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The COVID-19 pandemic has not only led to a rise in sickness and excess deaths, but also exacerbated the state of Americans’ mental health. On Tuesday, the U.S. Preventive Services Task Force recommended that kids 8 and older be screened for anxiety. The task force is also issuing an anxiety screening recommendation for all adult patients under age 65 that is currently in draft phase and accepting public comments through October 17.
Here’s what you need to know about the upcoming guidance and how an anxiety screening would work.
Why is the task force recommending anxiety screening for adults under 65?
The task force had been considering an anxiety screening recommendation for adults since before the pandemic. (The group published a similar recommendation for depression screening in 2016.) Data from 2001 to 2002 found that 26 percent of men and 40 percent of women experience an anxiety disorder at some point in their lives.
But the COVID-19 pandemic made the need to address Americans’ mental health more urgent. According to CDC data, more than one in five U.S. adults ages 18 to 44 received mental health treatment in 2021, a jump of nearly 5 percentage points from 2019.
Dr. Gbenga Ogedegbe, a physician on the task force and founding director of the Institute for Excellence in Health Equity at New York University Langone Health, said that the screening “can help identify adults with anxiety so they can be connected to appropriate care and the support they need.”
The task force notes that anxiety disorders often go unrecognized in primary care settings, which can lead to significant delays in treatment. A screening recommendation for all adults under 65 aims to prevent mental health disorders from going undetected and untreated.
Some mental health professionals, however, point out that screening for anxiety has little to no impact if subsequent care is inaccessible. Among the nearly 22 million adults who reported moderate to severe symptoms of anxiety and/or depression in 2019, 39 percent were not receiving treatment, according to a Kaiser Family Foundation analysis of National Health Interview Survey data. Barriers to mental health treatment include cost, not knowing where to obtain care, mental health provider shortages, and low rates of insurance acceptance.
Ogedegbe acknowledges that screening is “only the first step in helping adults with anxiety” and hopes that the recommendation “can help bring awareness of the need to create greater access to evidence-based mental health care for adults throughout the country.”
How does an anxiety screening work?
There are several existing tools for screening anxiety, many of them questionnaires. The General Anxiety Disorder-7 (GAD-7), for instance, is composed of seven questions and scores patients on a scale of 0 to 21.
The screening would most likely be conducted during primary care visits along with vital checks and other regular screenings. The task force said there was not enough evidence to determine an optimal timing and interval for anxiety checkup. Doctors should screen all adults who have not been screened previously and use their judgment to determine if additional screening is needed for high-risk patients, according to the recommendation.
Why is the recommendation only for adults under 65?
The task force limited its recommendation to adults under 65 because there is not enough evidence on the impact of anxiety screenings among older adults. This does not mean that older adults do not experience anxiety or would not benefit from screening but that more research is needed.
“We are calling for more research in this important area,” Ogedegbe said. “We should underscore that all adults with symptoms or signs of anxiety be referred by their health care professionals to appropriate care.”
Dr. Monica Gandhi, a primary care physician and director of the University of California San Francisco-Bay Area Center for AIDS Research, notes that among the population she treats—people living with HIV in San Francisco—73 percent are over the age of 50. Based on her experiences with patients, Gandhi says older people are not immune to anxiety.
“The pandemic affected young people, old people, middle-aged people—everyone got pulled into the anxiety of this,” Gandhi said. “Older people were even more isolated during the pandemic because they were most at risk for COVID.”
What are the next steps after getting screened?
Ogedegbe stresses that a screening test alone is not enough to diagnose anxiety. If a patient screens positive, they would have to undergo further evaluation to receive a diagnosis. A screening does not account for cultural factors or life situations, nor does it distinguish whether the patient is displaying signs of clinical or situational anxiety.
“People who are diagnosed with anxiety should work with their health care professionals to identify the treatment that is right for them,” Ogedegbe said. “That said, we recognize the challenges related to implementing recommendations in areas with limited access to health care and mental health services.”
Jonathan Shedler, a clinical professor of psychiatry at the University of California San Francisco, sees no benefit to a screening unless there is increased access to quality mental health care. “If people don’t have access to care, a screening serves no purpose whatsoever—you’re assessing people for conditions [for] which they can’t get treatment,” he said.
Shedler also worries that a positive screening result will lead directly to prescription writing without an official diagnosis. He compares anxiety and depression screenings to checking if someone has a fever: A positive result only tells you that something is wrong, but further assessment is needed to figure out the underlying problem.
“You cannot move from a score on a questionnaire to a treatment decision without figuring out why the person is anxious,” Shedler said. “The damage that these [screening] instruments do is they create the illusion that we’ve made an adequate psychological assessment and now we can just go ahead and treat someone.”
Gandhi agrees that a screening recommendation needs to be followed by efforts to improve access to care: “You can’t put out warnings or raise red flags for the health of the nation without having services to work on those concerns that you’re raising.”
However, she believes the implementation of anxiety screenings at this point can still make a positive impact, simply by bringing the topic of mental health into primary health care. Gandhi has found in her practice that patients find reassurance knowing that their primary care doctor cares about their mental health. “The very process of talking about it is therapeutic,” she said.
How can you provide feedback on the anxiety screening recommendation?
The draft recommendation is open for public comment through October 17. You can read the draft here and provide any feedback here. The task force will read all comments before publishing the final version of the recommendation.