The U.S. Preventive Services Task Force says for the first time that adults under 65 should be screened for anxiety, according to a draft recommendation released Tuesday.
The USPSTF is a group of independent disease prevention and medical experts whose recommendations help guide doctors’ decisions. The draft recommendation is not final, but will now enter the public comment period.
The panel found that “screening for anxiety in adults younger than 65, including those who are pregnant and postpartum … can help identify anxiety early,” team member Lori Pbert told CNN. “So it’s really exciting.”
The task force defines anxiety disorders as “characterized by increased duration or intensity of the stress response to everyday events.” Types include generalized anxiety disorder, social anxiety disorder, and agoraphobia. The USPSTF draft also recommends screening for major depressive disorder in adults, consistent with depression screening recommendations published in 2016.
Pbert, a clinical psychologist and professor at Chan Medical School in Massachusetts, said that a recommendation for anxiety was prioritized “because of the importance of public health, especially because of the increased attention to mental health in this country that we have had in the past few years.”
The Covid-19 pandemic led to a rise in new levels of anxiety and depression, although levels have since fallen somewhat. A recent report from the CDC found that adults aged 18 to 44 were the least likely to receive mental health treatment in 2019, but were the most likely in 2021.
The anxiety recommendation applies to adults over the age of 19 who have not been diagnosed with a mental health disorder. Depression screening recommendations apply to people over 18 years of age who have not been diagnosed with a mental health disorder and are not known to be at risk of depression or suicide.
Pbert emphasized that people who are already showing signs or symptoms should be evaluated and linked to care.
Brief screening tools for anxiety and depression have been developed and are available in primary care. Most screening tools today include questionnaires and scales.
Any positive screening result should lead to additional confirmatory evaluations, the task force says. It also notes that there is little evidence about the optimal time and interval for screening, and that more evidence is needed.
The USPSTF states that in the absence of data, a pragmatic approach is to screen all previously unscreened adults and use clinical judgment considering other factors, such as underlying health conditions and life events, to decide whether additional screening is warranted. necessary for people at high risk.
The recommendations for screening for anxiety and depression are what the USPSTF calls “B” classifications, meaning a physician should offer the service because there is a “moderate net benefit.”
The draft recommendations also include two “I statements,” which contain insufficient evidence to recommend for or against screening, Pbert said. Indications are for anxiety screening in adults 65 years of age and older and for suicide risk screening in adults. The task force calls for more research on both Statement I topics to help older Americans, as well as to understand the role of primary care in suicide prevention.
“There are missed opportunities in primary care practice, and that’s why we need to investigate the best way to screen people who don’t recognize signs or symptoms of suicide risk, identify them and connect them to care,” he said.
Screening for anxiety disorders is important because of its lifetime prevalence in the U.S., with draft recommendations at 26 percent for men and 40 percent for women, Pbert noted.
“It’s a very common mental health concern,” she said. “That’s why it’s so important for us to address anxiety disorders and study anxiety disorders.”
The draft recommendations on screening for anxiety, depression and suicide risk were combined “because we want to help primary care physicians address the urgent need to address the mental health of adults in the United States,” Pbert said. “We therefore see this set of recommendations as an opportunity to provide clinicians working with adult patients with comprehensive guidance on how to approach screening for anxiety, depression and suicide risk.”
Team members also hope the recommendations raise awareness of the need for mental health screening and treatment.
“That’s an area where we need a lot of work,” Pbert said. “There are so many gaps in the provision of mental health care, and our hope is that this group of recommendations will increase that.”
The task force is also very concerned about health equity, Pbert said.
“Our hope is that by raising awareness of these issues and having recommendations for clinicians, we will be able to help all adults in the United States, including those with disabilities,” she said.
The public will have the opportunity to comment on the draft recommendations until October 17.
“We want people to be honest, to give their input and their perspectives,” Pbert said, adding that the task force will read all comments. “It’s really important because it allows us to listen to the public, and the public includes people who are specialists in these areas. … We really value the contribution of other specialists who can give us their perspective and comments”.