Veterans with Non-Specific Anxiety Diagnosis Less Likely to Access Mental Healthcare than Veterans with Specific Anxiety Disorders
BACKGROUND:
Although much work has been done to improve the detection and treatment of depression in primary care settings, far less attention has been given to anxiety disorders, despite their greater prevalence (18% in the general population vs. 33% in the Veteran population). Further, some providers may use a non-specific diagnosis such as Anxiety Disorder Not Otherwise Specified (anxiety NOS) if they are unsure whether a patient meets diagnostic criteria for a specific anxiety disorder. The prevalence of anxiety NOS in the general population is unknown; however, anxiety NOS is the most commonly diagnosed anxiety disorder among active-duty service members and primary care patients. This retrospective cohort study sought to determine the rates of specific and non-specific anxiety diagnoses in a national sample of Veterans receiving outpatient care at VAMCs – and to examine patterns of mental healthcare use in the year following diagnosis. Using VA administrative data, investigators identified 292,244 Veterans who were newly diagnosed with anxiety in FY2010. Investigators then examined diagnostic rates of each anxiety disorder across care settings, as well as rates of mental health service utilization during the 12 months following diagnosis.
FINDINGS:
- Anxiety NOS was diagnosed in 38% of this Veteran cohort (180,646 diagnosed with a specific anxiety disorder; 111,598 diagnosed with anxiety NOS). Most Veterans with a specific anxiety diagnosis received mental health services, with treatment rates for patients with the most frequently diagnosed specific anxiety disorders (PTSD, generalized anxiety disorder, and panic disorder) ranging between 60% and 67%. In contrast, only 32% of patients with anxiety NOS received mental health services during the 12 months following diagnosis.
- Most Veterans with an anxiety NOS diagnosis did not go on to receive a specific diagnosis in the next 12 months. However, most anxiety NOS patients who later received a diagnosis of a specific anxiety disorder (87%) received mental health services in the year following their index date, compared to 29% of Veterans who did not receive a subsequent specific anxiety disorder diagnosis.
- Patient factors that increased the likelihood of an anxiety NOS diagnosis included: female gender, older age, the absence of specific comorbid diagnoses (i.e., substance-use disorders, bipolar disorder), and absence of service-connected disability.
- Veterans diagnosed in specialty mental health or integrated primary care-mental health settings were less likely to receive an anxiety NOS diagnosis than patients in primary care.
LIMITATIONS:
- This study included the use of CPT (Current Procedural Terminology) codes, developed by the AMA, to assess mental health service use. These codes were entered by the provider (therefore reflecting the provider's perspective on care provided), but were not independently verified.
- Investigators did not assess patients' use of mental health services after the 1-year follow-up period, and information regarding Veterans' use of non-VA services was not available.
AUTHOR/FUNDING INFORMATION:
This study was partly funded through HSR&D. All authors are part of HSR&D's Center for Innovations in Quality, Effectiveness and Safety, and the South Central Mental Illness Research, Education, and Clinical Center located in Houston, TX.
Barrera T, Mott J, Hundt N, et al. Diagnostic Specificity and Mental Health Service Utilization among Veterans with Newly Diagnosed Anxiety Disorders. General Hospital Psychiatry October 22, 2013;e-pub ahead of print.
