The authors have declared that no competing interests exist.
Conceived and designed the experiments: KW GR MG MB IN. Performed the experiments: KW MG. Analyzed the data: MG. Wrote the paper: KW GR MG MB IN.
Anxiety is common, with significant morbidity, but little is known about presentations and recording of anxiety diagnoses and symptoms in primary care. This study aimed to determine trends in incidence and socio-demographic variation in General Practitioner (GP) recorded diagnoses of anxiety, mixed anxiety/depression, panic and anxiety symptoms.
Annual incidence rates of anxiety diagnoses and symptoms were calculated from 361 UK general practices contributing to The Health Improvement Network (THIN) database between 1998 and 2008, adjusted for year of diagnosis, gender, age, and deprivation. Incidence of GP recorded anxiety diagnosis fell from 7.9 to 4.9/1000PYAR from 1998 to 2008, while incidence of anxiety symptoms rose from 3.9 to 5.8/1000PYAR. Incidence of mixed anxiety/depression fell from 4.0 to 2.2/1000PYAR, and incidence of panic disorder fell from 0.9/1000PYAR in 1998 to 0.5/1000PYAR in 2008. All these entries were approximately twice as common in women and more common in deprived areas. GP-recorded anxiety diagnoses, symptoms and mixed anxiety/depression were commonest aged 45–64 years, whilst panic disorder/attacks were more common in those 16–44 years. GPs predominately use broad non-specific codes to record anxiety problems in the UK.
GP recording of anxiety diagnoses has fallen whilst recording of anxiety symptoms has increased over time. The incidence of GP recorded diagnoses of anxiety diagnoses was lower than in screened populations in primary care. The reasons for this apparent under-recording and whether it represents under-detection in those being seen, a reluctance to report anxiety to their GP, or a reluctance amongst GPs to label people with anxiety requires investigation.
Anxiety disorders are very common in the community and yet there has been relatively little research focusing on them in comparison to other disorders, such as depression. Lifetime community prevalence rates of anxiety disorders reach between 16.6% and 28.8%
Very few studies have determined the incidence of anxiety disorders and anxiety symptoms, or explored trends in incidence over time. A systematic review of incidence and prevalence studies of anxiety disorders found an insufficient number of incidence studies available for inclusion to perform a meta-analysis, and concluded that further knowledge is required about the onset of anxiety disorders and in particular any social variables that may mediate the expression of these disorders
A number of studies have reported an under-detection of psychological disorders in general by General Practitioners (GPs)
The study was given a favourable opinion by the London Medical Research Ethics Committee (07/MRE02/5).
We used data from all adults aged 16 years and over registered with 361 general practices in the United Kingdom (UK) providing data to ‘The Health Improvement Network’ (THIN) during the period Jan 1998– Mar 2008. All participants had a minimum of one year follow-up data that met pre-defined quality standards.
The Health Improvement Network (THIN) database is a widely used primary care clinical longitudinal database with over 20 years of data on more than 6 million patients (
Read code lists were compiled and used to identify GP recording of i) diagnoses of anxiety diagnoses (eg. chronic anxiety, generalised anxiety disorder, anxiety state), ii) anxiety symptoms (e.g. ‘anxiousness’), iii) mixed anxiety and depression, iv) panic attacks and v) panic disorder. Codes for phobias, Obsessive Compulsive Disorder and Post Traumatic Stress Disorder were not included.
A new episode was defined as an entry in the records with no previous entry of that problem recorded in the previous year. Participants could have more than one new episode within the study follow-up period, providing there was 12 months between episodes. We excluded data from the first 12 months following new registration with a THIN practice, as this may be retrospective recording of a past history rather than a true incident recording of a new episode of anxiety or panic
For this study, data was only included for each participant where the practice had met pre-defined standards for acceptable data recording, including consistent recording of at least one medical record (e.g. a diagnostic entry), one additional health data record (e.g. a measurement or blood test result) and at least two prescriptions on average for the practice per patient per year and consistent reporting of mortality.
