The American Health Task Force calls for routine anxiety screening in adults

In a nod to the nation’s urgent mental health crisis, an influential group of medical experts is recommending for the first time that adults under 65 get an anxiety screening.

The draft recommendations, from the US Preventive Services Task Force, are designed to help primary care physicians identify early signs of anxiety during routine care, using questionnaires and other screening tools.

Anxiety disorders are often unrecognized and undetected in primary care: a study cited by the task force found that the average time to start treatment for anxiety is 23 years.

Although the task force’s initial deliberations on anxiety screening predated the coronavirus pandemic, the new guidance comes at a critical time, said task force member Lori Pbert, a clinical psychologist and professor of the University of Massachusetts Chan Medical School in Worcester, Massachusetts.

“Covid has taken a huge toll on the mental health of Americans,” Pbert said. “This is a priority issue because of its importance to public health, but it is clear that there has been an increased focus on mental health in this country over the last few years.”

In April, the task force made similar recommendations to begin screening for anxiety in children and adolescents, ages 8 to 18. The proposal announced Tuesday focuses on young and middle-aged adults, including those who are pregnant or postpartum, citing research showing that screening and treatment can improve anxiety symptoms in those under 65.

But the guideline, somewhat surprisingly, stops short of recommending anxiety screening for people 65 and older.

One reason: Many common symptoms of aging, such as trouble sleeping, pain and fatigue, can also be symptoms of anxiety. The task force said there was insufficient evidence to determine the accuracy of screening tools in older adults, who may not be sensitive enough to distinguish between anxiety symptoms and conditions of aging.

The task force advised doctors to use their judgment when discussing anxiety with older patients. The work group it also reiterated an earlier recommendation that adults of all ages undergo routine screening for depression.

The taskforce, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, wields enormous influence and, although its advice is not binding, the panel’s recommendations often they change the way doctors practice medicine in the United States.

Some doctors questioned how the recommendations would play out in the real world, where mental health providers say they can no longer meet patient demand and patients complain of waiting months for an appointment with a therapist.

“Screening is great, but with a severe labor shortage, it’s puzzling unless there are plans to increase funding for doctors,” said Eugene Beresin, a psychiatrist at Massachusetts General Hospital and executive director of the Clay Center for Young Healthy Minds.

The global prevalence of anxiety and depression increased by 25 percent during the first year of the pandemic, the World Health Organization reported earlier this year. By the end of 2021, WHO said, “the situation had improved somewhat, but today too many people are still unable to get the care and support they need for pre-existing and newly developing mental health conditions” .

Anxiety, with its telling dread and distressing physical signs, palpitations, sweaty palms, can manifest itself in several different diagnoses, including generalized anxiety disorder, social anxiety disorder, panic and others.

Together, they make up the most common mental illnesses in the United States, affecting 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment may include psychotherapy, especially cognitive-behavioral therapy; antidepressant or anti-anxiety medications; as well as various relaxation, mindfulness and desensitization therapies, the doctors said.

The panel also considered the benefits of screening patients for suicide risk, but concluded that Although suicide is one of the leading causes of death among adults, “there is insufficient evidence as to whether screening people without signs or symptoms will ultimately help prevent suicide.”

Still, the panel urged providers to use their own clinical judgment to determine whether individual patients should be screened for suicide risk.

For primary care physicians, who are already in the midst of a “crisis” of burnout, stress caused by the pandemic and their own mental health challenges, adding another screening test to a long list of clinical tasks can look heavy

“If primary care providers are asked to look at one more thing, we’re going to break even without more resources,” said a nurse practitioner in Northern California, who asked not to be named because she was not authorized by her clinic to speak. . on the subject

Considering current requirements, such as checking for up-to-date tests for cervical, colon and breast cancer, as well as food insecurity, domestic violence, alcohol and tobacco use, she said all s ‘must pack into a 15-minute appointment, while also treating patients with complex and chronic illnesses.

“It feels bad if people test positive for depression or anxiety, and we don’t have the mental health support to help them,” the doctor said.

But Mahmooda Qureshi, an internal medicine physician at Massachusetts General Hospital, said extra support for patients suffering from depression or anxiety will help.

“After 2020, it’s the rare patient who isn’t anxious,” said Qureshi, who noted that he now routinely asks patients, “How’s your stress?” “We’ve found that when it comes to mental health, if we don’t ask, we often don’t know.”

The task force acknowledged the challenges of providing mental health care to everyone who needs it, adding that less than “half of people with a mental illness will receive mental health care.”

The panel also cited “structural racism and policies” that disproportionately affect people of color. The panel noted that black patients are less likely to receive mental health services compared to other groups, and that misdiagnosis of mental health conditions occurs more often in blacks and Hispanics. patients

Pbert said the latest guidance is just one step in addressing patients’ urgent mental health needs. “Our hope is that this set of recommendations can raise awareness of the need to create greater access to mental health care across the country,” he said, noting “gaps in the evidence because the funders can support the necessary research in these areas.”

The proposed recommendations are open for public comment until Oct. 17, after which the task force will consider them for final approval.

Leave a Reply