Prevalence and rates of recognition of anxiety disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China.

OBJECTIVE: Assess the prevalence, risk factors and treating clinicians' rates of recognition of anxiety disorders in internal medicine departments of different types of general hospitals in Shenyang, China.

METHOD: A two-stage screening process using an expanded Chinese version of the 12-item General Health Questionnaire (GHQ) and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) identified 457 persons 15 years of age or older with current anxiety disorders from among 5312 consecutive attendees at the outpatient internal medicine departments of 23 randomly selected general hospitals. Clinical charts were reviewed to determine whether or not the treating internist had made a diagnosis of anxiety or prescribed anxiolytic medications.

RESULTS: The 1-month prevalence of any type of anxiety disorder was 9.8% (95% CI=9.0-10.8%). The prevalences of the three most common disorders: anxiety disorder not otherwise specified, generalized anxiety disorder and anxiety disorder due to a general medical condition, were 6.3% (5.6-7.1%), 2.4% (2.0-2.9%), and 0.6% (0.4-0.8%), respectively. Multivariate logistic regression analysis identified the following independent predictors of having a current anxiety disorder: every being married (OR=3.5, 95% CI=2.3-5.4), prior treatment for psychological problems (3.3, 1.8-6.0), having religious beliefs (1.9, 1.3-2.9), low family income (1.5, 1.2-1.9) and never having attended college (1.3, 1.02-1.8). Among the 402 patients with anxiety disorders for whom the clinical chart was reviewed only 16 (4.0%, CI=2.3-6.3%) were diagnosed with an anxiety condition or treated with anxiolytic medications.

CONCLUSION: The prevalence of anxiety in internal medicine outpatients in urban China is lower than that reported in most western countries and the profile of risk factors is somewhat different. The very low rate of recognition of these disorders by internists is related both to the low rates of care-seeking for psychological problems in the general population and to the high-volume collective model of care delivery in the outpatient departments of Chinese general hospitals. Steps to increase the recognition and treatment of anxiety disorders in Chinese general hospitals must focus both on changing attitudes of patients and clinicians and, more importantly, on altering the structure of care delivery.