Diagnostic Indicators of Anxiety and Depression in Older Dizzy Patients in
Primary Care J Geriatr Psychiatry Neurol 2011;24(2)98-107
Maarsingh
1
OR,
Dros
2
J,
van der Windt
3
DA,
ter Riet
2
G,
Schellevis
1
FG,
van Weert
2
HC,
van der Horst
1
HE,
1 EMGO+/VUmc
Amsterdam, Department of General Practice; 2 AMC Amsterdam, Department of General Practice; 3 Keele University, Staffordshire, United Kingdom
Corresponding author: o.maarsingh@vumc.nl
Background
Results
Dizzy patients with both psychological
and physical symptoms tend to have
high levels of disability and are at risk to
remain symptomatic and disabled. The
objective of this study was to develop a
prediction model for the presence of
anxiety and/or depression in older dizzy
patients in primary care.
According to the PHQ, an anxiety
and/or depressive disorder was
present in 90 patients (22%), of whom
35 reported no medical history of
anxiety or depression, nor current
pharmacological treatment for these
disorders. In the final model, dizzinessrelated disability, a history of
depression, and accompanying fear
were associated with an increased
odds of anxiety and/or depression,
whereas tinnitus and rotational
dizziness were associated with a
decreased odds of anxiety and/or
depression. The model showed good
calibration (Hosmer-Lemeshow P value
of 0.46) and discrimination (adjusted
AUC after bootstrapping of 0.82).
Methods
We performed a cross-sectional study
among 415 older patients consulting
their primary care physician for
persistent dizziness. Participants
underwent a standardized,
comprehensive evaluation and
completed self-administered
questionnaires regarding anxiety and
depression (PRIME-MD Patient Health
Questionnaire [PHQ]) and dizzinessrelated disability (Dizziness Handicap
Inventory).
To determine diagnostic indicators of
anxiety and/or depression, we used
multiple logistic regression analysis with
“presence of Panic Disorder, Other
Anxiety Disorder, or Major Depressive
Disorder” as dependent variable.
Potential diagnostic indicators included
dizziness-related disability, patient
characteristics, and dizziness
characteristics.
Conclusions
Primary care physicians should
consider the existence of anxiety and
depression in older patients presenting
with dizziness. After external validation,
our model may contribute to better
recognition and hence better
management of anxiety and
depression in older dizzy patients in
primary care.
Table 1. Patient Characteristics*
Patient characteristics
Gender, female
Age in years, mean ± SD
Living situation
Alone
Home for elderly/other institution
No. of drugs per patient, mean ± SD
No. of chronic disorders, mean ± SD
Psychiatric diagnosis (PRIME-MD PHQ)
Anxiety disorder
Panic Disorder
Other Anxiety Disorder
Depressive disorder
Major Depressive Disorder
Anxiety or depressive disorder (or both)
Anxiety and depressive disorder
305 (73)
78.5 ± 7.2
252 (61)
66 (16)
4.4 ± 3.0
3.5 ± 1.9
19 (5)
39 (9)
Foto: Alex de Groot,www.alexdegroot.nl
53 (13)
90 (22)
21 (5)
*: Values are the number (percentage) unless otherwise indicated
PHQ: Patient Health Questionnaire; SD: Standard Deviation
Table 2. Diagnostic Indicators of Anxiety and/or Depression*
OR
95% CI
P value
Patient characteristics
Depressive disorder in medical history
2.4
1.3-4.3
0.003
Dizziness characteristics
Description of dizziness: rotational sensation
Associated symptom during episode of dizziness: tinnitus
Associated symptom during episode of dizziness: fear
Score of Dizziness Handicap Inventory (0-100, in steps of 10)
0.5
0.2
2.8
1.8
0.3-0.8
0.1-0.6
1.5-5.2
1.5-2.1
0.008
0.005
0.001
<0.001
* : AUC 0.83 [CI 0.79-0.88], adjusted AUC 0.82, optimism 0.009
CI: Confidence Interval; OR: Odds Ratio