The new draft recommendation is timely, as mental health conditions are on the rise around the world, according to the World Health Organization. Anxiety disorders, which cause excessive, persistent fear or worry related to nondangerous situations, are the most common mental health concern in the United States, say experts at the National Alliance on Mental Illness (NAMI). More than 40 million American adults, or about 19 percent of the adult population, have an anxiety disorder. Despite how common anxiety disorders are, they often go undetected in primary care settings, leading to treatment delays, according to the USPSTF. And research, such as a study published in Depression and Anxiety in March 2018, suggests only about 1 in 10 people with an anxiety disorder receives the treatment they need. “The task force is very concerned about the state of mental health, including anxiety, in our population,” says Gbenga Ogedegbe, MD, MPH, an internal medicine doctor and USPSTF member. “Previously, we really did not have any guidelines on anxiety screening. But the evidence shows that screening is very good at detecting anxiety in adults under age 65 and can actually lead to benefits in the form of early detection and treatment. If it goes through, we’re recommending that this would be standard practice in primary care.” The draft recommendation is open for public comment until October 17, 2022, before the panel makes a final decision. But if it does go into effect, which it likely will, it could change the way primary care providers structure their visits with patients. Here’s what you need to know about the proposed guidelines.
Anxiety Screening: What Can You Expect?
Anxiety screening would likely be in the form of a questionnaire, says Dr. Ogedegbe. “There are several questionnaires that have been proposed for use, and they’re all pretty good at detecting people who are at high risk for anxiety,” he says. Though it’s not yet clear which screening tool will be implemented, the goal is to establish a simple and effective system that benefits both patients and doctors. “I think the first step with screening will be to bring awareness to the patient, because sometimes anxiety can look like irritability, sleeplessness, jitteriness, or appetite changes, and that might not be what you first think when you think of anxiety,” says Thea Gallagher, PsyD, a clinical assistant professor in the department of psychiatry at New York University Langone Health in New York City.
What Evidence Supports the Need for Screening?
The USPSTF conducted a systematic review to evaluate the benefits and harms of screening all adults under age 65 for anxiety. They found that the screening tools GAD-2 and GAD-7 are adequate in detecting generalized anxiety disorder in adults under age 65. Upon reviewing the literature, the task force concluded with “moderate certainty” that screening for anxiety in adults provides a “moderate net benefit” in improving outcomes like anxiety remission and response to treatment. “A large body of evidence supports the benefit of screening,” says Ogedegbe.
Who Will Be Screened?
The USPSTF recommendation for anxiety screening applies to adults ages 19 to 64 who do not have a diagnosed mental health disorder or any previously detected signs or symptoms of anxiety. This includes pregnant people and those who are postpartum. If people are already showing signs or symptoms of anxiety, they should be connected to care, according to Ogedegbe. As for people ages 65 or older, Ogedegbe says more research is needed before the USPSTF could recommend for or against screening. “The evidence is not enough to suggest that screening would be beneficial or harmful for older adults. So we’re calling for more research for people 65 and older,” he says. “This doesn’t mean that we shouldn’t watch out for mental health disorders in older populations,” adds Dr. Gallagher. “They just didn’t have the data to make the recommendation.”
Who Will Do the Screening?
The USPSTF recommends that the anxiety screenings be conducted by primary care professionals. The task force notes that the optimal interval for screening isn’t yet clear, and more research is needed to determine how often anxiety screenings should happen.
What Happens if You Screen Positive for Anxiety?
If you screen positive, Ogedegbe says the next step is to have a follow-up assessment. “That will be needed to confirm that the person actually has anxiety,” he explains. If a person does, indeed, meet the diagnostic criteria for anxiety, they should be connected to appropriate treatment, Ogedebge says. According to the USPSTF, treatments for anxiety may include:
Psychotherapy, aka talk therapyMedications, such as antidepressants, antihistamines, beta-blockers, anticonvulsants, or benzodiazepinesRelaxation or desensitization therapies, like those used in some cognitive behavioral therapies
The Challenges of the New Screening Guideline
The USPSTF acknowledges that there are some potential barriers to their proposed screening efforts. They point out that a provider’s knowledge about anxiety screening tools and comfort level using them could present challenges, as could the possibility of a false positive result. The cost of mental healthcare may also be an obstacle to people seeking treatment for anxiety, the USPSTF notes. Additionally, a lack of available mental health professionals may affect access to care. More than 150 million people in the United States live in federally designated mental health professional shortage areas, according to the Association of American Medical Colleges (AAMC). Some experts are concerned that if people who screen positive for anxiety aren’t able to access high-quality care, screenings likely won’t change the outcomes for these people.
Could the Screening Guidelines Affect Health Insurance Coverage?
Guidelines implemented by the USPSTF often determine insurance coverage for certain health services. If the guidelines go into effect, they could open up more options for expanding health insurance coverage for mental health services, says Ogedegbe.
The Bottom Line
If the task force’s recommendation to screen all adults under age 65 for anxiety goes into effect, it could change how primary care providers approach mental health issues with their patients. The goal is to get more people the help they need and create better opportunities for providing essential care. “The hope is that by just screening people we actually bring awareness to the need for creating greater access to evidence-based mental health services,” says Ogedegbe. Ideally, experts hope screening could also erase some of the stigma around anxiety and mental health in general. “The more we can break the stigma and we can talk about how we feel both internally and externally, both physically and mentally, all of those things together, we’re going to live happier, healthier, longer lives and have a better quality of life,” says Gallagher.
