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Exploring trends in recording anxiety symptoms in UK primary care

4 August 2021

The way GPs record anxiety in patient records could be leading to a reduction in formal anxiety diagnoses, new research from the University of Bristol has found. Anxiety disorders are common in the UK, with the level of anxiety symptoms being recorded by GPs increasing between 1998 and 2008. However, studies have shown that the recording of anxiety disorders decreased in the same period.

The reason for this contradiction and what it means for the treatment of patients are unclear. One explanation for this disconnect could be that symptoms of depression and anxiety are often both present in patients. In many cases like this, a GP will prioritise the depression diagnosis.

The fall in recorded anxiety diagnoses may also be because GPs are reluctant to formally label patients with an anxiety disorder. They may also prefer to use broad symptom codes rather than distinguishing between the subtypes of anxiety when recording anxiety in patients’ records.

To explore this further, a team of NIHR Bristol Biomedical Research Centre, NIHR Applied Research Collaborative West (ARC West) and NIHR School for Primary Care Research funded researchers from the Centre for Academic Primary Care conducted an interview-based study. Their aim was to examine these recent trends in recording anxiety, focussing on factors that may influence how GPs code anxiety.

The researchers found that broadly GPs’ and patients’ views differed on the value of diagnosing anxiety. The trends in symptom reporting and diagnoses may reflect changes in GP recording, rather than solely a change in the number of people with anxiety.

GPs reported that they had a role in helping patients understand that anxiety is experienced by everyone at some level, preferring to use symptoms rather than diagnostic codes. They also felt assigning diagnostic codes over symptom codes could be potentially unhelpful and stigmatising for the patient. GPs also felt their limited time with patients affected their ability to recommend effective treatment for a diagnosis. They felt this was more appropriate for a psychiatrist.

Patients highlighted barriers to consulting their GP, such as not realising the physical symptoms they were experiencing were due to anxiety, and a reluctance to discuss their symptoms. Overall, the researchers found that symptom codes were used for acute and mild anxiety whereas diagnostic codes tended to be used for chronic and severe anxiety.

This research formed part of Dr Charlotte Archer’s PhD. She added: “Our study highlights that patients would value GPs diagnosing anxiety disorders, as a diagnosis can be helpful in terms of understanding their symptoms and the need for treatment. For this to happen in practice, seeing the same GP over a period of time may be particularly important. This would encourage patients to disclose and give GPs sufficient time to discuss and diagnose anxiety disorders.

“This continuity of care may be particularly important for telephone consultations, which have increased as a result of the COVID-19 pandemic. It will be important for future research to understand if patients with anxiety have found it harder to disclose symptoms over the phone, and the impact this may have had on diagnosing anxiety disorders.”


Trends in the recording of anxiety in UK primary care: a multi-method approach by Charlotte Archer, Katrina Turner, David Kessler, Becky Mars and Nicola Wiles. Published in Social Psychiatry and Psychiatric Epidemiology. July 2021.

GPs’ and patients’ views on the value of diagnosing anxiety disorders in primary care: a qualitative interview study by Charlotte Archer, David Kessler, Nicola Wiles and Katrina Turner. Published in British Journal of General Practice. April 2021.


See also: Is there value in GPs diagnosing an anxiety disorder? (Blog)

Further information

About the Centre for Academic Primary Care, University of Bristol
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

About the National Institute for Health Research
The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

  • Funding high quality, timely research that benefits the NHS, public health and social care;
  • Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
  • Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
  • Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
  • Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
  • Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

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