Effectiveness of Models of Care for Managing Mild to Moderate Anxiety in Primary Care: A Systematic Review

Problem

Anxiety disorders are one of the most common mental health disorders seen in primary care. However the identification of anxiety disorders in primary care is under-researched and assessment of anxiety severity difficult due to the multiplicity of anxiety disorders and symptoms. As stepped care models match treatment options to patients’ level of need identification of the most effective tools for classifying anxiety severity in primary care is critical. We aimed to determine the most effective methods to identify anxiety severity in primary care and to identify the most effective interventions for reducing mild to moderate anxiety in primary care and in particular for specific at-risk or hard-to-access groups (e.g., Aboriginals, refugees, culturally and linguistically diverse (CALD) and chronically ill patients).

Approach

Four databases were systematically searched (Medline, PubMed, PsychINFO and the Cochrane Database of Systematic Reviews) for studies published from 2006-2016 for the identification of anxiety severity in primary care and the treatment of mild to moderate anxiety in adult primary care patients. For the treatment of anxiety, all study designs with a comparison group were included (except pilot studies). Studies were excluded if they were conducted in secondary care settings, included severe anxiety, or paediatric or adolescent patients. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and assessed article quality.

Findings

Of the 500 identified records, eleven met inclusion criteria. The GAD-7 was identified as the most effective method for classifying generalised anxiety disorder severity. The CALM intervention – a collaborative care model that treats the four main types of anxiety – was the most effective for symptom reduction and remission. Its effectiveness was not compromised by co-morbid depression, alcohol dependence, pain and pain medication, or previous trauma. No studies met inclusion criteria for hard-to-access groups (e.g. Aboriginals, refugees).

Consequences

The GAD-7 tool can be used in primary care to assess anxiety severity but further research is required to assess its performance relative to other tools. The CALM collaborative care intervention appears well suited to primary care but further research is required to establish the efficacy of interventions to reduce symptoms of mild to moderate anxiety in hard-to-access groups and at-risk groups, such as Aboriginals, CALD and refugees, and those with chronic illness and to establish the efficacy of interventions to reduce symptoms of mild anxiety in primary care patients.