Analysis was conducted using Stata version 11. We calculated annual incidence rates by dividing the annual number of incident cases by the total person years at risk (PYAR) for each year. We determined uni-variable associations between year of diagnosis (1998 to 2008), gender, age group and quintiles of deprivation score, with incidence of recorded anxiety diagnosis, anxiety symptoms, mixed anxiety and depression and panic disorder/attacks. We conducted multi-variable Poisson regression to investigate the adjusted associations between incidences of each anxiety sub-group with year of diagnosis, gender, age group and deprivation, using robust standard errors to account for clustering within practices. The significance of variables in the Poisson regression modelling was assessed using Wald tests. We examined for interactions between age, gender, deprivation and period. There were statistically significant interactions between age and gender and age and deprivation. However, the sizes of these differences were relatively small, varied between anxiety sub-groups and were not clinically meaningful. We have presented the main results un-stratified, and the stratified incidence rate ratios by age-group, gender and deprivation are available in
There were 3.7 million registered patients aged 16 years and over from January 1998 to March 2008, and 22 million patient years of follow-up time. There were 123,415 recorded new episodes of anxiety diagnoses; 109,672, new episodes of anxiety symptoms; 74,855 new episodes of mixed anxiety and depression, 41,774 new episodes of panic attacks and 14,602 new episodes of panic disorder. The median follow-up time was 5.5 years (IQR 3.0 to 8.5 years).
The most frequently used Read codes for each category are given in
Description of Read code | FrequencyN (%) |
|
|
Anxiety states | 102294 (82.9) |
Anxiety state NOS | 8367 (6.8) |
Generalised anxiety disorder | 3683 (3.0) |
[X]Generalized anxiety disorder | 3133 (2.5) |
Chronic anxiety | 2120 (1.7) |
|
|
Anxiousness - symptom | 71089 (64.8) |
Anxiousness | 35393 (32.3) |
Tension - nervous | 1112 (1.0) |
‘Nerves’ | 1014 (0.9) |
[D]Nervousness | 455 (0.4) |
|
|
Anxiety with depression | 71342 (95.3) |
[X]Mixed anxiety and depressive disorder | 3177 (4.2) |
[X]Mild anxiety depression | 336 (0.4) |
|
|
Panic attack | 33651 (80.6) |
C/O - panic attack | 7200 (17.2) |
[X]Panic attack | 624 (1.5) |
[X]Panic state | 299 (0.7) |
|
|
Panic disorder | 13538 (92.7) |
[X]Panic disorder [episodic paroxysmal anxiety] | 1064 (7.3) |
[X] = These Read Codes were added to the original Read code dictionary, to ensure mapping to all ICD codes.
[D] = Working diagnosis.
C/O = Short-hand notation for Complaining of (commonly used by doctors to record symptoms in the UK).
