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    Nazareth, Irwin and Kendrick, Tony 2014. Early Intervention in Psychiatry.


An international risk prediction algorithm for the onset of generalized anxiety and panic syndromes in general practice attendees: predictA

  • M. King (a1), C. Bottomley (a2), J. A. Bellón-Saameño (a3), F. Torres-Gonzalez (a4), I. Švab (a5), J. Rifel (a5), H.-I. Maaroos (a6), A. Aluoja (a6), M. I. Geerlings (a7), M. Xavier (a8), I. Carraça (a9), B. Vicente (a10), S. Saldivia (a10) and I. Nazareth (a2) (a11)
  • DOI:
  • Published online: 06 January 2011

There are no risk models for the prediction of anxiety that may help in prevention. We aimed to develop a risk algorithm for the onset of generalized anxiety and panic syndromes.


Family practice attendees were recruited between April 2003 and February 2005 and followed over 24 months in the UK, Spain, Portugal and Slovenia (Europe4 countries) and over 6 months in The Netherlands, Estonia and Chile. Our main outcome was generalized anxiety and panic syndromes as measured by the Patient Health Questionnaire. We entered 38 variables into a risk model using stepwise logistic regression in Europe4 data, corrected for over-fitting and tested it in The Netherlands, Estonia and Chile.


There were 4905 attendees in Europe4, 1094 in Estonia, 1221 in The Netherlands and 2825 in Chile. In the algorithm four variables were fixed characteristics (sex, age, lifetime depression screen, family history of psychological difficulties); three current status (Short Form 12 physical health subscale and mental health subscale scores, and unsupported difficulties in paid and/or unpaid work); one concerned country; and one time of follow-up. The overall C-index in Europe4 was 0.752 [95% confidence interval (CI) 0.724–0.780]. The effect size for difference in predicted log odds between developing and not developing anxiety was 0.972 (95% CI 0.837–1.107). The validation of predictA resulted in C-indices of 0.731 (95% CI 0.654–0.809) in Estonia, 0.811 (95% CI 0.736–0.886) in The Netherlands and 0.707 (95% CI 0.671–0.742) in Chile.


PredictA accurately predicts the risk of anxiety syndromes. The algorithm is strikingly similar to the predictD algorithm for major depression, suggesting considerable overlap in the concepts of anxiety and depression.

Corresponding author
*Address for correspondence: M. King, M.D., Ph.D., Department of Mental Health Sciences, University College London Medical School, Charles Bell House, 67–73 Riding House Street, London W1W 7EH, UK. (Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

P Andlin-Sobocki , HU Wittchen (2005). Cost of anxiety disorders in Europe. European Journal of Neurology 12 (Suppl. 1), 3944.

M Ansseau , B Fischler , M Dierick , A Mignon , S Leyman (2005). Prevalence and impact of generalized anxiety disorder and major depression in primary care in Belgium and Luxemburg: the GADIS study. European Psychiatry 20, 229235.

B Arroll , N Khin , N Kerse (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal 327, 11441146.

M Blaxter (1990). Health and Lifestyles. Routledge: London.

H Christensen , K Griffiths , A Mackinnon , K Kalia , P Batterham , J Kenardy , C Eagleson , K Bennett (2010). Protocol for a randomised controlled trial investigating the effectiveness of an online e health application for the prevention of generalised anxiety disorder. BMC Psychiatry 10, 25.

RM Conroy , K Pyorala , AP Fitzgerald , S Sans , A Menotti , G De Backer , D De Bacquer , P Ducimetiere , P Jousilahti , U Keil , I Njolstad , RG Oganov , T Thomsen , H Tunstall-Pedoe , A Tverdal , H Wedel , P Whincup , L Wilhelmsen , IM Graham , on behalf of the SCORE project group (2003). Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. European Heart Journal 24, 9871003.

J Das-Munshi , D Goldberg , PE Bebbington , DK Bhugra , TS Brugha , ME Dewey , R Jenkins , R Stewart , M Prince (2008). Public health significance of mixed anxiety and depression: beyond current classification. British Journal of Psychiatry 192, 171177.

BJ Deacon , JS Abramowitz (2004). Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. Journal of Clinical Psychology 60, 429441.

A Fernández , JM Haro , M Martinez-Alonso , K Demyttenaere , TS Brugha , J de Autonell , G de Girolamo , S Bernert , JP Lépine , J Alonso (2007). Treatment adequacy for anxiety and depressive disorders in six European countries. British Journal of Psychiatry 190, 172173.

J Gorman (1996). Comorbid anxiety and depression spectrum disorders. Depression and Anxiety 4, 160168.

