MindMed APA 2024: Screening Adults in the US General Population to Detect Cases of Undiagnosed Generalized Anxiety Disorder

Screening Adults in the US General Population to Detect Cases of

4339

Undiagnosed Generalized Anxiety Disorder

Daniel Karlin,1 Susan J. Suponcic,2 Kathy Annunziata,3 Corklin Steinhart,1 Phong Duong1

1MindMed, New York, NY, USA; 2Value & Access Advisors, LLC, St. Petersburg, FL, USA; 3Oracle Life Sciences, Austin, TX, USA

Background

• Recently, the US Preventive Services Task Force (USPSTF) recommended screening adults for generalized anxiety disorder (GAD) in the primary care setting, regardless of risk factors.1
• While evidence for the benefit or harm of GAD screening was not established in prior meta-analysis, GAD treatment was found to be beneficial, and validated screening tools were able to accurately identify cases; hence, routine screening was recommended to avoid delays in diagnosis and treatment.2
• However, estimates of the prevalence of GAD in the general population are outdated,2 and more recent estimates are based on small samples.3
• Current population-level data are thus needed, particularly on the prevalence of undiagnosed GAD, to inform clinical practice.

Objectives

• To quantify and characterize the US general adult population who screen positive and may have undiagnosed GAD.

Methods

Study Design

Results

Figure 1. GAD Subgroup Definitions and Population Size

Control

GAD Cohorts

Total US Adult Population (Age 18+)

Control Group (Total)

GAD Cohort (Total)

Diagnosed

Undiagnosed

253.1 M (N=75,261)

183.5 M (n=54,346)

69.6 M (n=20,915)

Diagnosed

Undiagnosed

Experiencing GAD but

Experiencing GAD and

GAD Diagnosed but

Never Diagnosed with GAD,

20.6 M (n=5,526)

49.0 M (n=15,389)

Not Diagnosed

Currently Diagnosed

Not Experiencing

Not Experiencing

10.0 M (n=2,808)

16.9 M (n=4,470)

5.8 M (n=1,653)

220.4 M (n=66,330)

Currently use Rx

Not currently using Rx

9.7 M (n=2,600)

7.2 M (n=1,870)

GAD-7 score: <10

GAD-7 score: <10

GAD-7 score: <10

GAD-7 score: <10

GAD-7 score: <10

(No GAD / Mild GAD)

(No GAD / Mild GAD)

(No GAD / Mild GAD)

(No GAD / Mild GAD)

(No GAD / Mild GAD)

4.8 M (n=1,327)

5.0 M (n=1,402)

3.5 M (n=935)

4.2 M (n=1,226)

176.6 M (n=52,422)

GAD-7 score: 10-14

GAD-7 score: 10-14

GAD-7 score: 10-14

No GAD Rx / therapy

GAD-7 score: 10-14

(Moderate GAD)

(Moderate GAD)

(Moderate GAD)

2.1 M (n=597)

(Moderate GAD)

2.8 M (n=790)

2.4 M (n=611)

1.8 M (n=452)

24.6 M (n=7,902)

Use GAD Rx / therapy

2.1 M (n=629)

GAD-7 score: 15-21

GAD-7 score: 15-21

GAD-7 score: 15-21

GAD-7 score: 15-21

(Severe GAD)

(Severe GAD)

(Severe GAD)

(Severe GAD)

GAD-7 score: 10-14

2.4 M (n=691)

2.3 M (n=587)

1.9 M (n=483)

19.2 M (n=6,006)

(Moderate GAD)

949 K (n=252)

GAD-7 score: 15-21

Abbreviations: M: millions, K: thousands

(Severe GAD)

675 K (n=175)

Conclusions

• Nearly a quarter of the US general adult population screened positive for GAD with the USPSTF-recommendedGAD-7 screening tool.
• A large majority, 83.1%, of those never received a GAD diagnosis (approximately 49 million adults), underscoring a substantial unmet need.
• Those without a GAD diagnosis were more often younger, employed men.
• Findings unequivocally support USPSTF recommendations to incorporate GAD screening into routine primary care to identify adults who require referral for diagnosis and treatment.

References

1. US Preventive Services Task Force, Barry MJ, Nicholson WK, et al.

Screening for anxiety disorders in adults: US Preventive Services Task

Force Recommendation Statement. JAMA. 2023;329(24):2163-2170.

• This cross-sectional retrospective study analyzed data from the 2022 US National Health and Wellness Survey (NHWS; N=75,261), an annual online self-report survey of adults (aged ≥18).
• NHWS is representative of the age, sex, and race / ethnicity distribution in the US Census.
• All respondents completed the 7-Item GAD Questionnaire (GAD-7;2-week recall period) and reported on GAD diagnosis and treatment.

