Original Research

Anxiety disorders: Psychiatric comorbidities and psychosocial stressors among adult outpatients

Carla Nel, Linda Augustyn, Nandie Bartman, Marizél Koen, Maggy Liebenberg, Jurgens Naudé, Gina Joubert
South African Journal of Psychiatry | Vol 24 | a1138 | DOI: https://doi.org/10.4102/sajpsychiatry.v24i0.1138 | © 2018 Carla Nel, Linda Augustyn, Nandie Bartman, Marizél Koen, Maggy Liebenberg, Jurgens Naudé, Gina Joubert | This work is licensed under CC Attribution 4.0
Submitted: 05 June 2017 | Published: 24 May 2018

About the author(s)

Carla Nel, Department of Psychiatry, University of the Free State, South Africa
Linda Augustyn, School of Medicine, University of the Free State, South Africa
Nandie Bartman, School of Medicine, University of the Free State, South Africa
Marizél Koen, School of Medicine, University of the Free State, South Africa
Maggy Liebenberg, School of Medicine, University of the Free State, South Africa
Jurgens Naudé, School of Medicine, University of the Free State, South Africa
Gina Joubert, Department of Biostatistics, University of the Free State, South Africa


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Abstract

Background: Anxiety disorders are the most prevalent class of lifetime mental disorders according to South African research. However, little is known about the prevalence of factors that might complicate treatment among adults in a psychiatric outpatient setting.

Aim: To explore the psychiatric comorbidities and psychosocial stressors among a population of adults treated for anxiety disorders at the outpatient unit of a tertiary psychiatric facility in Bloemfontein.

Methods: In this retrospective cross-sectional study, clinical files of all mental healthcare users receiving treatment were reviewed to identify those with a current or previous diagnosis of one or more of the following anxiety disorders: generalised anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD) and agoraphobia.

Results: Of the 650 available records, 103 (15.8%) included at least one anxiety disorder. Of those, 65.1% had GAD, 34.0% had panic disorder and 29.1% had SAD. Agoraphobia was diagnosed in 14.6% of patients almost exclusively as comorbid with panic disorder. Additional psychiatric disorders were present for 98.1% of patients and 36.9% had multiple anxiety disorders. The patients had a history of relational problems (64.1%), educational and occupational stressors (55.3%), abuse and neglect (28.2%), other problems related to the social environment (24.3%) and self-harm (23.3%).

Conclusion: Clinical practice should take the high rates of comorbidity into account and the importance of integrated substance-related interventions in mental healthcare settings is clear. Diagnostic practices regarding agoraphobia without panic, and the comorbidity of anxiety and personality disorders should receive further attention. Clinicians should be aware of the potential impact of the frequently reported psychosocial stressors.


Keywords

anxiety disorders; generalised anxiety disorder; panic disorder; agoraphobia; psychiatric comorbidity; psychosocial stressors

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