The combined incidence of anxiety diagnoses, symptoms, mixed anxiety and depression and panic fell slightly over time from 16/1000 Person Years at Risk (PYAR) in 1998 to 13/1000PYAR in 2008. Within this, time trends for anxiety sub-groups varied, with a reducing trend for anxiety diagnoses, mixed anxiety and depression and panic disorder, a rising trend for anxiety symptoms, and a more stable incidence of panic attacks over time (
The overall GP recorded incidence of anxiety diagnoses in the study period 1998–2008 was 5.7/1000PYAR (95%CI 5.7 to 5.8). The recorded incidence fell by a third from 7.9/1000PYAR (95%CI 7.7 to 8.1) in 1998 to 4.9/1000PYAR (95%CI 4.7 to 5.0) in 2008. (
Variable | No. of Events | PYAR | Incidence(95% CI) | Univariable |
P-Value |
Multivariable |
P-Value |
|
|
1998 | 6941 | 879491 | 7.9 (7.7,8.1) | Baseline | <0.0001 | Baseline | <0.0001 |
1999 | 8328 | 1143029 | 7.3 (7.1,7.4) | 0.92 (0.84,1.01) | 0.93 (0.85,1.02) | |||
2000 | 10730 | 1499653 | 7.2 (7.0,7.3) | 0.91 (0.82,1.00) | 0.92 (0.83,1.01) | |||
2001 | 11521 | 1776784 | 6.5 (6.4,6.6) | 0.82 (0.74,0.92) | 0.84 (0.75,0.93) | |||
2002 | 12518 | 2060714 | 6.1 (6.0,6.2) | 0.77 (0.68,0.86) | 0.79 (0.70,0.88) | |||
2003 | 13586 | 2291800 | 5.9 (5.8,6.0) | 0.75 (0.66,0.85) | 0.77 (0.68,0.87) | |||
2004 | 13495 | 2440041 | 5.5 (5.4,5.6) | 0.70 (0.62,0.80) | 0.72 (0.64,0.82) | |||
2005 | 13488 | 2598986 | 5.2 (5.1,5.3) | 0.66 (0.58,0.75) | 0.68 (0.60,0.78) | |||
2006 | 13523 | 2718023 | 5.0 (4.9,5.1) | 0.63 (0.55,0.72) | 0.65 (0.57,0.75) | |||
2007 | 12963 | 2768774 | 4.7 (4.6,4.8) | 0.59 (0.52,0.68) | 0.62 (0.54,0.70) | |||
2008 | 6322 | 1301973 | 4.9 (4.7,5.0) | 0.62 (0.54,0.71) | 0.64 (0.56,0.73) | |||
TOTAL | 123415 | 21479269 | 5.7 (5.7,5.8) | |||||
|
Male | 40628 | 10341390 | 3.9 (3.9,4.0) | Baseline | <0.0001 | Baseline | <0.0001 |
Female | 82787 | 11137879 | 7.4 (7.4,7.5) | 1.89 (1.85,1.94) | 1.92 (1.87,1.97) | |||
|
16 to 24 | 10567 | 2739664 | 3.9 (3.8,3.9) | Baseline | <0.0001 | Baseline | <0.0001 |
25 to 44 | 46697 | 7870402 | 5.9 (5.9,6.0) | 1.54 (1.48,1.60) | 1.56 (1.50,1.62) | |||
45 to 64 | 41242 | 63331832 | 6.5 (6.5,6.6) | 1.69 (1.61,1.77) | 1.73 (1.65,1.82) | |||
65 to 74 | 12856 | 2235334 | 5.8 (5.7,5.9) | 1.49 (1.40,1.59) | 1.49 (1.40,1.58) | |||
75+ | 12053 | 2302038 | 5.2 (5.1,5.3) | 1.36 (1.26,1.47) | 1.29 (1.20,1.40) | |||
|
Missing | 4722 | 1801970 | 2.6 (2.5,2.7) | Excluded | Excluded | ||
(Least Deprived) | Q1 | 27311 | 5075427 | 5.4 (5.3,5.4) | Baseline | <0.0001 | Baseline | <0.0001 |
Q2 | 23452 | 4430050 | 5.3 (5.2,5.4) | 0.98 (0.92,1.05) | 0.99 (0.93,1.06) | |||
Q3 | 23641 | 4153536 | 5.7 (5.6,5.8) | 1.06 (0.98,1.14) | 1.08 (1.00,1.16) | |||
Q4 | 23807 | 3610922 | 6.6 (6.5,6.7) | 1.23 (1.11,1.35) | 1.26 (1.15,1.39) | |||
(Most Deprived) | Q5 | 20482 | 2407364 | 8.5 (8.4,8.6) | 1.58 (1.37,1.82) | 1.65 (1.44,1.90) |
Standard Errors Adjusted For Practice;
P-value based on Wald test.
Mutually adjusted for period, gender, age and deprivation and for clustering by practice using robust standard errors.
