by Charlotte Archer, Senior Research Associate in Primary Care Mental Health, and Katrina Turner, Professor of Primary Care Research, Centre for Academic Primary Care, University of Bristol
Research has shown that fewer people in primary care are now being diagnosed with anxiety than in the past, despite reports that rates of anxiety have increased in the general population. Individuals with anxiety may be reluctant to seek help for their symptoms. They may also find it difficult to talk to their GP about their mental health or may normalise their symptoms.
Although most anxiety is managed in primary care by GPs, we know very little about whether GPs and patients think it is important to diagnose and manage anxiety disorders. Knowing this might help us identify possible reasons for the decline in their recording, and the potential impact of this on patient care and treatment outcomes.
We conducted in-depth interviews with 15 GPs and 20 primary care patients to explore their views on diagnosing anxiety disorders. GPs and patients were recruited via GP practices in Bristol and the surrounding area. The patients interviewed had symptoms of anxiety or had been diagnosed with an anxiety disorder in the last 12 months. This research has been recently published in the British Journal of General Practice.
What we found, and what this means for patients and GPs
We found that GPs and patients differed in their views in relation to two key areas: the value of diagnosing anxiety, and whether anxiety and depression should be treated as two separate conditions. GPs talked about their role in helping patients with anxiety, but said they were reluctant to diagnose an anxiety disorder.
Two reasons they gave for this were insufficient time to assess severity and chronicity of symptoms, and wanting to prioritise symptom management over diagnosing. GPs also worried that an anxiety disorder was a stigmatising label to give to patients. However, patients reported that they valued having a diagnosis, and said that discussing the diagnosis helped them to understand their symptoms and encouraged them to engage with treatment.
Patients also reported that they wanted anxiety to be considered as a separate condition from depression. They argued that the symptoms of anxiety were experienced before the symptoms of depression, and needed to be managed in a different way. They also felt that when anxiety and depression were not considered as distinct disorders, the anxiety was ignored.
This is a key point for GPs to note, as those interviewed said that they may not always explain this distinction to their patients. If GPs are able to explain some of the differences between the two conditions, patients may gain a better understanding of their mental health and be more likely to engage with treatment.
Our study highlights that patients would value GPs diagnosing anxiety disorders. For this to happen in practice, continuity of care may be necessary to encourage patient disclosure, and to give GPs sufficient time to discuss and diagnose anxiety disorders. Continuity of care may be particularly important for telephone consultations, which have increased substantially as result of the COVID-19 pandemic, as patients with anxiety may find it harder to disclose symptoms over the phone.
Paper: GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study by Charlotte Archer, David Kessler, Nicola Wiles and Katrina Turner. Published in British Journal of General Practice. April 2021.