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A LEADING mental health expert says anxiety and affective disorders need to be taken more seriously by the medical community, after research found only a small proportion of patients receive evidence-based treatment.
Professor Helen Christensen, professor of mental health at the University of NSW and chief scientist at the Black Dog Institute, told MJA InSight that anxiety in particular was often not perceived as being as severe as other mental illnesses, resulting in some diagnoses being missed.
“But anxiety is a debilitating condition that can reduce self-esteem [and] social engagement, and makes a person feel very isolated.”
Professor Christensen was responding to an MJA study that examined the frequency, type and quality of mental health treatment among Australian adults with affective and/or anxiety disorders. (1)
The authors analysed data from the 2007 National Survey of Mental Health and Wellbeing, a nationally representative household survey of 8841 Australians aged 16‒85 years. A total of 17% of the respondents met the criteria for an affective and/or anxiety disorder in the previous year.
Of these adults, 39% sought professional help for mental health, 26% received an evidence-based treatment and 16% received minimally adequate treatment, the authors said.
They found that younger adults (aged 16‒26 years) were less likely to receive any treatment. People who consulted a GP only were less likely to receive evidence-based or minimally adequate treatment than those who consulted a mental health professional.
Professor Christensen said she believed younger people were an at-risk group for anxiety disorders because it was often assumed that feeling anxious was a normal aspect of being a young adult.
“And young people may also not seek treatment because they just don’t recognise their own symptoms”, she said.
The MJA authors wrote that closing the gap in treatment quality required strategies to increase the use of evidence-based interventions and to ensure these were delivered in sufficient doses.
Further research was also needed to clarify why some patients were at increased risk of inadequate treatment, and exactly which aspects of treatment contributed to inadequate care, the authors said.
Dr Justin Coleman, a Brisbane GP and president of the Australasian Medical Writers Association, told MJA InSight he was concerned that such a large proportion of patients were not accessing care.
Dr Coleman said the study highlighted the need for a greater awareness among primary health care providers about the wide range of symptoms associated with affective and anxiety conditions.
“If patients don’t mention their symptoms to their GP, then the GPs need to be asking the questions, and be alert to the possibility of these disorders.”
However, Professor Malcolm Hopwood, professor of psychiatry at the University of Melbourne, believed a larger streamlining of care was needed to ensure patients received the right evidence-based treatment, and to prevent overmedicalising of anxiety and affective conditions.
He called for clearer guidelines for GPs on when and which cognitive behaviour therapies should be used, when medication was required and at what point a patient should be referred to a mental health specialist.
Professor Hopwood said that because anxiety especially was underrecognised, an ongoing GP training effort was required. “It needs to be put at the forefront of GPs’ minds as a potential diagnosis.”
One factor that contributed to anxiety diagnoses being missed was the difficulty of distinguishing between what was normal worry or anxiety, and what was not. This ultimately came down to an observation of the patient’s behaviour, Professor Hopwood said.
“If a patient’s symptoms are impacting on their functional capacity”, then it should be considered as an anxiety disorder.
Professor Christensen agreed that the diagnosis of anxiety was difficult, suggesting GPs may find checklists helpful, such as the Generalised Anxiety Disorder 7-item Scale (GAD-7), a patient questionnaire that serves as a screening tool and a severity measure. (2)
“This is simple and easy to use, and patients could even complete it on an iPad beforehand in the waiting room”.
Professor Christensen emphasised that cognitive behaviour therapies were as effective as medication in treating affective and anxiety conditions. In her experience, interactive, web-based psychological interventions had proven particularly helpful in treating younger adults.
Cognitive behaviour therapies should be encouraged as a first-line treatment for mild cases of anxiety and affective disorders, and to increase the use of these programs across all sectors of mental health, she said.
1. MJA 2015; 202: 185-189
2. Jean Hailes for Women’s Health; Self-assessment GAD-7
(Photo: Alexander Raths / shutterstock)
Presentations of patients in primary care that have anxiety as a cause or part of the cause are common but incredibly varied,often extremely chronic,and often with little or no patient insight especially in younger people as to any connection with a mental health disorder.
Younger patients do not attend often.
GP appointments are usually 10 minutes to 15 minutes long and they necessarily, because of financial reasons ,have to be all filled for a session.
How do academics in universities and doctors in secondary care suggest GPs could be able to do all they suggest to deal with the often physical symptoms ,exclude physical illnesses,explore mental health symptoms and signs and even do the mental health screening(what, a GAD-7 for everyone in the waiting room?) in the 10 to 15 minutes available? Oh ,and then arrange patient education,treatment,referral etc?
GPs generally do their very best to engage patients and get them to come back for ongoing review but In my case,because I charge $40 above the schedule,and a lot of people expect to pay nothing for GP care,it is difficult to get people back.
I do get annoyed by this arrogant advice from people who have little or no idea of the reality of primary care.
Although I agree that issues such as anxiety and affective disorders need more attention I am concerned that “diagnosis of a psychiatric condition” is automatically perceived as being a positive step. There is still significant stigma in the Australian community about psychiatirc conditions. A diagnosis of anxiety, dpression or other affective disorder does not improve a persons emplóyment opportunities and, from all the evidence available, if anything decreases the employment opportunities. If we are concerned that anxiety is “a debilitating condition that can reduce self-esteem and social engagement and make a person feel very isolated” then we should be equally concerned that a diagnosis of anxiety increases the risk that the person will be under-employed or unemployed, compounding the issues of self-esteem, social engagement and isolation.
Unfortunatley the diagnosis of a mental health disorder has social and economic implications that continue long after the biological event has resolved. In the 2013 beyondblue survey on doctors and medical student about 50% of the respondents thought that doctors thought less of colleagues with a history of depression and about 50% of respondents thought that a history of depression would have a negative impact on their career. If we recognise the very harmful effects of psychiatric diagnosis when appied to out colleagues why would be expect the outcome to be any better for other members of the community.
A diagnosis of mental illness causes stigma and discrimination; stigma and discrimination are always bad.
Oh agreed. Doctors do need to take Anxiety more seriously or mental health in general. Being a suferer who is unable to leave my home due to anxiety & fear I am STILL not getting any help. GP (I think I need to hit over the head to make him see) doesn’t do housecalls, can’t call him now because medicare won’t pay him for it. Call the 24 hr doctor they say (THEY ARE REFERRING ME BACK TO MY GP). So here I sit, a prisoner in my own home, the days are long but the nights are even longer. Suicide can’t even do that right. So sorry rant over.