Anxiety Screenings Could Become a Normal Part of Your Annual Physical


The central theses

  • A panel of medical experts proposed a recommendation that all adults ages 19 to 65 should be screened for anxiety disorders.
  • This is the first time the task force has recommended adult anxiety screening. It also updates its recommendations for screening for depression in this age group.
  • The guidance comes as the US continues to grapple with a mental health crisis made worse by the pandemic.

As part of efforts to address the US mental health crisis, a panel of medical experts proposed a recommendation that all adults under the age of 65 should be screened for anxiety disorders.

The US Task Force on Prevention Services’ draft recommendations propose that primary care providers use questionnaires and other tools to identify early symptoms of anxiety disorders and help patients seek additional mental health care.

“Everyone is afraid. It’s just part of being human,” Sanjay Mathew, MD, chief medical officer of the Anxiety and Depression Association of America, told Verywell. “The fact that it has been recommended for screening may elevate its status, if you will, to a medical symptom worth investigating further.”

Routine screening for anxiety and depression could help doctors identify mental health needs earlier. According to one study, the median length of delay in treating anxiety in the US is 23 years.

The draft guidelines were in the works before the COVID-19 pandemic. But more people have reported high levels of anxiety in recent years due to stressors, including fears of illness and the loss of loved ones to COVID-19.

In February 2021, 41.5% of adults had recent symptoms of an anxiety disorder or a depressive disorder, up from 36.4% in August 2020.

The panel earlier this year made a similar recommendation for anxiety screening in children and adolescents. It also updated its 2016 recommendation to screen adults under 65 for depression and suicide risk.

The guidelines were issued in draft form. The task force is accepting public comments through October 17 and will finalize the recommendations over the coming weeks.

What an anxiety screening can look like

The task force said anxiety disorders are “characterized by excessive and persistent fear and anxiety about everyday events.” These include generalized anxiety disorder, social anxiety disorder and agoraphobia.

During a primary care visit, providers may ask patients a series of questions to determine if they may be experiencing symptoms of an anxiety disorder. You may ask questions about a patient’s lifestyle, whether they worry excessively and intensely, and physical manifestations of anxiety, such as sweating and tremors.

There is a chance that anxiety screening will give false negative results. Some symptoms that appear to be linked to anxiety disorders can be “temporary” and resolve over time, Mathew said. In addition, self-reported information may not be entirely accurate.

“As opposed to screening for blood pressure issues or diabetes and whatnot, it can be a lot harder to get a valid and reliable screening tool,” Matthew said.

Once a patient has a positive screening result, they are referred to a mental health specialist who can diagnose and treat an anxiety disorder.

To be diagnosed with an anxiety disorder, a patient must meet certain criteria defined in the DSM-5, the Standard Manual for Mental Disorders. The doctor must rule out other factors, such as B. Disorders that may mimic psychiatric symptoms and substance use.

Anxiety and depression screening is not recommended for everyone

The task force said that anxiety screening is a “Class B” recommendation, meaning it will provide a “moderate net benefit” to patients. While healthcare providers are not required to follow the guidelines, the panel’s recommendations strongly influence the standard of care across the country.

In 2016, the task force led clinicians to screen adults, including pregnant women or those who have given birth, for depression. The panel said the prevalence of depression and depression symptoms in adults has decreased as a result.

However, mental health screenings in primary care may not always be helpful. According to a draft recommendation this year, there was insufficient evidence to conclude that screening for suicide risk in the general adult population would be beneficial rather than harmful.

The task force did not recommend anxiety screening for adults over 65 because the evidence of benefits and harms for this age group is limited. The symptoms of anxiety often resemble the symptoms of aging, such as fatigue and general aches and pains.

“Certainly, this is a more medically complicated population. You can be on multiple medications, with multiple chronic illnesses, many of which are already linked to anxiety,” Mathew said.

Addressing inequalities in mental health

Even after receiving a positive result on an anxiety or depression screening, it can be difficult for some patients to receive a diagnosis and access the mental health care they need.

In some closed healthcare systems, patients may be referred to GPs for mental health. But most healthcare organizations may not have the resources to provide mental health care to everyone in need. In fact, less than “half of people who have a mental illness will receive psychiatric care,” the task force said.

Access to medical care will be particularly important for groups most likely to be living with a mental disorder.

For example, women are almost twice as likely to develop depression as men, according to the task force. Black patients are less likely to be treated for mental illness than white patients, and black and Hispanic patients are more likely to be misdiagnosed.

A study showed that while suicide rates among young adults in the United States fell for the first time between 2018 and 2019, suicide rates among Black, Asian, and Pacific Islander young adults increased during that period.

During the pandemic, these needs have been exacerbated. Adults aged 18 to 44 were the least likely to have received psychiatric treatment in 2019, but this trend is reversed. In 2021, almost one in four adults in this age group was treated.

“There was definitely an increased demand for mental health services in general,” Mathew said. “Although these recommendations have been made before, they may gain in importance at this time.”

What that means for you

At your next primary care visit, your doctor may ask you some questions about how you experience and manage anxiety. Based on this screening, your provider may refer you to a psychologist for further support.



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