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Anxiety Symptoms in Allergic Patients: Identification and Risk Factors

From Semmelweis University, Faculty of Medicine, Institute of Behavioural Sciences, Budapest, Hungary

Address reprint requests to: Adriennne Stauder, MD, Semmelweis University, Faculty of Medicine, Institute of Behavioural Sciences, Nagyvarad ter 4, Budapest 1089, Hungary. E-mail: staadr{at}net.sote.hu

OBJECTIVES: Multiple relationships between anxiety, allergic symptoms, and treatment difficulties have been observed. The aim of the present study was to estimate the prevalence of anxiety disorders in outpatients with various allergic diseases, to identify diagnostic cues or possible risk factors, and to test the usefulness of self-administered questionnaire screening at the allergy clinic.

METHODS: Six hundred forty-six (646) consecutive patients with rhinoconjunctivitis (59.3%), asthma (26.8%), or "other" allergy (13.9%), aged 16 to 65 years, completed self-administered questionnaires in six outpatient allergy clinics; 60 of the respondents also participated in structured psychiatric interviews. Anxiety was measured with the Spielberger State-Trait Anxiety.

RESULTS: According to the interviews, STAI-T > 52 predicted with 86% accuracy a current psychiatric diagnosis, without differentiating between anxiety and depression. Using this threshold, the rate of anxiety and/or depressive disorders is estimated as 19% (95% CI: 15.9–22.1) in our unselected allergic outpatient sample; 46% of these patients never received any psychopharmacological treatment, indicating that anxiety related disorders are underdiagnosed and undertreated. Risk indicators were female gender; asthma; perennial symptoms; sleep problems; nonspecific allergy triggers like strong emotions; stressful situations; and considerable limitation in everyday activities attributed to the allergic symptoms.

CONCLUSIONS: Our findings confirm a high rate of anxiety and/or depressive disorders in patients visiting the allergy clinic. Self-administered questionnaires such as STAI-T provide reliable help for the identification of these frequent psychiatric problems.

Key Words: anxiety, • allergy, • rhinitis, • asthma, • Spielberger State-Trait Anxiety Inventory, • depression.

Abbreviations: DSM-IV = Diagnostic and Statistical Manual of Mental Disorders fourth edition; STAI-T = trait anxiety and STAI-S: state anxiety subscales of the Spielberger State-Trait Anxiety Inventory

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