Welcome to the Red Book, Anxiety

The first update to GP guidelines in eight years also includes sleep and gambling.

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Anxiety is the most common mental health condition in Australia, affecting one in six adults and one in 14 children, and commonly co-occurring with other mental health conditions such as depression. 

Last week the RACGP released the 10^th edition of the Guidelines for preventative activities in general practice, more commonly known as the “red book”, which includes anxiety for the first time. Sleep and gambling were among the other new topics to be covered in the latest edition. 

Screening for anxiety in the general population is not generally recommended. Instead, GPs should be alert to the possibility of anxiety disorders occurring in patients aged eight to 64 years, including pregnant and postpartum women. 

Individuals with a history of an anxiety disorder, possible somatic symptoms of an anxiety disorder or insomnia, and those who have experienced adverse or traumatic childhood events are particularly susceptible to anxiety. Victims of intimate partner violence can also have an increased risk of developing an anxiety disorder. 

The red book conditionally recommends asking patients with suspected anxiety about whether they are feeling anxious and their ability to control how worried they feel using the Generalized Anxiety Disorder 2-item scale as often as needed. 

The simple questionnaire asks how often, if at all, the respondent has been bothered in the previous two weeks by:  

1. Feeling nervous, anxious or on edge 

2. Not being able to stop or control worrying 

for a score ranging from zero to six.  

People who score three or more on the GAD-2 should be recommended for further assessment, as should patients who score less than three but indicate they avoid certain places or activities to the point where this behaviour causes problems in their lives.   

There are no specific considerations, recommendations or advice when screening or managing anxiety disorders in Aboriginal and Torres Strait Islander peoples.  

“The new topics we have introduced in this edition also reflect the changing landscape of general practice and our patients,” RACGP red book chair Professor Danielle Mazza AM said in a statement last week.  

“Mental health presentations were recorded as the most common issue in general practices in the RACGP Health of the Nation report for the sixth consecutive year, with 38% of consultations including a mental health component. In 2020-22, 1.9 million people sought professional help for mental health, and GPs were the most common health professional they sought out.”