Introduction

This chapter describes the types of anxiety disorders seen in primary care settings, the risk factors associated with those disorders, and possibilities for early intervention to avoid their progression.

Anxiety problems in the community

Anxiety and related difficulties are very common in primary care. Every general practitioner encounters patients with irrational fears; health visitors may be familiar with new mothers who have developed agoraphobia; and the community nurse will certainly come into contact with anxious relatives of ill patients.

Around one in six adults consulting general practitioners are ‘generally anxious’ (Lader, 1992). Others present with specific phobias, discrete panic disorder or obsessional–compulsive disorder, so the prevalence of anxiety disorders in primary care settings is at least 15%. Minor affective disorders, that is anxiety and mild depression or both, account for a large proportion of consultations in general practice (Goldberg & Huxley, 1980). Anxiety is more common even than depression and is usually managed in primary care, rather than being referred on for specialist attention (McPherson, 1987).

Primary care workers are well placed to help

The primary health care team is in contact with the majority of the individuals who need help in coping with anxiety. Furthermore, studies show that primary care professionals can be highly successful in helping the anxious to overcome problems using psychological methods. Catalan et al. (1984) found that general practitioners can successfully use problem-solving techniques rather than prescribe anxiolytic medication, while Marks (1985) established that trained practice nurses could work well as behaviour therapists in a primary care setting.