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An international risk prediction algorithm for the onset of generalized anxiety and panic syndromes in general practice attendees: predictA

Published online by Cambridge University Press:  06 January 2011

M. King ,
C. Bottomley ,
J. A. Bellón-Saameño ,
F. Torres-Gonzalez ,
I. Švab ,
J. Rifel ,
H.-I. Maaroos ,
A. Aluoja ,
M. I. Geerlings  and
M. Xavier
...Show all authors
M. King*
Affiliation:
Department of Mental Health Sciences, UCL Medical School, UK
C. Bottomley
Affiliation:
Department of Primary Care and Population Health, UCL Medical School, UK
J. A. Bellón-Saameño
Affiliation:
El Palo Health Centre, Department of Preventive Medicine, University of Malaga, Spain
F. Torres-Gonzalez
Affiliation:
Department of Psychiatry, University of Granada, Spain
I. Švab
Affiliation:
Department of Family Medicine, University of Ljubljana, Slovenia
J. Rifel
Affiliation:
Department of Family Medicine, University of Ljubljana, Slovenia
H.-I. Maaroos
Affiliation:
Faculty of Medicine, University of Tartu, Estonia
A. Aluoja
Affiliation:
Faculty of Medicine, University of Tartu, Estonia
M. I. Geerlings
Affiliation:
University Medical Center, Utrecht, The Netherlands
M. Xavier
Affiliation:
Faculdade Ciências Médicas, University of Lisbon, Portugal
I. Carraça
Affiliation:
Encarnação Health Centre, Portugal
B. Vicente
Affiliation:
Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Chile
S. Saldivia
Affiliation:
Departamento de Psiquiatría y Salud Mental, Universidad de Concepción, Chile
I. Nazareth
Affiliation:
Department of Primary Care and Population Health, UCL Medical School, UK Medical Research Council General Practice Research Framework, UK
*
*Address for correspondence: M. King, M.D., Ph.D., Department of Mental Health Sciences, University College London Medical School, Charles Bell House, 67–73 Riding House Street, London W1W 7EH, UK. (Email: [email protected])
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Abstract

Background

There are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes.

Method

Family practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile.

Results

There were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724–0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837–1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654–0.809) in Estonia, 0.811 (95% CI 0.736–0.886) in The Netherlands and 0.707 (95% CI 0.671–0.742) in Chile.

Conclusions

PredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression.

Keywords

Anxietypreventionprimary carerisk algorithm
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 8 , August 2011 , pp. 1625 - 1639
Copyright
Copyright © Cambridge University Press 2011