The overall GP recorded incidence of anxiety symptoms in the study period was 5.1/1000PYAR (95%CI 5.07 to 5.13) (
Variable | No of Events | PYAR | Incidence(95% CI) | Univariable |
P-Value |
Multivariable |
P-Value |
|
|
1998 | 3456 | 882698 | 3.9 (3.8,4.0) | Baseline | <0.0001 | Baseline | <0.0001 |
1999 | 4351 | 1147001 | 3.8 (3.7,3.9) | 0.97 (0.80,1.18) | 0.97 (0.80,1.18) | |||
2000 | 6036 | 1504479 | 4.0 (3.9,4.1) | 1.03 (0.83,1.26) | 1.04 (0.85,1.28) | |||
2001 | 7621 | 1781717 | 4.3 (4.2,4.4) | 1.09 (0.88,1.36) | 1.11 (0.90,1.38) | |||
2002 | 10371 | 2064140 | 5.0 (4.9,5.1) | 1.28 (1.02,1.61) | 1.30 (1.03,1.63) | |||
2003 | 11920 | 2294092 | 5.2 (5.1,5.3) | 1.33 (1.05,1.69) | 1.34 (1.06,1.70) | |||
2004 | 13135 | 2441491 | 5.4 (5.3,5.5) | 1.37 (1.07,1.76) | 1.39 (1.08,1.78) | |||
2005 | 14284 | 2599104 | 5.5 (5.4,5.6) | 1.40 (1.09,1.81) | 1.42 (1.11,1.84) | |||
2006 | 15342 | 2717026 | 5.6 (5.6,5.7) | 1.44 (1.13,1.84) | 1.47 (1.16,1.87) | |||
2007 | 15651 | 2766365 | 5.7 (5.6,5.7) | 1.45 (1.13,1.85) | 1.47 (1.15,1.88) | |||
2008 | 7505 | 1300640 | 5.8 (5.6,5.9) | 1.47 (1.15,1.89) | 1.51 (1.18,1.93) | |||
TOTAL | 109672 | 21498755 | 5.1 (5.1,5.1) | |||||
|
Male | 34943 | 10349131 | 3.4 (3.3,3.4) | Baseline | <0.0001 | Baseline | <0.0001 |
Female | 74729 | 11149624 | 6.7 (6.7,6.8) | 1.99 (1.93,2.04) | 2.00 (1.95,2.05) | |||
|
16 to 24 | 9634 | 2740836 | 3.5 (3.4,3.6) | Baseline | <0.0001 | Baseline | <0.0001 |
25 to 44 | 39326 | 7879886 | 5.0 (4.9,5.0) | 1.42 (1.36,1.48) | 1.47 (1.40,1.53) | |||
45 to 64 | 36308 | 6339300 | 5.7 (5.7,5.8) | 1.63 (1.55,1.71) | 1.70 (1.62,1.78) | |||
65 to 74 | 12067 | 2236507 | 5.4 (5.3,5.5) | 1.54 (1.43,1.64) | 1.57 (1.47,1.68) | |||
75+ | 12337 | 2302226 | 5.4 (5.3,5.5) | 1.53 (1.40,1.66) | 1.47 (1.35,1.59) | |||
|
Missing | 3343 | 1803736 | 1.9 (1.8,1.9) | Excluded | Excluded | ||
(Least Deprived) | Q1 | 23461 | 5080576 | 4.6 (4.6,4.7) | Baseline | <0.0001 | Baseline | <0.0001 |
Q2 | 21155 | 4433446 | 4.8 (4.7,4.8) | 1.03 (0.94,1.14) | 1.03 (0.93,1.14) | |||
Q3 | 22086 | 4156113 | 5.3 (5.2,5.4) | 1.15 (1.03,1.28) | 1.16 (1.04,1.29) | |||
Q4 | 21589 | 3613983 | 6.0 (5.9,6.1) | 1.29 (1.13,1.48) | 1.32 (1.15,1.51) | |||
(Most Deprived) | Q5 | 18038 | 2410901 | 7.5 (7.4,7.6) | 1.62 (1.37,1.92) | 1.69 (1.43,1.99) |
Standard Errors Adjusted For Practice;
P-value based on Wald test.
Mutually adjusted for period, gender, age and deprivation and for clustering by practice using robust standard errors.
