Panic Anxiety Education
Management Services

The Politics of Anxiety Disorder Treatments - Who suffers?

EFFECTIVE TREATMENT & PREVENTION OF
ANXIETY DISORDERS

In the South Australian study, the subjects reported a mean of 32 months between seeking help for their symptoms and a doctor making a correct diagnosis. (5) The lack of diagnosis has also been demonstrated in overseas. (13)

Another South Australian study into Obsessive Compulsive Disorder showed that 77% of the subjects had been treated by their psychiatrist with a total average of 55 visits. (15)

TREATMENT
In contrast to the high prevalence, degree of disability and cost to the community these Disorders once correctly diagnosed can be easily treated. Over the past decade effective treatments have been developed for many Anxiety Disorders. The most effective treatments are Cognitive Behavioural Therapy (12, 16,17,18,19) These treatments for Anxiety Disorders are time limited, self directed, produce high rates of end state functioning and are cost effective.

'Studies comparing the relative efficacy of pharmacologic and cognitive behavioural interventions report panic free rates above 80% for cognitive behavioural interventions and between 50% and 60% for pharmacotherapy' (16)

Long term studies show many patients require ongoing medication treatment and remain symptomatic despite this ongoing treatment....50-80% of patients continue to remain symptomatic at assessments ranging from 1.5 years to 6 years after initiation of medication treatment.... Discontinuation of medications (especially benzodiazepines) show the majority of patients in some studies experience symptoms as bad or worse than pre-treatment levels during discontinuation. (Ibid)0000

One recent Spanish study assessed the cost before and after diagnosis and treatment of 61 people with Panic Disorder. The treatment involved psychotropic drugs including 'Alprazolam (Xanax), tricyclic anti depressants also MAOI'. Direct costs prior to diagnosis were $US 29,158 : After diagnosis, $US 46,256 : Indirect cost prior to diagnosis were $US 65,643 after diagnosis, $13, 883. The increase in Direct costs were associated to the number of psychiatrist consultations which grew from 40 prior to diagnosis to 793 after diagnosis. While the study comments in the conclusion that 'Methods for improving early detection of Panic Disorder may substantially reduce the costs incurred before diagnosis' it does not make mention of improving the direct costs after diagnosis.(13)

In comparison a German study looked at the cost effectiveness of Cognitive Behavioural Therapy involving 66 people with Panic Disorder. At a three year follow up Anxiety related health care costs, direct and indirect, decreased by 81%. 'Taking the cost of Cognitive Behavioural Therapy into account the cost benefit ratio for the first two years was 1:5:6. Thus one dollar spent for Cognitive behavioural treatment yielded a saving of 5.6 Dollars in anxiety related costs'.(19)

PREVENTION
Not only are the direct and indirect costs to the community considered to be significant for people suffering from Anxiety Disorders, they are also unnecessary. Anxiety Disorders are treatable and in many cases preventable.

Early diagnosis of Anxiety Disorders can prevent expensive investigations and long term reliance on Health Services. The secondary conditions associated with Anxiety Disorders such as Agoraphobia, drug and/or alcohol abuse, major depression and suicide can be prevented by early intervention and effective treatment. The development of effective community education Programs may prevent some Anxiety Disorders. Most importantly, these Programs will lead to early diagnosis.

THE NEED FOR EDUCATION AND ATTITUDE CHANGE
People suffering from Anxiety Disorders are often described as the "worried well". This attitude is certainly not supported by research into the social and economic costs of these Disorders.

The development of effective services and community education about the nature of Anxiety Disorders is likely to return a high dividend to the community and to the Federal and State budgets.

THE ISSUES
1. The lack of diagnosis and appropriate treatment.

Anxiety Disorders have only been recognised by the Mental Health Profession since 1980. (20) As a consequence General Practitioners and in some case Psychiatrists have received very little, if any, training in the diagnosis and treatment of these Disorders.

There is a marked difference between the 'normal' experience of anxiety and that of an Anxiety Disorder. If it was purely the experience of anxiety per se, people would recognise what was wrong with them. It is this difference which is highlighted by the fact that many Health Professionals are still unable to recognise, let alone diagnose or treat these Disorders.

