If you’re younger than 65, your annual physical could soon include an anxiety screening.
The U.S. Preventive Services Task Force (USPSTF), a panel of national medical experts responsible for developing preventive care guidelines for Americans, is recommending that all adults age 19 to 64 be screened for anxiety as part of regular primary care. The recommendation is for people who are asymptomatic.
The panel issued the recommendation in draft form on Sept, 20 and will accept public comments until Oct. 17.
The new guidance around anxiety screening expands a recommendation issued in 2016 that calls for screening for depression in all adults, says Carol Mangione, MD, MSPH, chief of general internal medicine at UCLA Health and chair of the USPSTF.
What does this mean for you?
Since the adoption of the 2016 recommendation, many patients checking into primary care settings, including at UCLA Health, complete a two-item questionnaire that screens for depression, Dr. Mangione says. Similar short questionnaires exist to screen for anxiety.
People who screen positive for possible depression on these questionnaires are likely to be asked additional questions by their primary care provider and may be either treated in primary care or referred to a mental health provider for further help.
“A primary care clinician isn’t going to just put someone on antidepressant medication because of the way they answer two questions, but hopefully will conduct the needed longer interview during the visit to confirm whether a patient has depression,” Dr. Mangione says.
Instead, it starts a conversation in which a clinician can inquire further about what the patient is experiencing.
Dr. Mangione says she often tells her patients: “We give this screener to everybody who comes into our practice, because we know that if we screen for depression that we can improve people’s quality of life and that it’s a treatable condition.”
“With screening for anxiety and depression, as the population prevalence has gotten higher, the value of screening everyone increases,” she says. “People who maybe have rarely had feelings of anxiety or depression at other points in their life may not be so comfortable talking to their doctor about it. By screening everyone, we bring these treatable conditions out into the public space and destigmatize them for everyone.”
The recommendation for anxiety screening does not include people 65 and older because there wasn’t enough research to support the benefit of screening among asymptomatic people older than 64.
“That’s a really important evidence gap,” Dr. Mangione says.
It is important to remember that USPSTF recommendations are designed for asymptomatic individuals, and a person of any age who presents with symptoms of anxiety or raises concerns about the condition with their doctor should be screened, diagnosed and provided options for treatment.
What inspired the new recommendation?
The USPSTF started looking into developing a recommendation for anxiety screening before the COVID-19 pandemic sent the nation’s collective anxiety level soaring.
From August 2020 to February 2021, the percentage of adults experiencing symptoms of an anxiety or depressive disorder jumped from 36.4% to 41.5%, according to the U.S. Centers for Disease Control and Prevention. The World Health Organization reports that anxiety increased globally by 25% during the first year of the pandemic.
The USPSTF accepts nominations for health topics to consider that may benefit from having a preventive-service recommendation from any individual and organization across the country. Screening for anxiety was one of those suggestions several years ago that the USPSTF prioritized, Dr. Mangione says. The panel’s process to develop preventive screening recommendations includes extensive examination of the research about the topic — its prevalence in the U.S., characteristics that place a person at greater risk for the condition, and the risks and benefits of screening.
“Over the last decade, more and more people on standardized, population-based surveys are reporting that they’re struggling with anxiety,” says Dr. Mangione.
“We also prioritize problems that have health disparities in our country, because the task force really cares about improving health equity in the development and use of preventive services,” she says. “And this topic — screening for anxiety — had that characteristic.”
Structural inequities have contributed to less access to mental health care for racial and ethnic minorities compared to white people in the U.S. During the COVID-19 pandemic, Black, Hispanic, Asian and Indigenous Americans were more likely to screen positive for depression and anxiety than white Americans, according to a study published earlier this year in the scientific journal Plos One.
What about the national shortage of mental health providers?
The U.S. was experiencing a shortage of mental health providers even before the COVID-19 pandemic. In 2016, the U.S. Department of Health and Human Services predicted a shortage of more than 10,000 trained mental health care providers, including psychiatrists, psychologists, social workers and school counselors. A more recent study predicts a shortage of as many as 31,000 psychiatrists by 2024.
The USPSTF notes this shortage in its new draft recommendation for anxiety screening, Dr. Mangione says: “Screening doesn’t benefit anybody unless you can link it to treatment.”
Treatment for anxiety may include medication, or group or individual therapy, or a combination of these.
“We know we have a shortage of qualified mental health providers in our country,” Dr. Mangione says. “And in our recommendation, we call out the importance of health policy changes to address this critical shortage.”
The panel can’t outright call for training and hiring more mental health professionals, since its purview is recommending preventive care strategies for people in the U.S., she explains.
“We certainly call out the access problem,” she says. “And the access problem is much worse in low-income communities, much worse in communities of color, and this contributes to the health-equity problem. We do write about these important factors, because if people are going to derive benefit from screening, they need to have access to state-of-the-art treatment.”
What is the USPSTF?
Established by an act of Congress in 1984, the USPSTF is an all-volunteer panel of 16 primary care physicians and nurses with specialized research skills from across the country. They span disciplines — from psychology to family medicine to internal medicine to obstetrics and gynecology — and work together to evaluate scientific research and come up with preventive screening recommendations to improve the health of people of all ages.
“We have preventive therapy recommendations that really go from birth to death,” says Dr. Mangione, who has been a member of the task force since 2016.
The panel was developed "with the notion that it would be primary care experts making recommendations that providers in primary care delivery could then follow,” she says.
It is independent of the U.S. government and bases its recommendations on scientific research.
Contact a primary care physician if you have questions about mental health.
