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Original research
Recognition of anxiety disorders in children: a cross-sectional vignette-based survey among general practitioners
  1. Semiha Aydin1,2,3,
  2. Mathilde R Crone1,
  3. Bart M Siebelink3,
  4. Robert R J M Vermeiren3,4,
  5. Mattijs E Numans1,
  6. P Michiel Westenberg2
  1. 1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  2. 2Department of Developmental and Educational Psychology, Leiden University, Leiden, Zuid-Holland, The Netherlands
  3. 3Department of Child and Adolescent Psychiatry, Curium-LUMC, Leiden, Zuid-Holland, The Netherlands
  4. 4Youz, Rotterdam, Zuid-Holland, The Netherlands
  1. Correspondence to Semiha Aydin; s.aydin{at}


Objective To quantify general practitioners’ (GPs) sensitivity to anxiety disorders (ADs) when confronted with the range of symptoms common to children with ADs. Also, to explore GPs’ conscious preferences and implicit tendencies for referral of children with ADs to mental healthcare.

Design and setting In a cross-sectional vignette-based survey, all attendees of a Dutch continuing medical education conference for primary care physicians were presented with subtitled audio fragments of five vignettes that we constructed to mimic symptom presentation of children with ADs in general practice. We asked attendees to select per vignette the most plausible diagnoses and most adequate referral option, and for their general referral preferences when they suspect each of the most common mental health problems.

Participants A sample of 229 GPs, resulting in a total of 1128 vignette evaluations.

Main outcome measure GPs’ selection rate of ADs in the five vignettes compared with a benchmark provided by mental health professionals (MHPs).

Results Overall, recognition of ADs was less likely in GPs compared with MHPs (OR=0.26, 95% CI 0.15 to 0.46). GPs varied in their recognition of anxiety, with 44.1% not once selecting anxiety as the probable presenting problem. When asked explicitly, 63.9% of the GPs reported that they would refer a child to mental healthcare when they suspect probable ADs. By contrast, only 12.0% of the GPs who recognised anxiety in the vignettes actually selected that referral option.

Conclusion A significant fraction of GPs did not notice the depicted symptoms as anxiety. Despite the widespread prevalence of ADs, GPs seem to overlook anxiety already in their early diagnostic opinion. Improving GPs’ familiarity with initial symptom presentation, ADs’ base-rate, relevance and impact yields potential for timely recognition.

  • primary care
  • mental health
  • anxiety disorders
  • psychiatry
  • child & adolescent psychiatry

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  • Contributors SA analysed clinical referral letters of children, created the vignette drafts and drafted the manuscript. MC, PMW, BMS and MEN provided feedback to the vignette drafts during the iterative vignette development process. MC, MW and BMS contributed to the interpretation of the data. SA, MC, BMS, RRJV, MEN and PMW designed the study, critically revised and gave final approval for the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. No additional data are available for this study in repositories. Inquiries concerning the data may be made to the corresponding author.