The incidence of recorded episodes of mixed anxiety and depression was 3.5/1000PYAR (95%CI 3.45 to 3.50) overall (
Variable | No of Events | PYAR | Incidence(95% CI) | Univariable |
P-value |
Multivariable |
P-value |
|
|
1998 | 3537 | 883306 | 4.0 (3.9,4.1) | Baseline | <0.0001 | Baseline | <0.0001 |
1999 | 4850 | 1146749 | 4.2 (4.1,4.4) | 1.06 (0.93,1.20) | 1.06 (0.93,1.21) | |||
2000 | 6825 | 1503518 | 4.5 (4.4,4.6) | 1.13 (0.97,1.32) | 1.14 (0.98,1.33) | |||
2001 | 7939 | 1780650 | 4.5 (4.4,4.6) | 1.11 (0.96,1.29) | 1.13 (0.97,1.31) | |||
2002 | 8617 | 2064236 | 4.2 (4.1,4.3) | 1.04 (0.89,1.23) | 1.05 (0.89,1.24) | |||
2003 | 9031 | 2295956 | 3.9 (3.9,4.0) | 0.98 (0.83,1.17) | 0.99 (0.83,1.18) | |||
2004 | 8683 | 2444601 | 3.6 (3.5,3.6) | 0.89 (0.74,1.06) | 0.89 (0.75,1.06) | |||
2005 | 8111 | 2604062 | 3.1 (3.1,3.2) | 0.78 (0.65,0.93) | 0.79 (0.66,0.94) | |||
2006 | 7495 | 2723743 | 2.8 (2.7,2.8) | 0.69 (0.56,0.84) | 0.69 (0.57,0.84) | |||
2007 | 6879 | 2774830 | 2.5 (2.4,2.5) | 0.62 (0.49,0.78) | 0.62 (0.50,0.77) | |||
2008 | 2888 | 1305137 | 2.2 (2.1,2.3) | 0.55 (0.44,0.69) | 0.56 (0.45,0.68) | |||
TOTAL | 74855 | 21526788 | 3.5 (3.5,3.5) | |||||
|
Male | 24191 | 10357374 | 2.3 (2.3,2.4) | Baseline | <0.0001 | Baseline | <0.0001 |
Female | 50664 | 11169414 | 4.5 (4.5,4.6) | 1.94 (1.88,2.01) | 2.01 (1.95,2.08) | |||
|
16 to 24 | 6389 | 2743476 | 2.3 (2.3,2.4) | Baseline | <0.0001 | Baseline | <0.0001 |
25 to 44 | 32558 | 7883564 | 4.1 (4.1,4.2) | 1.77 (1.69,1.87) | 1.80 (1.71,1.90) | |||
45 to 64 | 25340 | 6347288 | 4.0 (3.9,4.0) | 1.71 (1.60,1.83) | 1.78 (1.67,1.89) | |||
65 to 74 | 5643 | 2242792 | 2.5 (2.5,2.6) | 1.08 (0.99,1.18) | 1.09 (1.01,1.17) | |||
75+ | 4925 | 2309669 | 2.1 (2.1,2.2) | 0.92 (0.83,1.02) | 0.88 (0.80,0.97) | |||
|
Missing | 3023 | 1803736 | 1.7 (1.6,1.7) | Excluded | Excluded | ||
(Least Deprived) | Q1 | 15494 | 5086918 | 3.0 (3.0,3.1) | Baseline | <0.0001 | Baseline | <0.0001 |
Q2 | 13901 | 4439284 | 3.1 (3.1,3.2) | 1.03 (0.92,1.14) | 1.04 (0.94,1.16) | |||
Q3 | 14492 | 4162459 | 3.5 (3.4,3.5) | 1.14 (1.01,1.30) | 1.17 (1.03,1.32) | |||
Q4 | 15109 | 3619361 | 4.2 (4.1,4.2) | 1.37 (1.17,1.60) | 1.41 (1.21,1.65) | |||
(Most Deprived) | Q5 | 12836 | 2415030 | 5.3 (5.2,5.4) | 1.75 (1.43,2.13) | 1.82 (1.50,2.21) |
Standard Errors Adjusted For Practice;
P-value based on Wald test.
