It was worse than the impairment of many patients with chronic medical conditions such as cardiac or pulmonary (lung) disease. The evidence also suggested that these individualswere already imposing an enormous burden on the health-care system by appearing in large numbers at community clinics and the offi ces of family doctors. Barrett, Barrett, Oxman, and Gerber (1988), assessing patients from a rural primary care practice, found that as many as 14.4% of patients presented with principal com-plaints of anxiety and depression. Other studies support this finding(Das-Munshi et al., 2008; Katon & Roy-Byrne, 1991; Roy-Byrne &Katon, 2000). Finally, evidence suggested that such people were at greatly increased risk of developing more severe mood or anxiety disorders (Moras et al., 1996; Roy-Byrne & Katon, 2000). Therefore, we concluded that it might be valuable to identify these people and find out more about the etiology, course, and maintenance of the problem. The authors of the ICD-10, recognizing this phenomenon is prevalent throughout the world, had created a category of mixed anxiety-depression, but they had not defi ned it or created any criteria that would allow further examination of the potential disorder. Therefore, to explore the possibility of creating a new diagnostic category (Zinbarg & Barlow, 1996; Zinbarg et al.,1994, 1998), a study was undertaken that had three specific goals. First, if mental health professionals carefully administered semistructured interviews (the ADIS-IV), would they find patients who fit the new category? Or would careful examination find the criteria for existing disorders that had been overlooked by health professionals not well trained in identifying psychological disorders? Second, if mixed anxiety-depression did exist, was it really more prevalent in medical primary care settings than in outpatient mental health settings? Third, what set of criteria (for example, types and number of symptoms) would best identify the disorder?
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