Accuracy of Anxiety Disorder Not Otherwise Specified Diagnosis in Older Veterans.

Abstract

We examined the accuracy of the anxiety not otherwise specified (anxiety NOS) diagnosis in 61 patients, using data from older Veterans screened for a large trial of cognitive behavioral therapy for late-life generalized anxiety disorder. We compared the anxiety NOS diagnoses based on the electronic medical record to diagnoses obtained via a gold standard structured diagnostic interview conducted for this trial. We found concordance of the anxiety NOS diagnosis in only 2 participants (3%). Most patients (77%) met diagnostic criteria for a specific Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorder, including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and/or social anxiety disorder, on the basis of a structured diagnostic interview. The erroneous diagnosis of anxiety NOS is a barrier to patients receiving appropriate evidence-based care for specific anxiety-related and trauma-related disorders. Undertreated anxiety can result in poorer health outcomes, overutilization of medical services, and increased health care costs. Accurate diagnosis of anxiety disorders is foundational to evidence-based treatment; thus, it is imperative that patients presenting with anxiety symptoms receive proper diagnostic assessment to facilitate access to the appropriate evidence-based mental health services.