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References

Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, de Girolamo, G, Graaf, R, Demyttenaere, K, Gasquet, I, Haro, JM, Katz, SJ, Kessler, RC, Kovess, V, Lepine, JP, Ormel, J, Polidori, G, Russo, LJ, Vilagut, G, Almansa, J, Arbabzadeh-Bouchez, S, Autonell, J, Bernal, M, Buist-Bouwman, MA, Codony, M, Domingo-Salvany, A, Ferrer, M, Joo, SS, Martinez-Alonso, M, Matschinger, H, Mazzi, F, Morgan, Z, Morosini, P, Palacin, C, Romera, B, Taub, N, Vollebergh, WA; ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project (2004 a). Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica Supplement 420, 21–27.Google Scholar
Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, de Girolamo, G, Graaf, R, Demyttenaere, K, Gasquet, I, Haro, JM, Katz, SJ, Kessler, RC, Kovess, V, Lepine, JP, Ormel, J, Polidori, G, Russo, LJ, Vilagut, G, Almansa, J, Arbabzadeh-Bouchez, S, Autonell, J, Bernal, M, Buist-Bouwman, MA, Codony, M, Domingo-Salvany, A, Ferrer, M, Joo, SS, Martinez-Alonso, M, Matschinger, H, Mazzi, F, Morgan, Z, Morosini, P, Palacin, C, Romera, B, Taub, N, Vollebergh, WA; ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project (2004 b). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica Supplement 420, 47–54.Google Scholar
Andlin-Sobocki, P, Wittchen, HU (2005). Cost of anxiety disorders in Europe. European Journal of Neurology 12 (Suppl. 1), 39–44.Google Scholar
Ansseau, M, Fischler, B, Dierick, M, Mignon, A, Leyman, S (2005). Prevalence and impact of generalized anxiety disorder and major depression in primary care in Belgium and Luxemburg: the GADIS study. European Psychiatry 20, 229–235.Google Scholar
Arroll, B, Khin, N, Kerse, N (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal 327, 1144–1146.CrossRefGoogle ScholarPubMed
Barbor, TF, de la Fuente, JR, Saunders, J, Grant, M (1989). The Alcohol Use Disorders Identification Test: Guidelines for the Use in Primary Health Care. World Health Organization: Geneva.Google Scholar
Blaxter, M (1990). Health and Lifestyles. Routledge: London.Google Scholar
Brugha, T, Bebbington, P, Tennant, C, Hurry, J (1985). The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189–194.CrossRefGoogle ScholarPubMed
Christensen, H, Griffiths, K, Mackinnon, A, Kalia, K, Batterham, P, Kenardy, J, Eagleson, C, Bennett, K (2010). Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of generalised anxiety disorder. BMC Psychiatry 10, 25.CrossRefGoogle ScholarPubMed
Conroy, RM, Pyorala, K, Fitzgerald, AP, Sans, S, Menotti, A, De Backer, G, De Bacquer, D, Ducimetiere, P, Jousilahti, P, Keil, U, Njolstad, I, Oganov, RG, Thomsen, T, Tunstall-Pedoe, H, Tverdal, A, Wedel, H, Whincup, P, Wilhelmsen, L, Graham, IM, on behalf of the SCORE project group (2003). Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. European Heart Journal 24, 987–1003.Google Scholar
Cooper, H, Hedges, LV (1994). The Handbook of Research Synthesis. Russell Sage Foundation: New York.Google Scholar
Copas, JB (1983). Regression, prediction and shrinkage. Journal of the Royal Statistical Society (Series B) 45, 311–354.Google Scholar
Das-Munshi, J, Goldberg, D, Bebbington, PE, Bhugra, DK, Brugha, TS, Dewey, ME, Jenkins, R, Stewart, R, Prince, M (2008). Public health significance of mixed anxiety and depression: beyond current classification. British Journal of Psychiatry 192, 171–177.CrossRefGoogle ScholarPubMed
Deacon, BJ, Abramowitz, JS (2004). Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. Journal of Clinical Psychology 60, 429–441.CrossRefGoogle ScholarPubMed
Fernández, A, Haro, JM, Martinez-Alonso, M, Demyttenaere, K, Brugha, TS, de Autonell, J, de Girolamo, G, Bernert, S, Lépine, JP, Alonso, J (2007). Treatment adequacy for anxiety and depressive disorders in six European countries. British Journal of Psychiatry 190, 172–173.Google Scholar
Fink, LA, Bernstein, D, Handelsman, L, Foote, J, Lovejoy, M (1995). Initial reliability and validity of the childhood trauma interview: a new multidimensional measure of childhood interpersonal trauma. American Journal of Psychiatry 152, 1329–1335.Google Scholar
Goldberg, DP, Krueger, RF, Andrews, G, Hobbs, MJ (2009). Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 2043–2059.Google Scholar
Gorman, J (1996). Comorbid anxiety and depression spectrum disorders. Depression and Anxiety 4, 160–168.3.0.CO;2-J>CrossRefGoogle Scholar
Griffith, JW, Zinbarg, RE, Craske, MG, Mineka, S, Rose, RD, Waters, AM, Sutton, JM (2010). Neuroticism as a common dimension in the internalizing disorders. Psychological Medicine 40, 1125–1136.Google Scholar
Hoek, W, Schuurmans, J, Koot, H, Cuijpers, P (2009). Prevention of depression and anxiety in adolescents: a randomized controlled trial testing the efficacy and mechanisms of Internet-based self-help problem-solving therapy. Trials 10, 93.CrossRefGoogle ScholarPubMed
Janssen, I, Hanssen, M, Bak, M, Bijl, RV, de Graaf, R, Vollebergh, W, McKenzie, K, van Os, J (2003). Discrimination and delusional ideation. British Journal of Psychiatry 182, 71–76.Google Scholar
Jenkinson, C, Layte, R, Jenkinson, D, Lawrence, K, Petersen, S, Paice, C, Stradling, J (1997). A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health Medicine 19, 179–186.Google Scholar
