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Anxiety Disorder Management in Primary Care

More than 30 million Americans will experience anxiety at some point in their lifetime. Most patients first express feelings of anxiety to their primary care providers. About 60% of patients with mental health conditions and 90% of patients with substance abuse disorders will fail to receive adequate treatment.

Nurses are critical to identifying signs of anxiety and managing the associated mental health conditions, particularly nurse practitioners. The COVID-19 pandemic has only exacerbated a need for widespread mental health support systems, and some are now referring to it as a "mental health pandemic." Since nurses focus on holistic care, they will continue to help restore this nation's mental health.

What Is Anxiety?

Anxiety is a feeling of fear or dread that puts the body on alert. While a healthy amount of pressure or stress can help people make decisions under pressure like during a test or an important presentation at work, too much anxiety can be overwhelming and impede the ability to think clearly, concentrate and make decisions. Excessive fear and worry can be symptoms of a diagnosis of anxiety disorder. 

The difference between anxiety and an anxiety disorder is the impact and frequency of symptoms. Normal anxiety is often related to a situation or problem. It is proportional to the circumstances and usually only lasts as long as the situation or problem. Generalized anxiety disorder is when the anxiety comes on unexpectedly, often for seemingly no reason. In cases of a disorder, anxiety is often more powerful and longer than the circumstance requires and significantly impacts everyday life.

What Are Some Common Anxiety Disorders?

Anxiety-related disorders are the most common psychiatric diagnosis in the U.S. Nearly one-third (28.8%) of people will develop an anxiety-related disorder in their lifetime. Anxiety also tends to be early-onset, affecting 25% of children between 13 and 18 years old.

Some common anxiety disorders and their prevalence in the general population include:

  • Generalized Anxiety Disorder (3.1%)
  • Panic Disorder (2.7%)
  • Social Anxiety Disorder (6.8%)
  • Phobias (8.7%)
  • Obsessive-Compulsive Disorder (1.0%)
  • Post-Traumatic Stress Disorder (3.5%)

The Anxiety and Depression Association of America (ADAA) reports that only 36.9% of people with anxiety disorders receive treatment. Both medications and behavioral health approaches are needed to manage these disorders.

Why Is Anxiety Awareness Critical in Primary Care?

Anxiety can create physical symptoms, often leading people to seek care. Approximately 25% to 50% of patients experiencing anxiety will go to their primary care provider first, often with unexplained medical symptoms. Because of this, it is essential to conduct anxiety screenings in the primary care setting.  

Anxiety-related disorders are often present with somatic symptoms that seem to have no medical explanation. Examples include gastrointestinal distress, aches and pains, fatigue, and trouble falling asleep or staying asleep. Other symptoms, such as excessive worrying, panic attacks, restlessness, and even avoidance of social situations, may all point to an anxiety disorder.

How Can Mental Health Services Improve?

Mental illness is a genuine illness. While the public may accept the concept of mental disorders, many have a negative view of it. Stigma, prejudice, and discrimination hinder people from recognizing or admitting they have a problem and seeking care. This stigma can be more robust in certain cultures and lead to mistrust of the health system. Nurse practitioners can help remove that barrier by talking openly and normalizing mental health treatment.

One strategy to improve mental health services is an integrated care model, sometimes called a collaborative care model. A mental health integrated care model is a joint effort between primary care teams, mental health specialists, and patients. This blend of behavioral medicine and general medicine reduces the stigma, improves outcomes, and decreases cost. Often, a primary care provider leads the collaborative care team. The American Psychiatric Association offers free provider training in the Collaborative Care Module as part of the Centers for Medicare and Medicaid Services Transforming Clinical Practice Initiative.

The collaboration between primary care and specialty services will continue to grow. Nurse practitioners receive specialized training to understand other care team members' roles and work effectively with other disciplines. With an increase in patients needing mental health services, the demand for nurse practitioners will continue to grow, especially in primary and psychiatric care.  

Learn more about St. Thomas University's online Master of Science in Nursing – Psychiatric-Mental Health Nurse Practitioner program.


Sources: 

Agency for Healthcare Research and Quality: Integrating Behavioral Health & Primary Care

American Colleges of Obstetricians and Gynecologists: Six-Months After COVID-19: The Pandemic and Mental Health

American Psychiatric Association:
Learn About the Collaborative Care Model
Get Trained in the Collaborative Care Model
Stigma, Prejudice and Discrimination Against People with Mental Illness

Anxiety & Depression Association of America:
Facts & Statistics
Irritable Bowel Syndrome (IBS)

Healthline: 11 Signs and Symptoms of Anxiety Disorders

Here to Help: What's the Difference Between Anxiety and an Anxiety Disorder?

Medline Plus: Anxiety

Science Direct: Anxiety Disorders in Primary Care

Single Care: Anxiety Statistics 2021

The Journal of Nurse Practitioners: Identifying and Managing Anxiety Disorders in Primary Care


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