorders increased the lifetime probability of treatment contact.

Conclusions: Treatment-seeking rates for most anxiety disorders are low, are associated with long delays, and sometimes are hindered by co-occurrence of other psychopathology. These patterns highlight the complex interplay of personal characteristics, individual psychopathology, and social variables in the treatment-seeking process.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Age Factors
  • Anti-Anxiety Agents / therapeutic use*
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / drug therapy*
  • Anxiety Disorders / epidemiology*
  • Anxiety Disorders / psychology
  • Cohort Studies
  • Comorbidity
  • Epidemiologic Studies
  • Female
  • Humans
  • Male
  • Minority Groups / psychology
  • Minority Groups / statistics & numerical data
  • Panic Disorder / diagnosis
  • Panic Disorder / drug therapy
  • Panic Disorder / epidemiology
  • Panic Disorder / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Personality Disorders / diagnosis
  • Personality Disorders / drug therapy
  • Personality Disorders / epidemiology
  • Personality Disorders / psychology
  • Phobic Disorders / diagnosis
  • Phobic Disorders / drug therapy
  • Phobic Disorders / epidemiology
  • Phobic Disorders / psychology
  • Probability
  • Referral and Consultation / statistics & numerical data*
  • Sex Factors
  • Social Identification
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / psychology
  • United States
  • Utilization Review / statistics & numerical data

Substances

  • Anti-Anxiety Agents