Guidelines for preventive activities in general practice

Mental health and substance use

Anxiety

      1. Anxiety

Mental health and substance use | Anxiety

Case finding age bar

09* 1014 1519 2024 2529 3034 3539 4044 4549 5054 5559 6064 6569 7074 7579 ≥80
*from age 8 years
 

Anxiety is the most common mental health condition experienced in the Australian population, affecting 17% of adults (aged 16–85 years) and 7% of children (aged 4–15 years).1 Anxiety commonly co-exists with other mental health conditions, particularly depression.2,3 It is estimated that 23% of men and 34% of women aged 16–85 years have experienced any anxiety disorder in their lives.1 Yet, feeling anxious is also a common experience of all people, especially at times of ill health, when they are more likely to consult their GP. So the GP’s task is not only to detect and offer appropriate treatment options to those who meet the diagnostic criteria for anxiety, but also, equally, to offer reassurance and practical advice to people in distress, aiming to prevent the progression of that worry to something more serious. Fortunately, there are some very simple, brief questions the GP can use that are reasonably specific and sensitive to the probability of an anxiety disorder;4,5 hence they can be used as part of a case finding approach to more efficiently detect patients who need a more thorough assessment.

There is a risk of underdiagnosis and delayed diagnosis because many people do not seek treatment. GPs should be aware of a patient’s worries about stigma and that under-reporting by patients is common.6

Screening

Recommendation Grade How often References
General population screening for anxiety is not recommended.
 
Generally not recommended N/A 7,8
 

Case finding

Recommendation Grade How often References
Be alert to possible anxiety disorders in those aged 8–64 years, including pregnant and postpartum women (particularly in people with a history of an anxiety disorder, possible somatic symptoms of an anxiety disorder, in those who have experienced traumatic or adverse childhood events or in those with insomnia). Practice Point As required 6,7,8
Consider asking the person (aged 18–64 years) about their feelings of anxiety, and their ability to stop or control the worry, using the Generalized Anxiety Disorder 2-item (GAD-2) scale. Conditionally recommended As required 6

For a common condition like anxiety, there is an overlap of symptoms with other conditions like depression.6 This allows the introduction of a stepped care model in mental health care that attempts to encourage people with milder symptoms of distress to engage in lower intensity interventions (eg self-help and eMental Health programs) and allocate more intense interventions (eg medication and individual psychotherapy) to those who are most likely to benefit.9 In the context of inequitable distribution of mental health care in Australia, ensuring resources reach those most in need remains an ongoing challenge.10 The quiz on the Australian Government’s Head to Health website is an example of such an approach,11 informed by algorithms developed using Australian primary care population data to predict which patients presenting to the GP are likely to have a more severe outcome from depression and anxiety symptoms at three months12 to help GPs and their patients in navigating the system.

There are no specific recommendations or advice for Aboriginal and Torres Strait Islander peoples.

In 2018, 11% of anxiety disorders in women were attributable to intimate partner violence, and 27% of anxiety disorders were attributable to child abuse and neglect.13 For more information on these topics, refer to the Intimate partner violence and Bullying and child abuse chapters.

Quiz | Australian Government Head to Health website
Screen for Child Anxiety Related Disorders (SCARED) tool

  1. Australian Institute of Health and Welfare. Prevalence and impact of mental illness. Australian Government, 2024 [Accessed 5 March 2024].
  2. Goldstein-Piekarski AN, Williams LM, Humphreys K. A trans-diagnostic review of anxiety disorder comorbidity and the impact of multiple exclusion criteria on studying clinical outcomes in anxiety disorders. Transl Psychiatry 2016;6(6):e847. doi: 10.1038/tp.2016.108.
  3. Tiller JW. Depression and anxiety. Med J Aust 2013;199(S6):S28–31. doi: 10.5694/mja12.10628.
  4. Sapra A, Bhandari P, Sharma S, Chanpura T, Lopp L. Using Generalized Anxiety Disorder-2 (GAD-2) and GAD-7 in a primary care setting. Cureus 2020;12(5):e8224. doi: 10.7759/cureus.8224.
  5. Medscape. Generalized Anxiety Disorder 2 (GAD-2). Medscape, 2020 [Accessed 5 March 2024].
  6. National Institute for Health and Care Excellence (NICE). Common mental health problems: Identification and pathways to care. NICE, 2011 [Accessed 5 March 2024].
  7. U.S. Preventive Task Force (USPSTF). Anxiety in children and adolescents: Screening. USPSTF, 2022 [Accessed 5 March 2024].
  8. U.S. Preventive Task Force (USPSTF). Anxiety disorders in adults: Screening. USPSTF, 2023 [Accessed 5 March 2024].
  9. Ho FYY, Yeung WF, Ng THY, Chan CS. The efficacy and cost-effectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders: A systematic review and meta-analysis. Sci Rep 2016;6(1):29281. doi: 10.1038/srep29281.
  10. Meadows GN, Enticott JC, Inder B, Russell GM, Gurr R. Better access to mental health care and the failure of the Medicare principle of universality. Med J Aust 2015;202(4):190–94. doi: 10.5694/mja14.00330.
  11. Head to Health. Quiz. Department of Health and Aged Care, n.d [Accessed 5 March 2024].
  12. Fletcher S, Spittal MJ, Chondros P, et al. Clinical efficacy of a decision support tool (Link-me) to guide intensity of mental health care in primary practice: A pragmatic stratified randomised controlled trial. Lancet Psychiatry 2021;8(3):202–14. doi: 10.1016/S2215-0366(20)30517-4.
  13. Australian Institute of Health and Welfare. What are the consequences of family, domestic and sexual violence? Australian Government, 2023 [Accessed 5 March 2024].
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  Lifecycle-chart.pdf (PDF 0.12 MB)

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