(301) Anxiety Disorders Diagnosed in Outpatient Encounters Among Commercially Insured US Adults

Background: Little is known regarding how anxiety is currently diagnosed and treated in outpatient encounters.

Objectives: To assess the type of anxiety disorder, prevalence, and medical services provided in outpatient encounters of commercially insured adults in 2021.

Methods: We performed a cross-sectional study using Merative MarketScan Research Databases, 2021 Commercial Database, V1.0. We included privately insured individuals aged 19-64 and who were continuously insured for the 12 months of 2021. The primary outcome was any diagnosis of an anxiety disorder, defined by the International Classification of Diseases–Revision 10 (ICD-10), during an outpatient encounter. We reported the prevalence of anxiety diagnosis by age and sex. We also characterized treatment settings, medications, and other comorbid psychiatric conditions among individuals with anxiety. We conducted two sensitivity analyses. First, we restricted our cohort to individuals whose primary diagnosis was anxiety disorder. Second, we repeated our analysis using data from 2019 to capture the unexpected effect of COVID-19 on prevalence estimates.

Results: Among 10,305,926 commercially insured adults, 1,730,397 (16.8%) had an outpatient encounter in 2021 with an anxiety diagnosis. Among women, 1,182,850 (22.1%) were diagnosed with anxiety; among men, 547,547 (11.1%). The most frequent specific subtypes of anxiety were anxiety, unspecified (47.1%); generalized anxiety disorder (36.5%); adjustment disorder (19.2%); post-traumatic stress disorder (6.1%); and panic disorder (6.0%). Comorbidity with other psychiatric conditions was diagnosed in 49.3% of total anxiety population. Overall, 74.5% were treated with psychoactive medication for anxiety and/or a comorbid mental disorder. Psychotherapy was provided to 33.9%, and 10.7% saw a psychiatric specialist. The prevalence of outpatient anxiety diagnosis varied in both sensitivity analyses.

Conclusions: Real-world evidence reveals a high rate of adult outpatient encounters for anxiety, including more than 1 in 5 females. Using real-world evidence to profile current medical care provides a new perspective that was unavailable in previous surveys conducted in small samples many years previously.