Mutually adjusted for period, gender, age and deprivation and for clustering by practice using robust standard errors.
The overall incidence of recorded episodes of panic attacks was 1.9/1000PYAR (95%CI 1.9 to 2.0) and panic disorder was 0.7/1000PYAR (95%CI 0.7 to 0.7) (
Variable | No. of Events | PYAR | Incidence(95% CI) | Univariable |
P-Value |
Multivariable |
P-Value |
|
|
1998 | 1740 | 884855 | 2.0 (1.9,2.1) | Baseline | <0.0001 | Baseline | <0.0001 |
1999 | 2068 | 1149351 | 1.8 (1.7,1.9) | 0.91 (0.83,1.00) | 0.92 (0.84,1.01) | |||
2000 | 2739 | 1507574 | 1.8 (1.7,1.9) | 0.92 (0.82,1.03) | 0.93 (0.83,1.04) | |||
2001 | 3423 | 1785764 | 1.9 (1.9,2.0) | 0.97 (0.87,1.10) | 0.99 (0.88,1.11) | |||
2002 | 4201 | 2069896 | 2.0 (2.0,2.1) | 1.03 (0.91,1.17) | 1.05 (0.93,1.18) | |||
2003 | 4915 | 2301418 | 2.1 (2.1,2.2) | 1.09 (0.96,1.23) | 1.10 (0.97,1.25) | |||
2004 | 5077 | 2449652 | 2.1 (2.0,2.1) | 1.05 (0.93,1.19) | 1.07 (0.95,1.21) | |||
2005 | 5090 | 2608566 | 2.0 (1.9,2.0) | 0.99 (0.87,1.13) | 1.01 (0.89,1.14) | |||
2006 | 4993 | 2727744 | 1.8 (1.8,1.9) | 0.93 (0.82,1.05) | 0.95 (0.84,1.07) | |||
2007 | 5145 | 2777964 | 1.9 (1.8,1.9) | 0.94 (0.83,1.07) | 0.96 (0.85,1.09) | |||
2008 | 2383 | 1306350 | 1.8 (1.8,1.9) | 0.93 (0.82,1.05) | 0.94 (0.83,1.07) | |||
TOTAL | 41774 | 21569138 | 1.9 (1.9,2.0) | |||||
|
Male | 12108 | 10372503 | 1.2 (1.1,1.2) | Baseline | <0.0001 | Baseline | <0.0001 |
Female | 29666 | 11196634 | 2.7 (2.6,2.7) | 2.27 (2.20,2.34) | 2.34 (2.27,2.41) | |||
|
16 to 24 | 5901 | 2744119 | 2.2 (2.1,2.2) | Baseline | <0.0001 | Baseline | <0.0001 |
25 to 44 | 17767 | 7901654 | 2.2 (2.2,2.3) | 1.05 (1.00,1.09) | 1.08 (1.03,1.13) | |||
45 to 64 | 11967 | 6365161 | 1.9 (1.8,1.9) | 0.87 (0.83,0.92) | 0.92 (0.87,0.97) | |||
65 to 74 | 3215 | 2246019 | 1.4 (1.4,1.5) | 0.67 (0.63,0.71) | 0.68 (0.64,0.72) | |||
75+ | 2924 | 2312184 | 1.3 (1.2,1.3) | 0.59 (0.55,0.63) | 0.56 (0.52,0.60) | |||
|
Missing | 1392 | 1805612 | 0.8 (0.7,0.8) | Excluded | Excluded | ||
(Least Deprived) | Q1 | 8187 | 5096334 | 1.6 (1.6,1.6) | Baseline | <0.0001 | Baseline | <0.0001 |
Q2 | 7529 | 4447572 | 1.7 (1.7,1.7) | 1.05 (0.99,1.12) | 1.06 (0.99,1.13) | |||
Q3 | 8540 | 4170082 | 2.0 (2.0,2.1) | 1.27 (1.20,1.35) | 1.27 (1.20,1.35) | |||
Q4 | 8884 | 3627286 | 2.4 (2.4,2.5) | 1.52 (1.41,1.65) | 1.51 (1.41,1.63) | |||
(Most Deprived) | Q5 | 7242 | 2422250 | 3.0 (2.9,3.1) | 1.86 (1.70,2.03) | 1.85 (1.69,2.02) |
Standard Errors Adjusted For Practice;
P-value based on Wald test.
