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Catherine A. Marco


The prevalence of mental illness in the US population is common, with an estimated value of 8%. The emergency department patient population is especially vulnerable to mental illness. Previous studies from 2012 and 2017 estimated the rate of undiagnosed mental illness in the Emergency Department (ED) at 41-42%.1,2 According to the studies, only a minority of these were identified by the physician.

DSM-5 defines the criteria for generalized anxiety disorder (GAD) as “excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)”.3 The Generalized Anxiety Disorder 7-item (GAD-7) scale is a short screening tool that has demonstrated good validity and reliability for anxiety.4,5,6,7,8,9 A patient score of 8 or greater suggests that a diagnosis of generalized anxiety disorder.

There were an estimated 1.2 million ED visits related to anxiety in the US annually between 2009-2011 (approximately 1% of visits).10 A recent study from our institution identified an existing diagnosis of anxiety, as noted in the medical record, among 35% of ED patients.11 However, in this study the documented diagnosis was not confirmed and occult anxiety was not studied. There are no previous Emergency Medicine studies that identify the prevalence of GAD and risk factors that physicians should be aware of in the ED.