Requirements for population-based needs assessment in anxiety disorders

The basic prerequisites for a population-based evaluation of need for anxiety disorder treatment in developed health care systems are: (1) clearly specified disorders and/or related disabilities for which (2) effective and (3) acceptable interventions/treatments are available and (4) can be provided (Häfner, 1979; Wittchen, 1988).

It is generally agreed that these basic requirements are widely met for most forms of anxiety disorder. First, explicit diagnostic criteria, operationalized diagnoses [DSM-III, American Psychiatric Association (APA), 1980; DSM-IV, APA, 1994; and ICD-10, World Health Organization (WHO), 1993] and diagnostic instruments [i.e., the Composite International Diagnostic Interview (CIDI, WHO, 1990)] allow mental health specialists and primary care doctors to recognize and diagnose most forms of anxiety disorder reliably (Wittchen, 1994).

The improved diagnostic techniques have led to better identification of the risk factors for first developing anxiety disorders, secondary psychosocial disability, and psychopathological complications (Kessler et al., 1994; Magee, Eaton, Wittchen, McGonagle & Kessler, 1996; Wittchen et al., 1995 a,b,c). They have also allowed characterization of the disorder's natural course, which is usually persistent (Wittchen, 1991). Rice & Miller (1998) demonstrate the impact that anxiety disorders have on society, by revealing that more is spent, in direct and indirect costs, on anxiety disorders than on depressive or psychotic disorders.

Second, there are various highly effective pharmacological and psychological treatments for anxiety disorders, and their disadvantages and limitations have been described (Andrews, Crino, Hunt, Lampe & Page, 1994; Bond & Lader, 1996; Elkin, Pilkonis, Docherty & Sotsky, 1988; Fineberg & Drummond, 1995).