Mutually adjusted for period, gender, age and deprivation and for clustering by practice using robust standard errors.
Variable | No. of Events | PYAR | Incidence(95% CI) | Univariable |
P-Value |
Multivariable |
P-Value |
|
|
1998 | 839 | 885658 | 0.9 (0.9,1.0) | Baseline | <0.0001 | Baseline | <0.0001 |
1999 | 1165 | 1150276 | 1.0 (1.0,1.1) | 1.07 (0.93,1.23) | 1.09 (0.94,1.26) | |||
2000 | 1375 | 1508653 | 0.9 (0.9,1.0) | 0.96 (0.83,1.12) | 0.98 (0.84,1.14) | |||
2001 | 1489 | 1787435 | 0.8 (0.8,0.9) | 0.88 (0.75,1.03) | 0.91 (0.77,1.06) | |||
2002 | 1662 | 2072163 | 0.8 (0.8,0.8) | 0.85 (0.71,1.01) | 0.88 (0.75,1.03) | |||
2003 | 1563 | 2304423 | 0.7 (0.6,0.7) | 0.72 (0.60,0.86) | 0.74 (0.62,0.88) | |||
2004 | 1505 | 2453276 | 0.6 (0.6,0.6) | 0.65 (0.53,0.79) | 0.68 (0.56,0.82) | |||
2005 | 1510 | 2612172 | 0.6 (0.5,0.6) | 0.61 (0.50,0.74) | 0.64 (0.53,0.77) | |||
2006 | 1462 | 2731408 | 0.5 (0.5,0.6) | 0.57 (0.47,0.68) | 0.59 (0.49,0.71) | |||
2007 | 1382 | 2781746 | 0.5 (0.5,0.5) | 0.52 (0.43,0.64) | 0.56 (0.46,0.67) | |||
2008 | 650 | 1308178 | 0.5 (0.5,0.5) | 0.52 (0.43,0.64) | 0.55 (0.45,0.67) | |||
TOTAL | 14602 | 21595391 | 0.7 (0.7,0.7) | |||||
|
Male | 4267 | 10379918 | 0.4 (0.4,0.4) | Baseline | <0.0001 | Baseline | <0.0001 |
Female | 10335 | 11215472 | 0.9 (0.9,0.9) | 2.24 (2.14,2.35) | 2.34 (2.23,2.46) | |||
|
16 to 24 | 1768 | 2747904 | 0.6 (0.6,0.7) | Baseline | <0.0001 | Baseline | <0.0001 |
25 to 44 | 6527 | 7912587 | 0.8 (0.8,0.8) | 1.28 (1.20,1.37) | 1.29 (1.21,1.38) | |||
45 to 64 | 4396 | 6372629 | 0.7 (0.7,0.7) | 1.07 (1.00,1.15) | 1.09 (1.01,1.17) | |||
65 to 74 | 1097 | 2248082 | 0.5 (0.5,0.5) | 0.76 (0.69,0.84) | 0.75 (0.67,0.82) | |||
75+ | 814 | 2314188 | 0.4 (0.3,0.4) | 0.55 (0.48,0.62) | 0.51 (0.45,0.57) | |||
|
Missing | 789 | 1806106 | 0.4 (0.4,0.5) | Excluded | Excluded | ||
(Least Deprived) | Q1 | 2842 | 5101528 | 0.6 (0.5,0.6) | Baseline | <0.0001 | Baseline | <0.0001 |
Q2 | 2589 | 4452337 | 0.6 (0.6,0.6) | 1.04 (0.93,1.17) | 1.06 (0.95,1.18) | |||
Q3 | 2819 | 4175626 | 0.7 (0.7,0.7) | 1.21 (1.05,1.40) | 1.22 (1.06,1.40) | |||
Q4 | 2969 | 3633018 | 0.8 (0.8,0.8) | 1.47 (1.26,1.71) | 1.48 (1.28,1.73) | |||
(Most Deprived) | Q5 | 2594 | 2426774 | 1.1 (1.0,1.1) | 1.92 (1.57,2.35) | 1.94 (1.59,2.37) |
Standard Errors Adjusted For Practice;
P-value based on Wald test.
