Anxiety and depression in primary care patients: predictors of symptom severity and developmental correlates

A study in a German general practice used the Hospital Anxiety and Depression Scale (HADS) to determine the prevalence of anxiety and depression in 242 consecutive patients. The study had two additional goals: (1) to identify indicators of symptom severity and (2) to validate the HADS by relating it to measures of developmental psychopathology.

In addition to the HADS, clinical/sociodemographic data were collected. Patients filled up additional questionnaires measuring attachment characteristics, recalled parental rearing behavior, resilience, adverse childhood experiences, and physical complaints.

Using HADS cutoff scores of > or =11 in total, we found that 21.1% of the patients showed clinically relevant anxiety levels; the rate for depression was 12.0%, that for anxiety or depression was 26.1%, and that for anxiety and depression combined was 7%. With the exception of psychiatric disorders, the HADS did not differentiate between subgroups with different somatic diseases. HADS scores were shown to be predicted by the patients' sex, family status, number of consultations, and subjective physical complaints. Patients with higher HADS scores also indicated lower resilience, more insecure attachment, and negative recalled parental rearing behavior. Resilience, attachment security, and specific parental behavior (control/warmth) independently predicted anxiety, depression, and physical complaints.

This study provides further support for the usefulness of the HADS as a measure for routine screening for anxiety and depression and its relationship with constructs from developmental psychopathology. We recommend the use of the HADS in combination with potential indicators of symptom severity (fatigue, cardiovascular symptoms, high number of consultations) to identify patients needing psychosocial support.