Definitions

• Undiagnosed GAD group was defined as: no GAD diagnosis + positive screen (GAD-7 score ≥10).
• Diagnosed GAD group was defined as: GAD diagnosis + perceived anxiety; GAD diagnosis + no perceived anxiety + positive screen or treatment for GAD.
• • Treatment for GAD was defined as: currently use a prescription for GAD or have seen a psychiatrist or psychologist / therapist in the past 6 months.
• Control group was defined as: no GAD diagnosis + no positive screen or GAD diagnosis + no positive screen
• • no treatment for GAD.
• Moderate and severe GAD symptoms were defined as: GAD-7 scores of 10-14 and ≥15, respectively.

Study Sample (Figure 2)

• Among 75,261 NHWS respondents, 23.3% (95% CI: 23.1%-23.5%) had a positive screen. This projects to ~59 million adults with a positive screen in the US population.
• • Of these, 55.1% (95% CI: 54.7%-55.5%) and 44.9% (95% CI: 44.5%-45.3%) had moderate and severe anxiety symptoms, respectively.
• Of those who screened positive, 83.1% (95% CI: 82.8%-83.4%) never received a diagnosis for GAD (projects to ~49 million adults).
• • 56.0% (95% CI: 55.5%-56.4%) and 44.0% (95% CI: 43.6%-44.5%) had moderate and severe anxiety symptoms, respectively.

Figure 2. Estimated Number of US Adults with a GAD-7 Positive Screen

Total US Adult Population (Age 18+)

253.1 M (N=75,261)

Demographics and Health Characteristics (Table 1)

• Compared with controls and diagnosed GAD groups,	• Compared with controls and diagnosed GAD groups,
undiagnosed GAD was more often:	undiagnosed GAD was less often:
-	Younger (aged 37.5 years vs. 51.8 years and	-	White (50.8% vs. 64.5% and 69.3%)
	42.1 years)	-	Obese/overweight (44.5% vs. 61.5% and
-	Male (53.9% vs. 49.4% and 25.5%)		68.2%)

• Current smoker (36.4% vs. 15.0% and 22.9%)
• Alcohol drinker (72.4% vs. 64.1% and 65.1%)
• Employed (74.6% vs. 55.4% and 49.8%)
• Had annual household income ≥$75,000
  (58.5% vs. 45.7% and 25.6%)

Table 1. Sociodemographic and Health Characteristics of Controls, Diagnosed GAD, and Undiagnosed GAD

2.	O'Connor EA, Henninger ML, Perdue LA, Coppola EL, Thomas RG,
	Gaynes BN. Anxiety screening: evidence report and systematic review
	for the US Preventive Services Task Force. JAMA. 2023;329(24):2171-
	2184.
3.	Momin A, Rodrigues K, Stead T, Mangal R, Ganti L. The prevalence of
	undiagnosed anxiety: a national survey. J Affect Disord Rep. 2023 Jul
	1;13:100584.
4.	US Census Bureau. Current Population Survey 2021. Retrieved from:
	https://www.census.gov/data/datasets/time-series/demo/cps/cps-
	basic.2021.html (last accessed: October 7, 2022).

Acknowledgements / Disclosures

Subgroup Definitions and Projected Sizes (Figure 1)

• Respondents were classified into subgroups based on experience with GAD, diagnosis of GAD, treatment status, and GAD-7 score.
• Estimates of population size for each group were represented in millions (M) or thousands (K), as well as actual sample size of survey respondents (n).

Data Analysis

•	Prevalence estimates were reported as percentages with 95% confidence intervals (CIs).
•	Weighting was used to project results to the overall US adult population, with population estimates
	referenced from the 2021 Current Population Survey (Annual Demographics File) of the US Census Bureau.4
	- Projected results are shown, followed by unweighted results in parentheses.

Severe GAD

Symptoms 26,453,222

Moderate GAD

Symptoms 32,517,265

Mild GAD

Symptoms 49,140,655

No / Minimal

GAD Symptoms

59 M Adults with a

Positive Screen

(23.3% of total)

Severe=45%

Moderate=55%

145,039,262

Undiagnosed GAD

49 M Adults

(83.1% of those with a

positive screen)

Severe=44%

Moderate=56%

	Control Group	Diagnosed GAD	Undiagnosed GAD
	183.5 M Adults	20.6 M Adults	49.0 M Adults
	(n=54,346)	(n=5,526)	(n=15,389)
Mean age (years)	51.8	42.1	37.5
Male	49.4%	25.5%	53.9%
White (non-Hispanic)	64.5%	69.3%	50.8%
Employed (full-time,part-time, or self-employed)	55.4%	49.8%	74.6%
Annual household income ≥$75,000	45.7%	25.6%	58.5%
Current smoker	15.0%	22.9%	36.4%
Alcohol drinker	64.1%	65.1%	72.4%
Overweght / obese (BMI ≥25kg/m2)	61.5%	68.2%	44.5%

• The study was funded by Mind Medicine Inc.
• Dr. Corklin Steinhart is a former employee of MindMed and was employed at the time of this work.

• Undiagnosed GAD was compared with controls and diagnosed GAD on sociodemographic and health

characteristics.

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

160,000,000

Abbreviation: M: millions

Abbreviations: M: millions, BMI: body mass index

 American Psychiatric Association (APA) Annual Meeting | May 4-8, 2024 | New York, New York, USA 