The nation’s top panel of preventive health experts has recommended that doctors routinely screen all adult patients under 65 for anxiety disorders, a common but often overlooked mental health condition that can impair quality of life and physical health.
The U.S. Preventive Services Task Force (USPSTF) issued its final recommendation on Tuesday, based on evidence that screening can help identify and treat anxiety disorders, which affect about 25% of men and 40% of women at some point in their lives. The recommendation applies to adults ages 19 to 64, including pregnant and postpartum people, who do not have a diagnosed mental health disorder or any signs or symptoms of anxiety.
“Anxiety disorders are common, and they can really impact people’s quality of life, and what the task force found is that screening for anxiety disorders in the general adult population can lead to identifying these conditions early and then, if those people who are identified get linked up with appropriate care, they will benefit,” said Dr. Michael Silverstein, vice chair of the USPSTF and a professor of pediatrics at Boston University School of Medicine.
Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobias, and agoraphobia. They can cause excessive worry, nervousness, fear, or panic that interfere with daily activities and relationships. Anxiety disorders often co-occur with other mental health conditions, such as depression, substance use disorders, and posttraumatic stress disorder.
Screening for anxiety involves using validated instruments that can accurately identify anxiety symptoms and severity in primary care or comparable settings. Screening tools alone cannot diagnose anxiety disorders, but they can help clinicians decide whether further evaluation and treatment are warranted.
Treatment for anxiety disorders can include psychotherapy, pharmacotherapy, or both. Evidence-based psychotherapies include cognitive behavioral therapy, exposure therapy, and acceptance and commitment therapy. Pharmacotherapy options include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, benzodiazepines, and buspirone.
The USPSTF also reaffirmed its previous recommendation that all adults be screened for major depressive disorder, noting that depression and anxiety are different conditions but they commonly can happen together. “While rates of clinical depression had been rising steadily in the United States, they jumped significantly during the Covid-19 pandemic,” according to a CNN article.
The USPSTF found insufficient evidence to recommend for or against screening for anxiety in older adults (age 65 and older) or in children seven or younger. The USPSTF recommends screening for anxiety in children and adolescents aged 8–18, noting that anxiety is one of the most common mental health disorders and is associated with a risk of anxiety disorders in adulthood.
The USPSTF is an independent panel of experts that reviews the latest scientific evidence and makes recommendations on preventive health services. Its recommendations are not binding but are widely followed by doctors, insurers, and policymakers.
The USPSTF recommendation statement was published in the Journal of the American Medical Association (JAMA) along with an accompanying editorial and evidence review. The recommendation was first proposed as a draft in September 2022 and was open for public comment until October 2022.
“Clinicians should be cognizant to stigma issues associated with mental health diagnoses and should aim to develop trusting relationships with patients, free of implicit bias, by being sensitive to cultural issues,” the USPSTF said in its statement. “Clinicians are encouraged to consider the unique balance of benefits and harms in the perinatal period when deciding the best treatment for anxiety disorders for a pregnant or breastfeeding person.”
Relevant articles:
US task force recommends screening adults for anxiety disorders, CNN, 06/20/2023
Experts recommend screening all adults under age 65 for anxiety disorders, MSN, 06/20/2023
USPSTF Recommends Depression Screening, Anxiety Screening, The Times and Democrat, 06/20/2023
Recommendation: Anxiety Disorders in Adults: Screening, United States Preventive Services Taskforce, 06/20/2023