Daniel Karlin, MD: Prevalence of Undiagnosed Generalized Anxiety Disorder

A recent study highlighted the large number of US adults with undiagnosed generalized anxiety disorder (GAD), underscoring the unmet need for anxiety screening.

Daniel Karlin, MD, from MindMed, presented the data at the annual American Psychiatric Association (APA) 2024 conference in New York. The findings were presented in 2 posters: “Quantifying the Burden of Undiagnosed Generalized Anxiety Disorder in the US General Adult Population” and “Screening Adults in the US General Population to Detect Cases of Undiagnosed Generalized Anxiety Disorder.” 2,3 HCPLive sat down with Karlin to discuss the unmet need for anxiety screening.

Economic and Humanistic Burden of GAD

Adults with undiagnosed GAD exhibited greater levels of activity impairment, absenteeism, presenteeism, and work productivity impairment compared to adults with diagnosed GAD, a recent cross-sectional retrospective analysis found.

“In many cases, if people are walking around with the symptoms of GAD but haven't been diagnosed and therefore haven't been treated, the burden on the person is worse, as is the burden on the healthcare system and on the employers as well,” Karlin told HCPLive.

Investigators sought to understand the impact of undiagnosed GAD by assessing the financial and emotional toll of GAD among US adults who were diagnosed and undiagnosed. They leveraged data from the 2022 National Health and Wellness Survey, an annual online survey of adults aged ≥ 18 years who self-reported the 7-item GAD questionnaire (GAD-7), GAD diagnosis, and treatment.

Undiagnosed GAD was defined as participants who had a GAD-7 score of ≥ 10 but no diagnosis, and diagnosed GAD was defined as either a diagnosis and perceived anxiety or a diagnosis and GAD-7 score of ≥ 10 but no perceived anxiety.

Compared to adults with diagnosed GAD, adults with undiagnosed GAD were more likely to be younger (36.6 vs 43.1 years old), male (57.5% vs 21.4%), Hispanic (29.9% vs 14.0%), employed (80.0% vs 50.9%), current smoker (38.6% vs 21.8%), and alcohol drinker (75.0% vs 66.3%). Adults with undiagnosed GAD had fewer reported comorbidities of depression (15.0% vs 78.5%) and pain (9.6% vs 44.3%) (all, P <.001).

The study found undiagnosed adults had a greater number of hospitalizations (1.2 vs 0.3) and emergency room visits (1.3 vs 0.5) but fewer provider visits (3.0 vs 8.7) compared to diagnosed adults (P < .001).

Ultimately, undiagnosed adults had 1.6, 3.1, 1.9, and 1.9 times greater activity impairment, absenteeism, presenteeism, and work productivity impairment, respectively, than diagnosed adults.

Karlin said the findings align with the US Preventive Services Task Force recommendation for anxiety screening.3 For ≥ 30 years, primary care settings have screened for depression—but not for anxiety.

“The more that we are able to screen for anxiety disorders, the more likely we are to catch them and be able to diagnose them and then get people appropriate treatment,” Karlin said. “… If we don't screen, and we don't ask, then we will miss a big portion of these patients.”

Incorporating GAD Screening into Routine Primary Care

Another poster at APA 2024 displayed how undiagnosed adults were younger, more often male, current smokers, alcohol drinkers, and employed. The poster also stated undiagnosed adults were less likely to be White and obese or overweight.

The study found nearly a quarter of the US general adult population screened positive for GAD. Of those people, 83.1% were undiagnosed, which equates to approximately 49 million adults. The findings underscore the substantial unmet need for anxiety screening.

“Given that we now know that there's a significant portion of the population, walking around with moderate to severe symptoms of G D, but having not been diagnosed, it's incumbent on folks practicing in all areas of medicine to start screening for GAD,” Karlin said.

Disclosures for Karlin include Otsuka Pharmaceutical Development & Commercialization, Inc. and Ostuka America Pharmaceutical, Inc.

References

1. ^{Karlin, D. Quantifying the Burden of Undiagnosed Generalized Anxiety Disorder in the US General Adult Population. Poster presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4 – 8, 2024.}
2. ^{Karlin, D. Screening Adults in the US General Population to Detect Cases of Undiagnosed Generalized Anxiety Disorder. Poster presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 4 – 8, 2024.}
3. ^{Anxiety Disorders in Adults: Screening. US Preventive Services Task Force. June 20, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/anxiety-adults-screening. Accessed May 8, 2024.}