Anxiety disorders are characterized by excessive and persistent feelings of worry or fear. The most common mental health disorders are anxiety disorders. The prevalence of anxiety disorders (including obsessive–compulsive disorder and post-traumatic stress disorder) in Canada was 4.9% in 2015. In the United States, 32% of people have had an anxiety disorder at some time in their life (lifetime prevalence). In Ontario, 2.5% of adults have experienced generalized anxiety disorder.
Anxiety disorders have a substantial effect on those with a disorder and their families, contributing to poorer quality of life. Anxiety disorders can lead to significant distress and functional impairment for people living with them. The incident cases of social phobia, panic disorder, and agoraphobia in Ontario were approximately 9,000, 21,000, and 1,500 per year, respectively; these had an impact on people’s health and function that equated to losses of approximately 33,000, 10,000, and 5,300 health-adjusted life-years, respectively.
Anxiety disorders also contribute to considerable economic burden. Anxiety has been estimated to cost the Canadian economy $17.3 billion a year due to lost productivity. In 2015, Canada’s estimated public and private expenditure on mental health, including anxiety disorders, was $15.8 billion.
In 2017/18, 81% of those admitted to hospital in Canada with a mental health or addictions condition were admitted through the emergency department (ED). Rates of people with ED visits attributable to anxiety disorders vary across Ontario. In 2018, there was a nearly a threefold difference between the local health integration networks (LHINs) with the highest and lowest rates of adults with ED visits for anxiety (593 per 100,000 population in the North East LHIN, compared with 198 per 100,000 population in the Central LHIN [NACRS, provided by ICES, 20191, Statistics Canada]). For people who visited the ED for an anxiety disorder, the rates of unscheduled ED revisits within 30 days for mental health and addictions varied across Ontario. There was an 1.5-fold difference between the LHINs with the highest and lowest rates of ED visits for an anxiety disorder that were followed within 30 days by an unscheduled visit to the ED for mental health and addictions (13.0% for the Central West LHIN compared with 20.7% for the Toronto Central and North West LHINs; NACRS, provided by ICES, 2019*).
In 2018, 32.5% of adults and 38.0% of children and youth in Ontario had their first contact for an anxiety disorder in the ED, which means that they had not accessed mental health or addictions services from a physician in the 2 years prior to that (NACRS, DAD, OMHRS, and OHIP Claims Database, provided by ICES, 2019*). This finding may reflect people getting care from providers who are not physicians, people unable to access mental health and addictions services delivered by physicians, and potential missed opportunities for mental health services in primary and community care. Rates of first contact in the ED for an anxiety disorder were higher in rural areas (NACRS, DAD, OMHRS, and OHIP Claims Database, provided by ICES, 2019*).
Furthermore, in Ontario, only about one-third of patients admitted to hospital for an anxiety disorder (including OCD) have a follow-up visit with a physician within 7 days of leaving hospital, reflecting opportunities to improve monitoring and the transition from hospital to home.
Several equity factors—including gender, age, income, Indigenous identity, and geography—may affect specific populations with anxiety disorders. Women have high prevalence rates and are more likely to have an anxiety disorder than men. Older adults with anxiety often present and describe symptoms differently from younger people, making detection more difficult. The lowest neighbourhood income quintile had the highest proportion of people who reported a diagnosis of an anxiety disorder or obsessive–compulsive disorder (Canadian Community Health Survey, Mental Health, 2012). As well, more people in rural areas reported a diagnosis of an anxiety disorder or obsessive–compulsive disorder than people in urban areas (7.5% versus 4.8%, respectively; Canadian Community Health Survey, Mental Health, provided by the ICES, 2012). In 2017, fewer mental health workers were available in rural areas than in urban areas.
There are significant opportunities, through the delivery of high-quality health care, to improve care in Ontario for people living with anxiety disorders. Anxiety disorders are underdiagnosed and undertreated. The median time between the onset of a person’s symptoms and the person seeking care is 16.1 years; and even among people diagnosed with anxiety and related disorders, about 40% are untreated. Earlier identification and diagnosis are key first steps to accessing appropriate evidence-based treatment.