Does This Patient Have Generalized Anxiety or Panic Disorder?: The Rational Clinical Examination Systematic Review
Abstract
IMPORTANCE: In primary care settings, generalized anxiety disorder (GAD) and panic disorder are common but underrecognized illnesses. Identifying accurate and feasible screening instruments for GAD and panic disorder has the potential to improve detection and facilitate treatment. OBJECTIVE: To systematically review the accuracy of self-report screening instruments in diagnosing GAD and panic disorder in adults. DATA SOURCES: We searched MEDLINE, PsycINFO, and the Cochrane Library for relevant articles published from 1980 through April 2014. STUDY SELECTION: Prospective studies of diagnostic accuracy that compared a self-report screening instrument for GAD or panic disorder with the diagnosis made by a trained clinician using Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria. RESULTS: We screened 3605 titles, excluded 3529, and performed a more detailed review of 76 articles. We identified 9 screening instruments based on 13 articles from 10 unique studies for the detection of GAD and panic disorder in primary care patients Across all studies, diagnostic interviews determined that 257 of 2785 patients assessed had a diagnosis of GAD while 224 of 2637 patients assessed had a diagnosis of panic disorder. The best-performing test for GAD was the Generalized Anxiety Disorder Scale 7 Item (GAD-7), with a positive likelihood ratio of 5.1 (95% CI, 4.3-6.0) and a negative likelihood ratio of 0.13 (95% CI, 0.07-0.25). The best-performing test for panic disorder was the Patient Health Questionnaire, with a positive likelihood ratio of 78 (95% CI, 29-210) and a negative likelihood ratio of 0.20 (95% CI, 0.11-0.37). CONCLUSIONS AND RELEVANCE: Two screening instruments, the GAD-7 for GAD and the Patient Health Questionnaire for panic disorder, have good performance characteristics and are feasible for use in primary care. However, further validation of these instruments is needed because neither instrument was replicated in more than 1 primary care population.
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The PHQ-9 and GAD-7 are among the best validated and most commonly used measures of depression and anxiety, respectively.
“The Patient Health Questionnaire 9-item depression scale (PHQ-9) and 7-item Generalized Anxiety Disorder scale (GAD-7) are among the best validated and most commonly used depression and anxiety measures, respectively.20-25”
From Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials (2016) · cites this paper as [24]
A recent systematic review on diagnostic accuracy found only limited self-report measures such as GAD-7 have good performance characteristics.
“This recent review 60 demonstrated that only limited self-reported measures of anxiety such as Generalised Anxiety Disorder Assessment (GAD-7) have good performance characteristics and are promising as a case-finding instrument.”
From Anxiety in Informal Dementia Carers: A Meta-Analysis of Prevalence (2020) · cites this paper as [60]
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Screening-Instrumente für den Hausarzt
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- Authors
- Herr, N. R., Williams, J. W., Benjamin, S., & McDuffie, J.
- Affiliations
- American University (US)
- Duke University (US)
- Grand River Hospital (CA)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-07-02
- Volume
- 312
- Issue
- 1
- Pages
- 78
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2135859066
- Cited by
- 74
- References
- 29
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 8 · 2023: 8 · 2022: 13 · 2021: 3 · 2020: 7 · 2019: 4 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 2
- FWCI
- 5.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- generalized anxiety disorder, panic disorder, screening tool, diagnostic accuracy, GAD-7, Patient Health Questionnaire, self-report questionnaire, primary care, likelihood ratios, anxiety disorders
- MeSH terms
- Anxiety Disorders, Humans, Interview, Psychological, Primary Health Care, Psychiatric Status Rating Scales, Panic Disorder, Self Report
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