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Accuracy of Anxiety Disorder Not Otherwise Specified Diagnosis in Older Veterans


Journal of Psychiatric Practice®: September 2019 - Volume 25 - Issue 5 - p 358–364
doi: 10.1097/PRA.0000000000000408

We examined the accuracy of the anxiety not otherwise specified (anxiety NOS) diagnosis in 61 patients, using data from older Veterans screened for a large trial of cognitive behavioral therapy for late-life generalized anxiety disorder. We compared the anxiety NOS diagnoses based on the electronic medical record to diagnoses obtained via a gold standard structured diagnostic interview conducted for this trial. We found concordance of the anxiety NOS diagnosis in only 2 participants (3%). Most patients (77%) met diagnostic criteria for a specific Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorder, including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and/or social anxiety disorder, on the basis of a structured diagnostic interview. The erroneous diagnosis of anxiety NOS is a barrier to patients receiving appropriate evidence-based care for specific anxiety-related and trauma-related disorders. Undertreated anxiety can result in poorer health outcomes, overutilization of medical services, and increased health care costs. Accurate diagnosis of anxiety disorders is foundational to evidence-based treatment; thus, it is imperative that patients presenting with anxiety symptoms receive proper diagnostic assessment to facilitate access to the appropriate evidence-based mental health services.

FLETCHER, HUNDT, KUNIK, STANLEY: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; and South Central Mental Illness Research, Education and Clinical Center (a virtual center), Houston, TX

SINGH: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center (MEDVAMC 152), Houston, TX and Department of Medicine, Baylor College of Medicine, Houston, TX

Supported by the National Institute of Mental Health (Grant MH053932) awarded to Dr. Stanley and also supported in part by a Career Development Award to the second author (CDA 13-264), the Department of Veterans Affairs South Central Mental Illness Research Education and Clinical Center (MIRECC), and the VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), Michael E. DeBakey VA Medical Center, Houston, TX. The sponsors played no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

The views expressed reflect those of the authors and are not necessarily those of the Department of Veterans Affairs, the United States government, or the Baylor College of Medicine.

The authors declare no conflicts of interest.

Please send correspondence to: Terri L. Fletcher, PhD, Houston VA HSR&D Center of Innovations in Quality, Effectiveness and Safety (MEDVAMC 152), 2002 Holcombe Boulevard, Houston, TX 77030 (e-mail:

Online date: September 6, 2019

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