The lack of understanding results in a 'generic' diagnosis of either anxiety or stress. It is this lack of specific diagnosis and appropriate treatment which is the major driving force in the development of the disabilities associated to these Disorders.

A South Australian study conducted by Dr Malcolm Battersby for our Association in 1991 (5) showed a time gap of thirty two months from first presentation to a doctor to diagnosis. Anecdotal reports from our clients show people have experienced an Anxiety Disorder for five, ten and in some cases 20 -50 years before receiving an accurate diagnosis. While some studies suggest people wait years before seeking treatment, the majority of our client group have sought treatment from their first panic attack. As they think they are going to die or have a heart attack why would they wait years before seeking treatment? What is not acknowledged in these studies is people are not diagnosed and many either stay trapped in the health care system or have given up completely and do not seek further treatment.

Three years ago, we had our first client diagnosed within a month of their first panic attack. We now have had a number of clients who have been accurately diagnosed within the first week of their panic attacks, but unfortunately the majority are still undiagnosed and are not receiving appropriate treatment.

A random check of five of our clients in October 1996 showed three were still undiagnosed and had self diagnosed after reading articles about Anxiety Disorders. Two out of the three had been receiving treatment via a psychiatrist for over two years with medication being the only treatment offered. The other three had only seen their General Practitioner. Although a random check, their experience mirrors the experience of many of our client group.

Although we have seen small isolated areas of change over the last two years, the changes have had little impact overall on our client group. The lack of recognition, understanding and appropriate treatment services for people with Anxiety Disorders is still far from adequate both in the public and private sector.

Public sector treatment services for people with Anxiety Disorders, while currently under review in South Australia, are minimal throughout the country. Many of our clients are in the ludicrous position of being able to access State services for co-morbid depression, suicide attempts, drug and alcohol abuse but are still limited in obtaining treatment services for their primary Anxiety Disorder.

The enormous and often unnecessary personal and financial costs of these Disorders are now well documented. It does not make economic sense, both at a State and Federal level, for this situation to continue in this way. Much of the costs are unnecessary. With earlier diagnosis and appropriate treatment the impact of an Anxiety Disorder on the individual can be minimised and the serious disabilities prevented. This would also ensure cost savings to both State and Federal Governments.

OUTCOMES
Without meaning to be factitious, this lack of diagnosis and/or appropriate treatment by health professionals has contributed greatly to the 'health outcomes' of our client group. These include co-morbid depression, suicide, drug and alcohol abuse and avoidance behaviour (Agoraphobia). Not to mention marital difficulties, financial problems, loss of a productivity and/or job loss and restrictive lifestyles.

The outcomes for the Federal and State budgets, include over reliance on primary health care services (21) through years of treatment with general practitioners and/or psychiatrists without any substantial gains being made. (16)

'People with Anxiety Disorders are a large group which is not well recognised by general health services yet are disproportionate users of these services across a range of primary care and specialist medical settings.' (18)

'Epidemiologic studies have found that 15% of primary care patients suffer from current anxiety or depressive disorders and these Disorders are associated with substantial disability and functional impairment. Follow up studies also show a 'significant risk of chronicity and incomplete recovery'. Ibid

One paper found among primary care patients, anxiety and depressive disorders are associated with markedly higher health care costs even after adjustment for medical co-morbidity.....These costs at baseline had markedly higher baseline costs of $2390 than patients with subthreshold disorders, $1098, and those with no anxiety or depressive disorder, $1397. (21)

91% of General Practitioners interviewed in one study in New South Wales reported Anxiety Disorders and mixed anxiety and depression represented 64% of all consultations. (18)

In 1980 the economic costs of Panic Disorder alone, calculated in terms of employment losses, disability benefits, financial support and health care costs were estimated to be One Billion dollars in the United States. (8)

A recent survey in the United Kingdom has placed the economic costs of Anxiety Disorders (calculated solely on the basis of absenteeism) at about 3 Billion Pounds per year. (7)

The tragedy is the majority of the personal and financial costs of these Disorders are preventable with early diagnosis and effective, appropriate treatment.

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