Mutually adjusted for period, gender, age and deprivation and for clustering by practice using robust standard errors.
There was a trend showing a reduced incidence of anxiety diagnoses, panic disorder and mixed anxiety and depression being recorded in patient records, alongside a corresponding increase in the recorded incidence of anxiety symptoms over the decade 1998–2008. The incidence of panic attacks has been more stable over time. The recorded incidence of all five sub-groups of anxiety was approximately twice as high in women as men. For anxiety diagnoses, anxiety symptoms and mixed anxiety and depression the recorded incidence was highest in the middle aged to pre/early retirement group (45–64years). Panic disorder and panic attacks, however, were more commonly recorded in younger people (25–44years) and the incidence fell in later life (those aged 65 years or more). The recorded incidence of all sub-types (including panic) was increased in those living in more deprived areas.
These findings may be explained by changes in GPs’ recording behaviour, with an increased preference for recording symptoms over anxiety diagnoses in more recent years, rather than a true decrease in the incidence of anxiety diagnoses, panic disorder and mixed anxiety and depression. Over the past decade there has been increasing debate about the meaning of psychiatric disease categories, in particular for those with milder presentations common in primary care
There have been few previous epidemiological studies on anxiety disorders in primary care settings, in particular studies of incidence, with which to compare this work. Our study reports on GP recording of anxiety over a ten year period and, in order to be included, people would have needed to both seek help for their anxiety or consult with another problem, and to have their anxiety symptoms identified and considered sufficiently important for the GP to record them in their electronic health record. One other UK study has reported the incidence of GP recorded anxiety, although it did not differentiate between sub-types of anxiety and included both symptoms and diagnoses combined. It found a combined recorded incidence of anxiety of 9.7/1000PYAR
Our findings of an increased incidence of all types of anxiety reported in women are consistent with past community studies in screened populations
Our incidence rates for GP recorded episodes of anxiety diagnoses were lower than incidence rates from screened populations in primary care waiting rooms, where the 6 month incidence of anxiety/panic was 5.5%
This is the first large nationally representative study which documents the trends in recording of anxiety diagnoses and symptoms in primary care over a 10 year period, including more than 360,000 incident episodes. Anxiety diagnoses recorded by GPs in the UK have been validated in previous work and show a high specificity for anxiety, where 121/135 (89.6%) of those with recorded diagnoses had confirmed diagnoses using questionnaires
Recorded episodes of anxiety diagnoses, panic disorder and mixed anxiety and depression fell over time, whilst the recording of anxiety symptoms increased. This may reflect changes in the attitudes of GPs to recording psychiatric disorder or true changes in incidence over time.
Clinical databases are a rich potential source of data on mental health problems and psychiatric disorders, however researchers and policy makers should be aware that in the UK GPs use predominately non-specific or descriptive codes such as ‘anxiety state’ or ‘anxiousness’ in recording anxiety presentations and it is difficult to compare clinical practice using routinely collected data with findings from epidemiological surveys using standardised diagnostic instruments. Recorded incidence rates for anxiety are lower than in screened populations in this setting, and further work is needed to determine whether GPs are using other methods of recording, such as free text entries or coding presentations as depression when symptoms co-exist. We need to estimate the sensitivity of recorded anxiety diagnoses, and explore reasons why anxiety may be unrecognised in primary care, or acknowledged and discussed but not recorded.
Recorded incidence by anxiety sub-group, stratified for interactions between age group with gender and age group with deprivation.
(DOCX)