Anxiety Diagnosis for Veterans Lacks Specificity

Anxiety is like all other mental disorders in that early detection and intervention is a critical component for a successful recovery. For some there is a reluctance to seek treatment due to a fear of being stigmatized, for others it’s a lack of health insurance. And then there are the many veterans that don’t receive the care they need because they haven‘t received a precise diagnosis. A study, conducted by researchers at the VA Medical Center in Houston, found that many veterans receive a diagnosis of generalized anxiety without any additional follow-up diagnosis. As a result the veterans may not be receiving appropriate care. The findings appear in a recent issue of the journal General Hospital Psychiatry. Led by Terri L. Barrera, Ph.D, the researchers examined data from the Veterans Health Administration outpatient records for patients documented as having anxiety. Of the veterans diagnosed with anxiety, 38 percent were given a general diagnosis of anxiety non-specified (NOS). While the research team expected to see anxiety NOS as a temporary diagnosis until more specific symptoms could be determined, only 12 percent of the people diagnosed with anxiety NOS later received a more specific diagnosis within one year. In order to be treated effectively patients require a more accurate diagnosis. For instance, a patient labeled with anxiety NOS could be suffering from any one of a number of disorders, including post-traumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder and phobia. While treatment for these disorders can be similar they may differ in important ways. When a specific diagnosis was given to the patient, 60 to 67 percent received treatment. Among those diagnosed with anxiety NOS, only 32 percent received services for mental health in the year after they were diagnosed. Early detection and treatment is critical for all individuals diagnosed with anxiety, but for veterans it may be especially important to determine a correct diagnosis. Among the general population, 18 percent meet criteria for anxiety, while veterans are diagnosed at a rate of 33 percent. Given that anxiety disorders are associated with varying levels of disability and an increased risk for suicide, appropriate treatment is critical. However, in primary care settings anxiety is often unrecognized. The study highlights the importance of screening tools for anxiety among veterans because of their increased risk of the disorder. In cases where the patient is diagnosed with anxiety NOS, the primary care physician may not be sure how to direct the patient to more specialized care. One potential solution is the implementation of mental health professionals working in connection with a primary care clinic. This could be a psychiatric nurse, a psychiatrist or a psychologist who can provide consultation when anxiety is suspected. An alternative approach would be to use short screening tools to determine whether a patient’s symptoms may need to be reviewed by a mental healthcare worker. The study highlights the importance of adequate screening tools in primary care physician exams. The use of anxiety NOS must be used as only a temporary diagnosis, with patients receiving a more specific diagnosis following a referral to a mental health specialist.