Anxiety disorders in the general hospital setting.

Using the 1987 National Hospital Discharge Survey database, one percent of adult medical/surgical inpatients with a principal medical or surgical diagnosis were found to have a concurrent anxiety disorder. The anxiety comorbidity inpatients were older, more likely to be white, female, and unmarried compared to others (inpatients without anxiety noted on the discharge summary). In addition to an anxiety disorder, 7% had a substance use disorder, and 5% had a major affective disorder. Anxiety comorbidity inpatients stayed longer in the hospital than other inpatients: mean (SD) 7.1 (9.4) vs 6.3 (8.6) days. Anxiety comorbidity inpatients were less likely to die in the hospital, and were more likely to leave the hospital against medical advice than other inpatients. Medical/surgical inpatients received less diagnoses of anxiety disorders than predicted by surveys of community-dwelling individuals (7.3%) or by anxiety symptom screens among medical inpatients (20-25%). The difference may be explained by under-reporting, under-recognition, or the rationalization by physicians that anxiety is an expected part of an acute medical hospital stay. The inpatients receiving an anxiety diagnosis may represent the most severely affected individuals, whose anxiety most significantly affected the hospital course. Since timely psychosocial intervention has been shown to reduce hospital stay, a psychiatric consultation may have the added benefit of shortening stays and cutting costs, while improving the quality of care received by medical and surgical inpatients with anxiety disorders in the general hospital setting.