US doctors should routinely screen all adults under the age of 65 for anxiety, an influential medical guidelines group suggested on Tuesday.
This is the first time the US Prevention 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 The proposal is open for public comment until Oct. 17, but the group usually confirms its draft guidance.
The recommendations are based on a review that began before the COVID-19 pandemic and evaluated studies showing the potential benefits and risks of screening. Given reports of a surge in mental health problems linked to pandemic isolation and stress, the recommendations are “very timely,” said Lori Pbert, a task force member and co-author. Pbert is a research psychologist at the Chan University of Massachusetts Medical School.
The task force said evidence of benefits, including effective treatments, outweighed any risks, which included inaccurate screening results that could lead to unnecessary follow-up treatment.
Anxiety disorders are among the most common mental health complaints, affecting about 40% of American women at some point in their lives and more than 1 in 4 men, Pbert noted.
Black people, those 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 as panic attacks, phobias, or a constant feeling of tension. In addition, approximately 1 in 10 pregnant and laboring women experience anxiety.
Common screening tools include short questionnaires about symptoms such as fears and worries that interfere with normal activities. They can be easily provided in primary care settings, the task force said, although it did not specify how often patients should be screened.
“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 professionals.
Megan Whalen, a 31-year-old marketing professional who was diagnosed with anxiety in 2013, says that regular doctors should screen for mental health issues as often as physical ones.
“Health is health, whether the problem is visible or not,” said Whalen, of Hoboken, New Jersey.
She received help from medicine and talk therapy, but her symptoms worsened during the pandemic and she returned home temporarily.
“The pandemic made me afraid to leave the house, my anxiety told me that anywhere outside my childhood home was dangerous,” Whelan said. “Sometimes I still struggle with feelings of dread and fear. At the moment, it’s just a part of my life, and I’m trying to manage it as best I can.”
The task force said there are not enough strong studies in older people to recommend whether or not to screen for anxiety at age 65 or older.
The group still recommends depression screening for adults and children, but said there is insufficient evidence to assess the potential benefits and harms of suicide screening in adults who do not show distressing symptoms.
In April, the group issued similar draft guidelines 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 recommendations 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 screening for women and girls starting at age 13.
Melissa Lewis-Duarte, a health coach in Scottsdale, Arizona, says rhythmic breathing, meditation, and making a daily list of three things she’s grateful for have all helped her manage her anxiety.
“Doctors say, ‘Make sure you sleep, control your stress.’ Yes, I get it,” but not everyone knows how, said the 42-year-old mother of three. “It’s hard to prioritize self-care, but it’s necessary.”