Qualitative analysis of mental health clinicians’ perspectives on external barriers to diagnosing anxiety disorders in the Veterans Health Administration.

Anxiety disorders have increased over the past decade, affecting millions worldwide. Among veterans, the prevalence is at least double that of the general population. Despite growing recognition of the need for appropriate treatment, frequent labeling of patients with an "unspecified anxiety disorder" diagnosis hinders targeted treatments. This study examines why clinicians use unspecified anxiety disorder diagnoses without a subsequent specific anxiety disorder diagnosis and explores external factors that influence clinicians' diagnostic decisions. We conducted semistructured interviews in 2020-2021 with 32 Veterans Health Administration mental health clinicians across the United States from Primary Care Mental Health Integration and General Mental Health clinics. Qualitative content analysis revealed that external barriers fell into three primary areas: limited resources, logistics, and patient factors. Clinicians cited insufficient diagnostic tools, limited time, and inadequate patient history as barriers to diagnostic specificity. They also noted that referrals from medical clinicians provided limited information about the presenting problem, hindering the diagnostic process. Patient-related barriers to specific anxiety diagnosis included difficulty articulating internal experiences and mental health stigma. Suggested solutions included increased access to screening tools, expanded clinician education offerings, enhanced communication between clinicians, and collateral reports. Future research should examine environmental factors in integrated clinical settings beyond Veterans Health Administration medical centers and explore the impact of potential solutions on improving accurate diagnosis. (PsycInfo Database Record (c) 2026 APA, all rights reserved).