Health Care Resource Use Associated with Generalized Anxiety Disorder Among Adults in the United States

OBJECTIVES: Generalized anxiety disorder (GAD) is under-diagnosed, despite its high prevalence, which may have downstream economic impact that has not been well-characterized. This study aimed to compare health care resource use (HCRU) across adults who are undiagnosed with GAD, adults without GAD, and those diagnosed with GAD.

METHODS: This cross-sectional study analyzed data from the 2022 US National Health and Wellness Survey, a nationally-representative, online-based survey. Adults ≥18 were categorized as diagnosed GAD (reported GAD diagnosis, n=4,433), undiagnosed GAD (positive screen [GAD-7≥10] without reported GAD diagnosis, n=13,759), and no-GAD (negative screen [GAD-7<10] without reported GAD diagnosis, n=36,505). Outcomes included health care provider (HCP) visits, emergency room (ER) visits, and hospitalizations within the past 6 months. Groups were compared on confounder-adjusted outcomes using generalized linear models (negative binomial distribution, log link). Point estimates and 95% confidence intervals (CIs) for average number of visits and incidence density ratios (IDRs) are reported.

RESULTS: Diagnosed GAD had an adjusted average of 3.1 HCP visits, 0.31 ER visits, and 0.19 hospitalizations within the past 6 months. Compared with diagnosed GAD, undiagnosed GAD had significantly lower rates of HCP visits (IDR: 0.71, 95%CI: 0.66-0.77). However, undiagnosed GAD was 1.64 times more likely to have an ER visit (95%CI: 1.42-1.90) and 1.95 times more likely to have a hospitalization (95%CI: 1.59-2.40) than diagnosed GAD, suggesting significantly greater HCRU among the undiagnosed group. No-GAD had significantly lower rates of HCP (IDR: 0.64, 95%CI: 0.59-0.68) and ER (IDR: 0.84, 95%CI: 0.73-0.96) visits and similar hospitalization rates (IDR: 0.97, 95%CI: 0.80-1.19) than diagnosed GAD.

CONCLUSIONS: Overall, significantly greater ER visits and hospitalizations were observed among undiagnosed GAD than diagnosed GAD and no-GAD. These findings lend further support to efforts to screen for, diagnose, and effectively treat GAD to potentially reduce preventable and costly HCRU.