U.S. health task force calls for routine anxiety screening in adults

In response to America’s pressing mental health crisis, an influential panel of medical experts is recommending anxiety screening for adults under 65 for the first time.

The draft recommendations from the U.S. Preventive Services Task Force aim to help primary care clinicians identify early signs of anxiety during routine care using questionnaires and other screening tools.

Anxiety disorders are often unrecognized and under-detected in primary care: A study cited by the task force found that the median time to start treatment for anxiety disorders was a staggering 23 years.

Working group member Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chen School of Medicine in Worcester, Massachusetts, said that while the task force’s initial consideration of anxiety screening predates the coronavirus pandemic, the new guidelines come at a time when crucial moment.

“Covid has taken a huge toll on the mental health of Americans,” Pbert said. “It’s a topic that prioritizes public health importance, but it’s clear that over the past few years there has been an increased focus on mental health in this country.”

In April, the task force made similar recommendations to begin screening for anxiety among children and adolescents between the ages of 8 and 18. The proposals announced Tuesday focused on young and middle-aged adults, including those who are pregnant or postpartum, citing research showing that screening and treatment can improve anxiety symptoms in people under the age of 65.

But, somewhat surprisingly, the guidelines do not recommend anxiety screening for people 65 and older.

One reason: Many common symptoms of aging, such as trouble sleeping, pain, and fatigue, can also be symptoms of anxiety. The task force said there was insufficient evidence to determine the accuracy of screening tools for older adults, which may not be sensitive enough to distinguish between anxiety symptoms and aging conditions.

The task force recommends that clinicians use their judgment when discussing anxiety with older patients.Task Force It also reiterated earlier recommendations that adults of all ages be routinely screened for depression.

The task force, an independent panel of experts appointed by the Agency for Healthcare Research and Quality, has enormous influence, and while its recommendations are not mandatory, the group’s recommendations often change the way physicians practice medicine in the United States.

Some doctors have questioned how the advice will work in the real world, and mental health providers say they’re running out of time to meet the needs of patients, who complain about waiting months for an appointment with a therapist.

“Screening is great, but because of the severe labor shortage, it’s confusing unless there are plans to increase funding for clinicians,” said Eugene Bay, a psychiatrist at Massachusetts General Hospital and executive director of the Clay Center for Younger Health Minds Resin said.

The World Health Organization reported earlier this year that the global prevalence of anxiety and depression increased by 25 percent in the first year of the pandemic. WHO said that by the end of 2021, “the situation has improved, but too many people today do not have access to the care and support they need for pre-existing and emerging mental health conditions.”

Anxiety, with overt fear and distressing gastrointestinal, racing heart, sweaty palms signs, can manifest in many different diagnoses, including generalized anxiety disorder, social anxiety disorder, panic disorder, and more.

Together, these constitute the most common mental illness in the United States, affecting 40 million adults each year, according to the Anxiety and Depression Association of America. Treatment can include psychotherapy, especially cognitive behavioral therapy; antidepressants or anti-anxiety medications; and various relaxation, mindfulness and desensitization therapies, doctors say.

The team also considered the benefits of screening patients for suicide risk, but concluded that Although suicide is the leading cause of death in adults, “there is insufficient evidence to show whether screening people without signs or symptoms ultimately helps prevent suicide.”

Nonetheless, the panel urges providers to use their own clinical judgment in determining whether individual patients should be screened for suicide risk.

For primary care physicians already in a “crisis” of burnout, pandemic-driven stress and their own mental health challenges, adding another screening test to a long list of clinical tasks can feel overwhelming.

“If primary care providers are asked to screen for one more thing, we’re going to be interrupted without more resources,” said a nurse practitioner in Northern California, who spoke on condition of anonymity because her clinic did not allow her to speak. . about this issue.

Tick ​​off current requirements, such as verifying the latest screenings for cervical, colon and breast cancer, as well as food insecurity, domestic violence, alcohol and tobacco use, and she said everything had to be packed into a 15-minute appointment while also treating Patients with complex chronic diseases.

“If people are positive for depression or anxiety and we don’t have mental health support to help them, it doesn’t feel right,” the practitioner said.

But Mahmooda Qureshi, an internist at Massachusetts General Hospital, said extra support for patients with depression or anxiety can help.

“After 2020, very few patients are not anxious,” Qureshi said, noting that she now regularly asks patients, “How is your stress?” “We found that when it comes to mental health, if we don’t ask, usually we do not know.”

The task force acknowledged the challenges of providing mental health care to all those in need, adding that less than “half of people with mental illness receive mental health care”.

The group also cited “racist and structural policies” that disproportionately affect people of color. The panel noted that black patients were less likely to receive mental health services than other groups, and that blacks and Hispanics were more likely to be misdiagnosed with mental health conditions.

The latest guidelines are just one step in addressing the urgent mental health needs of patients, Pbert said. “We hope this set of recommendations will raise awareness of the need to create more mental health care services across the country, and highlight “gaps in evidence so funders can support much-needed research in these areas,” she said. “

The proposed proposal is open for public comment by October. 17, after which the Working Group will consider them for final approval.

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