Diagnosis and Treatment of Generalized Anxiety Disorder in Japan: Psychiatric Specialist Survey

Abstract

Purpose

Generalized anxiety disorder (GAD) is a suboptimally managed chronic recurring psychiatric condition with a lifetime prevalence of 2.6% in Japan. We assessed the current status of GAD management in Japan.

Patients and Methods

This was an observational, cross-sectional study conducted through an anonymous web-based survey in Japan from December 12–16, 2022. Psychiatrists and psychosomatic medicine physicians who agreed to participate and saw ≥10 outpatients in the previous month were eligible. Survey questionnaire comprised 37 single/multiple choice, numerical entry, or open-ended questions in Japanese.

Results

Among 509 participants (493 psychiatrists and 16 psychosomatic medicine physicians), 96.9% were aware of GAD. On average, 12.4 outpatients and 1.0 inpatient were diagnosed with GAD per physician per month. Of 433 physicians having patients diagnosed with GAD, 46.9% used operational diagnostic tools; among these, DSM-5 diagnostic criteria were used by 81.5% physicians. The majority (54.7%) of participants did not use a self-administered rating scale; depression scales were used more than anxiety scales. Among these 433 physicians, 96.8% used selective serotonin reuptake inhibitors for GAD management, and 79.2% used it as the first choice; of 431 physicians who prescribed drug therapy, 54.3% gave antidepressant monotherapy as first choice. The most frequent symptom in patients diagnosed with GAD was excessive anxiety/worry (96.5%); depression was the most commonly reported comorbidity (84.3%) as per physicians aware of GAD (N=508).

Conclusion

This study illustrates that although GAD awareness is high among Japanese psychiatric specialists, GAD is not frequently diagnosed using operational diagnostic approaches. Due to a lack of Japanese guidelines for GAD diagnosis and treatment, diverse international guidelines are followed, with similar treatment paradigms as that of depression. This may not be an optimal approach given cultural/geographical differences. These findings highlight the need for uniform diagnosis and treatment recommendations for GAD management in Japan.

Clinical Trial Registration

UMIN-CTR: UMIN000049572.

Keywords:

• anxiety
• GAD
• psychiatrist
• psychosomatic medicine physician
• survey

Abbreviations

CBT, cognitive behavioral therapy; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, fifth edition; GAD, generalized anxiety disorder; SNRI, serotonin and norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; URL, uniform resource locator.

Data Sharing Statement

The data that support the findings of this study are available from Viatris Inc. but restrictions apply to the availability of these data, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Viatris Inc.

Acknowledgments

Medical writing and editorial assistance were provided by Minal Jaggar and Vidula Bhole of MedPro Clinical Research with funding from Viatris Inc. The authors would like to thank Haruhiko Seki, INTAGE Healthcare Inc., for coordinating the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Keisuke Nomoto, Satoshi Matsuyama, and Shingo Higa are full-time employees of Viatris Pharmaceuticals Japan Inc. Osamu Takashio reported honoraria from lectures from Viatris Pharmaceuticals Japan Inc., Meiji Seika Pharma, Takeda Pharmaceutical, Sumitomo Pharma, and Otsuka Pharmaceutical. Tempei Otsubo has received lecture fees from Viatris Pharmaceuticals Japan Inc., Takeda Pharmaceutical, Otsuka Pharmaceutical, Sumitomo Pharma, Yoshitomi Yakuhin, Mochida, Meiji Seika Pharma, Kyowa Pharmaceutical, Lundbeck Japan, and IQVIA.

Additional information

Funding

This work was supported by Viatris Pharmaceuticals Japan Inc.