W Hoek , J Schuurmans , H Koot , P Cuijpers (2009). Prevention of depression and anxiety in adolescents: a randomized controlled trial testing the efficacy and mechanisms of Internet-based self-help problem-solving therapy. Trials 10, 93.

I Janssen , M Hanssen , M Bak , RV Bijl , R de Graaf , W Vollebergh , K McKenzie , J van Os (2003). Discrimination and delusional ideation. British Journal of Psychiatry 182, 7176.

C Jenkinson , R Layte , D Jenkinson , K Lawrence , S Petersen , C Paice , J Stradling (1997). A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health Medicine 19, 179186.

M King , C Walker , G Levy , C Bottomley , P Royston , S Weich , JA Bellón-Saameño , B Moreno , I Svab , D Rotar , J Rifel , HI Maaroos , A Aluoja , R Kalda , J Neeleman , MI Geerlings , M Xavier , I Carraca , M Goncalves-Pereira , B Vicente , S Saldivia , R Melipillan , F Torres-Gonzalez , I Nazareth (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: The PredictD Study. Archives of General Psychiatry 65, 13681376.

M King , S Weich , F Torres-González , I Svab , H Maaroos , J Neeleman , M Xavier , R Morris , C Walker , JA Bellón-Saameño , B Moreno-Küstner , D Rotar , J Rifel , A Aluoja , R Kalda , MI Geerlings , I Carraça , MC de Almeida , B Vicente , S Saldivia , P Rioseco , I Nazareth (2006). Prediction of depression in European general practice attendees: the PREDICT study. BMC Public Health 6, 6.

RF Krueger , KE Markon (2006). Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annual Review of Clinical Psychology 2, 111133.

DS Mennin , RG Heimberg , DM Fresco , MR Ritter (2008). Is generalized anxiety disorder an anxiety or mood disorder? Considering multiple factors as we ponder the fate of GAD. Depression and Anxiety 25, 289299.

KG Moons , AR Donders , EW Steyerberg , FE Harrell (2004). Penalized maximum likelihood estimation to directly adjust diagnostic and prognostic prediction models for overoptimism: a clinical example. Journal of Clinical Epidemiology 57, 12621270.

MS Pepe , H Janes , G Longton , W Leisenring , P Newcomb (2004). Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. American Journal of Epidemiology 159, 882890.

N Qureshi , J Bethea , B Modell , P Brennan , A Papageorgiou , S Raeburn , R Hapgood , M Modell (2005). Collecting genetic information in primary care: evaluating a new family history tool. Family Practice 22, 663669.

LN Robins , J Wing , HU Wittchen , JE Helzer , TF Babor , J Burke , A Farmer , A Jablenski , R Pickens , DA Regier , (1988). The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 10691077.

P Royston , KGM Moons , DG Altman , Y Vergouwe (2009). Prognosis and prognostic research: developing a prognostic model. British Medical Journal 338, b604.

DB Rubin (1987). Multiple Imputation for Non-Response in Surveys. John Wiley and Sons: New York.

DB Rubin (2003). Discussion on multiple imputation. International Statistical Review 71, 619625.

JL Schafer (1999). Multiple imputation: a primer. Statistical Methods in Medical Research 8, 315.

NB Schmidt , MJ Zvolensky (2007). Risk factor research and prevention for anxiety disorders: introduction to the special series on risk and prevention of anxiety pathology. Behavior Modification 31, 37.

RL Spitzer , K Kroenke , JB Williams (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association 282, 17371744.

JF Taylor , RC Rosen , SR Leiblum (1994). Self-report assessment of female sexual function: psychometric evaluation of the Brief Index of Sexual Functioning for Women. Archives of Sexual Behavior 23, 627643.

P Tyrer , B Seivewright , J Ferguson , J Tyrer (1992). The general neurotic syndrome: a coaxial diagnosis of anxiety, depression and personality disorder. Acta Psychiatrica Scandinavica 85, 201206.

N van 't Veer-Tazelaar , H van Marwijk , P van Oppen , G Nijpels , H van Hout , P Cuijpers , W Stalman , A Beekman (2006). Prevention of anxiety and depression in the age group of 75 years and over: a randomised controlled trial testing the feasibility and effectiveness of a generic stepped care programme among elderly community residents at high risk of developing anxiety and depression versus usual care [ISRCTN26474556]. BMC Public Health 6, 186.

S Weich , G Lewis (1998). Poverty, unemployment, and common mental disorders: population based cohort study. British Medical Journal 317, 115119.

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Psychological Medicine
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