A woman looks out a window at a nearly empty terminal at an airport in Atlanta, June 1, 2020. An influential health guidelines group says US doctors should regularly screen adults for anxiety. It is the first time that the US Preventive Services Task Force has recommended screening for anxiety in primary care for asymptomatic adults. (Charlie Riedel, Associated Press)
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WASHINGTON — American doctors should regularly screen all adults under the age of 65 for anxiety, an influential health guidelines group proposed Tuesday.
It is the first time that the US Preventive Services Task Force has recommended screening for anxiety in primary care for asymptomatic adults. The proposal is open for public comment until Oct. 17, but the group usually affirms its draft guidance.
The recommendations are based on a review that began before the COVID-19 pandemic, evaluating studies showing potential benefits and risks of screening. Given reports of an increase in mental health problems related to pandemic isolation and stress, the guidance is “very timely,” said task force member and co-author Lori Pbert. Pbert is a research psychologist at the University of Massachusetts Chan Medical School.
The task force said evidence of the benefits, including effective treatments, outweighs the risks, which include inaccurate screening results that could lead to unnecessary follow-up care.
Anxiety disorders are among the most common mental health complaints, affecting about 40 percent of American women at some point in their lives and more than 1 in 4 men, Pbert noted.
Black people, people living in poverty, people who have lost a partner, and those with other mental health problems are among adults who face a higher risk of developing anxiety, which can manifest like panic attacks, phobias or always feeling on the sidelines. In addition, approximately 1 in 10 pregnant and postpartum women experience anxiety.
Common screening tools include brief questionnaires about symptoms such as fears and worries that interfere with usual activities. These can easily be given in a primary care setting, the task force said, although it did not specify how often patients should be reviewed.
“The most important thing to recognize is that a screening test alone is not enough to diagnose anxiety,” Pbert said. The next step is a more thorough evaluation by a mental health professional, although Pbert acknowledged that finding mental health care can be difficult given the shortage of specialists.
Megan Whalen, a 31-year-old marketing specialist who was diagnosed with anxiety in 2013, says regular doctors should screen for mental health problems as often as they do for physical problems.
“Health is health, whether the problem is visible or not,” said Whalen, of Hoboken, New Jersey.
Health is health, whether the problem is visible or not.
He has received help from medicine and talk therapy, but his symptoms worsened during the pandemic and he temporarily moved home.
“The pandemic made me afraid to leave the house, my anxiety telling me that anywhere outside my childhood home was not safe,” Whelan said. “Sometimes I still struggle with feelings of fear and dread. It’s just a part of my life at this point and I try to manage it as best I can.”
The task force said there is not enough strong research in older adults to recommend for or against screening for anxiety in people 65 and older.
The group continues to recommend depression screening for adults and children, but said there is insufficient evidence to assess the benefits and potential harms of suicide screening in adults who do not have worrisome symptoms.
In April, the group issued similar draft guidance for children and adolescents, recommending screening for anxiety but saying more research is needed on the potential benefits and harms of screening for suicide in children without obvious signs .
Task force guidelines often determine insurance coverage, but anxiety is already on the radar of many primary care physicians. In 2020, a panel affiliated with the American College of Obstetricians and Gynecologists recommended routine primary care anxiety screening for women and girls age 13 and older.
Melissa Lewis-Duarte, a wellness coach in Scottsdale, Arizona, says rhythmic breathing, meditation, and making a daily list of three things she’s grateful for have helped with her anxiety.
“Doctors say, ‘Make sure you’re sleeping, get your stress under control.'” Yes, I understand,” but not everyone knows how, said the 42-year-old mother of three. “It’s hard to prioritize self-care, but that’s what it takes.”