The management of anxiety disorders in UK primary care

: a multi-method study

Abstract

Background
Between 1998 and 2008, GP recorded anxiety symptoms increased, but recorded anxiety disorders decreased. No data are available for recent years. Little is known about trends in prescriptions for anxiety, or the views of individuals with anxiety and those who treat it. This thesis aimed to understand the identification, diagnosis and management of anxiety in UK primary care.

Methods
Qualitative interviews with 15 GPs, 20 patients, and 9 therapists, explored practitioners’ and patients’ views on the identification, diagnosis and management of anxiety.
Two quantitative studies used Clinical Practice Research Datalink data (n=2,569,153 adults registered with UK practices between 2003-2018). Incidence rates and 95% confidence intervals were calculated for: (1) recorded anxiety symptoms and diagnoses; (2) anxiolytic prescriptions.

Results
Interview findings indicated that having an anxiety disorder diagnosed, and considered as a separate condition to depression, helped patients understand their symptoms and the treatment needed. However, GPs were reluctant to give a diagnosis, and did not distinguish between the two conditions. GPs held the view that patients prefer to take medication, whereas patients did not view medication as a positive choice. GPs and therapists commented on a recent rise in anxiety in young adults.
The incidence of anxiety symptoms rose from 6.2 to 14.7/1000 person years at risk (PYAR) from 2003-2018. Between 2003-2008, the incidence of anxiety diagnoses fell from 13.2 to 10.1/1000PYAR; markedly increasing between 2014-2018 to 15.3/1000PYAR.
Between 2003-2008, the incidence of antidepressant prescriptions decreased from 10.2 to 7.4/1000PYAR; rising to 11.7/1000PYAR in 2018. Incidence of prescriptions of beta-blockers increased over the study, whereas incident benzodiazepine prescriptions decreased.
Incidence of anxiety symptoms and diagnosis, and of prescriptions of each drug class, rose particularly in young adults in recent years.

Conclusion
Recent increases in anxiety and anxiolytic prescriptions may reflect increased presentation to primary care, especially in young adults.

Date of Award	21 Jan 2021
Original language	English
Awarding Institution	University of Bristol
Supervisor	Nicola J Wiles (Supervisor), Katrina M Turner (Supervisor) & David S Kessler (Supervisor)