An international risk prediction algorithm for the onset of generalized anxiety and panic syndromes in general practice attendees: predictA.

BACKGROUND: There are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes. METHOD: Family practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile. RESULTS: There were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724-0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837-1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654-0.809) in Estonia, 0.811 (95% CI 0.736-0.886) in The Netherlands and 0.707 (95% CI 0.671-0.742) in Chile. CONCLUSIONS: PredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression.

[Depression]. / Depressão.

The Portuguese Medical Association, through its Colleges of Specialistes, has decided to establish working groups to establish Therapeutic Guidelines in pathologies of great interest and current relevance in order to improve and rationalize health care. The group in charge of establishing the Therapeutic Recommendations in Depression, whose work I had the responsability and pleasure of coordinating during part of 1998 and 1999, is comprised of colleagues selected by the Portuguese Medical Association (Ordem dos Médicos). In the last few years, there has been rapidly increasing clinical and scientific interest in the study and treatment of depression throughout the life cycle, in different contexts and levels of medical practice. The rapid progress made in the neurosciences and psychopharmacology, new research in the field of psychotherapies and improved knowledge of relevant psychosocial aspects has not only broadened our knowledge of the aetiology and pathogenesis of depression, but also improved our criteria of diagnosis and classification. This has allowed the development of new therapeutic approaches and new drugs of proven efficacy. These Recommendations are aimed at systematizing and disseminating a consensus on interventions in depression, supported by evidence and the most recent scientific developments, in a way that will optimise therapeutic treatment. Due to some delay in the publication of these Recommendations (through no fault of the working group), and the rapid evolution of knowledge in this area, some of the contents may shortly need to be revised and updated. The writers and publishers of this document are fully aware of this and in accordance.