Karasek, RA, Theorell, T (1990). Healthy Work: Stress, Productivity, and the Reconstruction of Working Life. Basic Books: New York.Google Scholar
King, M, Speck, P, Thomas, A (1995). The Royal Free interview for religious and spiritual beliefs: development and standardization. Psychological Medicine 25, 1125–1134.CrossRefGoogle Scholar
King, M, Walker, C, Levy, G, Bottomley, C, Royston, P, Weich, S, Bellón-Saameño, JA, Moreno, B, Svab, I, Rotar, D, Rifel, J, Maaroos, HI, Aluoja, A, Kalda, R, Neeleman, J, Geerlings, MI, Xavier, M, Carraca, I, Goncalves-Pereira, M, Vicente, B, Saldivia, S, Melipillan, R, Torres-Gonzalez, F, Nazareth, I (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: The PredictD Study. Archives of General Psychiatry 65, 1368–1376.Google Scholar
King, M, Weich, S, Torres-González, F, Svab, I, Maaroos, H, Neeleman, J, Xavier, M, Morris, R, Walker, C, Bellón-Saameño, JA, Moreno-Küstner, B, Rotar, D, Rifel, J, Aluoja, A, Kalda, R, Geerlings, MI, Carraça, I, de Almeida, MC, Vicente, B, Saldivia, S, Rioseco, P, Nazareth, I (2006). Prediction of depression in European general practice attendees: the PREDICT study. BMC Public Health 6, 6.Google Scholar
Krueger, RF, Markon, KE (2006). Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology 2, 111–133.Google Scholar
Mennin, DS, Heimberg, RG, Fresco, DM, Ritter, MR (2008). Is generalized anxiety disorder an anxiety or mood disorder? Considering multiple factors as we ponder the fate of GAD. Depression and Anxiety 25, 289–299.Google Scholar
Middeldorp, CM, Cath, DC, Van Dyck, R, Boomsma, DI (2005). The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychological Medicine 35, 611–624.CrossRefGoogle ScholarPubMed
Moons, KG, Donders, AR, Steyerberg, EW, Harrell, FE (2004). Penalized maximum likelihood estimation to directly adjust diagnostic and prognostic prediction models for overoptimism: a clinical example. Journal of Clinical Epidemiology 57, 1262–1270.Google Scholar
Pepe, MS, Janes, H, Longton, G, Leisenring, W, Newcomb, P (2004). Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. American Journal of Epidemiology 159, 882–890.CrossRefGoogle ScholarPubMed
Qureshi, N, Bethea, J, Modell, B, Brennan, P, Papageorgiou, A, Raeburn, S, Hapgood, R, Modell, M (2005). Collecting genetic information in primary care: evaluating a new family history tool. Family Practice 22, 663–669.Google Scholar
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA, et al. (1988). The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 1069–1077.CrossRefGoogle ScholarPubMed
Royston, P, Moons, KGM, Altman, DG, Vergouwe, Y (2009). Prognosis and prognostic research: developing a prognostic model. British Medical Journal 338, b604.CrossRefGoogle ScholarPubMed
Rubin, DB (1987). Multiple Imputation for Non-Response in Surveys. John Wiley and Sons: New York.CrossRefGoogle Scholar
Rubin, DB (2003). Discussion on multiple imputation. International Statistical Review 71, 619–625.Google Scholar
Schafer, JL (1999). Multiple imputation: a primer. Statistical Methods in Medical Research 8, 3–15.CrossRefGoogle ScholarPubMed
Schmidt, NB, Zvolensky, MJ (2007). Risk factor research and prevention for anxiety disorders: introduction to the special series on risk and prevention of anxiety pathology. Behavior Modification 31, 3–7.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JB (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association 282, 1737–1744.Google Scholar
Sproston, K, Primatesta, P (2003). Health Survey for England 2002: A Survey Carried out on Behalf of the Department of Health. Volume 1: The Health of Children and Young People. The Stationery Office: London.Google Scholar
Taylor, JF, Rosen, RC, Leiblum, SR (1994). Self-report assessment of female sexual function: psychometric evaluation of the Brief Index of Sexual Functioning for Women. Archives of Sexual Behavior 23, 627–643.Google Scholar
Tyrer, P (1990). Personality disorder and social functioning. In Measuring Human Problems: a Practical Guide (ed. Peck, D. F. and Shapiro, C. M.), pp. 119–142. John Wiley & Sons: Chichester and New York.Google Scholar
Tyrer, P, Seivewright, B, Ferguson, J, Tyrer, J (1992). The general neurotic syndrome: a coaxial diagnosis of anxiety, depression and personality disorder. Acta Psychiatrica Scandinavica 85, 201–206.Google Scholar
van Boeijen, CA, van Oppen, P, van Balkom, AJ, Visser, S, Kempe, PT, Blankenstein, N, van Dyck, R (2005). Treatment of anxiety disorders in primary care practice: a randomised controlled trial. British Journal of General Practice 55, 763–769.Google Scholar
van 't Veer-Tazelaar, N, van Marwijk, H, van Oppen, P, Nijpels, G, van Hout, H, Cuijpers, P, Stalman, W, Beekman, A (2006). Prevention of anxiety and depression in the age group of 75 years and over: a randomised controlled trial testing the feasibility and effectiveness of a generic stepped care programme among elderly community residents at high risk of developing anxiety and depression versus usual care [ISRCTN26474556]. BMC Public Health 6, 186.Google Scholar
Weich, S, Lewis, G (1998). Poverty, unemployment, and common mental disorders: population based cohort study. British Medical Journal 317, 115–119.Google Scholar
World Health Organization (1997). Composite International Diagnostic Interview (CIDI), Version 2.1. WHO: Geneva.Google Scholar