Quality statement 1: Assessment of suspected anxiety disorders

Quality statement

People with a suspected anxiety disorder receive an assessment that identifies whether they have a specific anxiety disorder, the severity of symptoms and associated functional impairment.

Rationale

Accurate diagnosis of a person's specific anxiety disorder can help them understand their condition and ensure that they are offered the most appropriate treatment at the earliest opportunity.

Quality measures

Structure

a) Evidence of local arrangements for people with a suspected anxiety disorder to receive an assessment that identifies whether they have a specific anxiety disorder, the severity of symptoms and associated functional impairment.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that healthcare professionals receive training to perform assessments of anxiety disorders.

Data source: Local data collection.

Process

Proportion of people with a suspected anxiety disorder who receive an assessment that identifies whether they have a specific anxiety disorder, the severity of symptoms and associated functional impairment.

Numerator – the number of people in the denominator who receive an assessment that identifies whether they have a specific anxiety disorder, the severity of symptoms and associated functional impairment.

Denominator – the number of people with a suspected anxiety disorder.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure they provide services for people who have a suspected anxiety disorder to diagnose specific anxiety disorders, and that the assessment services are delivered by fully trained healthcare professionals.

Healthcare professionals carry out an assessment for people who have a suspected anxiety disorder to diagnose specific anxiety disorders, or refer to a practitioner who is trained to carry out such an assessment.

Commissioners ensure that they commission services that carry out assessments for people with a suspected anxiety disorder to diagnose specific anxiety disorders.

What the quality statement means for service users and carers

People who may have an anxiety disorder are offered an assessment to find out whether they do have an anxiety disorder, what type of disorder it is and the effect it may have on their everyday life.

Source guidance

Definitions of terms used in this quality statement

Anxiety disorder

Anxiety disorders are generalised anxiety disorder, social anxiety disorder, post-traumatic stress disorder, panic disorder, obsessive–compulsive disorder and body dysmorphic disorder.

Assessment of anxiety disorders

Assessment of anxiety disorders includes the nature, duration and severity of the presenting disorder and associated functional impairment. It also includes consideration of the ways in which the following factors may have affected the development, course and severity of the disorder:

  • a history of any mental health disorder

  • a history of a chronic physical health problem

  • any past experience of, and response to, treatments

  • the quality of interpersonal relationships

  • living conditions and social isolation

  • a family history of mental illness

  • a history of domestic violence or sexual abuse

  • employment and immigration status.

[NICE clinical guideline 123, recommendations 1.3.2.4 and 1.3.2.6]

A diagnostic or problem identification tool or algorithm may be used to inform the assessment. [NICE clinical guideline 123, recommendation 1.3.2.3, NICE clinical guideline 159, recommendations 1.2.7 and 1.4.9 to 1.4.12]

Assessment of social anxiety disorder

The assessment of social anxiety disorder is slightly different from assessment of other anxiety disorders. It includes consideration of fear, avoidance, distress and functional impairment. It takes into account comorbid disorders, including avoidant personality disorder, alcohol and substance misuse, mood disorders, other anxiety disorders, psychosis and autism. A detailed description of the person's current social anxiety and associated problems and circumstances is obtained, including:

  • feared and avoided social situations

  • what they are afraid might happen in social situations (for example, looking anxious, blushing, sweating, trembling or appearing boring)

  • anxiety symptoms

  • view of self

  • content of self-image

  • safety-seeking behaviours

  • focus of attention in social situations

  • anticipatory and post-event processing

  • occupational, educational, financial and social circumstances

  • family circumstances and support (for children and young people)

  • friendships and peer groups (for children and young people)

  • medication, alcohol and recreational drug use.

[NICE clinical guideline 159, recommendations 1.2.5 to 1.2.9 and 1.4.5 to 1.4.8]

Suspected anxiety disorder

An anxiety disorder may be suspected in people with a past history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or recent experience of a traumatic event, and in people who avoid social situations. It may be suspected because of the person's responses to initial questions about their symptoms. The 2-item Generalized Anxiety Disorder scale may be used to ask the person about their feelings of anxiety and their ability to stop or control worry. [NICE clinical guideline 123, recommendation 1.3.1]

Equality and diversity considerations

Consideration should be given to modifying the method and mode of delivery of assessment according to the needs of the person with a suspected anxiety disorder. Technology should be considered for people who may find it difficult to, or choose not to, attend a specific service, for example people with social anxiety who are anxious about attending a healthcare service. Communication needs should be considered for people who do not have English as their first language, for example by providing bilingual therapists or independent translators.

For people with sensory impairment or a learning disability, use of the distress thermometer and asking a family member or carer about the person's symptoms should be considered.

When assessing people with a suspected anxiety disorder and a moderate to severe learning disability or moderate to severe acquired cognitive impairment, consideration should be given to consulting a relevant specialist.

Assessments should be culturally sensitive, using suitable explanatory models of common mental health disorders and addressing any cultural and ethnic needs. Relevant information, including cultural or other individual characteristics that may be important in subsequent care, should be identified during assessment. For example, if the boundary between religious or cultural practice and obsessive–compulsive symptoms is unclear, healthcare professionals should, with the service user's consent, consider seeking the advice and support of an appropriate religious or community leader to support the therapeutic process.